Physician obligations don’t end when patients pursue care abroad
Each year, a growing number of medical tourists travel abroad or across borders to receive treatments or procedures. Many aspects of the trend confound ethical expectations regarding patients’ rights, including rights to informed consent, continuity of care and access to medical records, says an AMA Council on Ethical and Judicial Affairs report adopted at the 2018 AMA Annual Meeting in Chicago.
The practice can also make it harder for the patient tourists’ physicians back home to fulfill their responsibilities to promote quality of care and patient safety, and to be prudent stewards of health care resources.
“When asked to make right what went wrong as a result of medical travel, physicians can be confronted with a problematic position when they lack vital information to guide follow-up care,” said AMA Immediate Past Chair Patrice A. Harris, MD. “The AMA’s new ethical policy will help guide physicians on the implications of medical tourism and their responsibilities with patients.”
The policy adopted by the AMA House of Delegates says physicians need to be aware of the implications of medical tourism for individual patients and the community.
Collectively, through their specialty societies and other professional organizations, physicians should:
- Support collection of and access to outcomes data from medical tourists to enhance informed decision making.
- Advocate education for health care professionals about medical tourism.
- Advocate appropriate oversight of medical tourism and companies that facilitate it to protect patient safety and promote high quality care.
- Oppose policies that would require patients to accept care abroad as a condition of access to needed services.
Individually, physicians should:
- Be alert to indications that a patient may be contemplating seeking care abroad and explore with the patient the individual’s concerns and wishes about care.
- Seek to familiarize themselves with issues in medical tourism to enable them to support informed decision making when patients approach them about getting care abroad.
- Help patients understand the special nature of risk and limited likelihood of benefit when they desire an unapproved therapy. Physicians should help patients frame realistic goals for care and encourage a plan of care based on scientifically recognized interventions.
- Advise patients who inform them in advance of a decision to seek care abroad whether the physician is or is not willing to provide follow-up care for the procedure or procedures, and refer the patient to other options for care.
- Offer their best professional guidance about a patient’s decision to become a medical tourist, just as they would any other decision about care. This includes being candid when they deem a decision to obtain specific care abroad not to be in the patient’s best interests.
- Encourage patients who seek unapproved therapy to enroll in an appropriate clinical trial.
- Respond compassionately when a patient who has undergone treatment abroad without the physician’s prior knowledge seeks nonemergent follow-up care.
According to the policy, physicians reluctant to provide such care should carefully consider:
- The nature and duration of the patient-physician relationship.
- The likely impact on the individual patient’s well-being.
- The burden declining to provide follow-up care may impose on fellow professionals.
- The likely impact on the health and resources of the community.
“Physicians who are unable or unwilling to provide care in these circumstances have a responsibility to refer the patient to appropriate services,” the newly adopted policy concludes.
Read more news coverage from the 2018 AMA Annual Meeting.