Written by: Ankur Gupta, Senior Level Executive Contributor
Executive Contributors at Brainz Magazine are handpicked and invited to contribute because of their knowledge and valuable insight within their area of expertise.
Medical tourism is the phenomenon of patients travelling outside their home country for medical treatment (Foley et al., 2019). Medical tourism is an increasingly popular way for patients to receive medical treatment abroad and is a multi-billion industry growing yearly. A study published in 2020 estimated that the industry will enjoy a growth of 25% every year for the next ten years and that 3% to 4% of the world’s population will travel internationally for healthcare (Radovcic & Nola, 2018). Travelling for medical care includes lower costs, shorter wait times, and better quality of care, often combined with a holiday in the destination country. The industry is an important revenue earner for several Asian and South American countries. Research has established that factors that influence tourists in choosing their destination country include perceived quality, length of stay (Rahman et al., 2022) trust and word-of-mouth (Hyder et al., 2019)
Communication is a crucial factor in establishing trust between patients and healthcare providers. An essential part of communication and gaining the patient's agreement for proceeding with the treatment is informed consent. Informed consent (Gogos et al., 2011) is a process whereby a patient is given information about a proposed medical treatment to make an informed decision about whether to undergo the treatment. Informed consent must be obtained from patients before any medical procedure can be performed. This includes procedures as minor as a blood draw or as significant as surgery. The process of obtaining informed consent is not limited to informing the patient of the risks and benefits of the procedure. They need to know about alternatives to the recommended procedure. Patients should also be informed of their right to refuse a procedure, even if their doctor recommends it. This process is essential to ensure that patients make informed decisions about their health care.
Informed consent is an integral part of patient-physician communication. Regulations for medical tourism vary from country to country, but the basis of informed consent is similar. It helps ensure that patients make informed decisions about their health care and allows them to participate in their care. Patients are used to being informed fully in their home country and expect the same in the host country.
However, medical tourists often have concerns about the informed consent process. As medical tourism becomes more popular, there is an increasing need for better-informed consent processes. Some risks are common to all procedures, such as the risk of infection. Others are specific to a particular procedure. For example, the risk of a blood clot after surgery is well known, while the risk of radiation exposure from a CT scan is less well known. Some risks can be severe. For example, a patient may experience a heart attack or stroke after surgery. Others may be less serious but still cause discomfort or inconvenience. For example, a patient may react to the anaesthesia used during surgery.
Patients need to understand the risks associated with a particular procedure before undergoing it. In some cases, medical tourists may not be given all of the information they need in order to make an informed decision about their treatment. Even if comprehensive information is provided, tourists may struggle because they are in a foreign country and may not be familiar with the local language or health care system. They do not have the support of family or friends either. All these factors can make it difficult for medical tourists to make an informed choice regarding the treatment they are seeking to receive. Consent forms are an essential part of the medical process, but they can also be confusing. Nevertheless, medical tourists are given a paper form to sign, which is many pages long with complex medical information, which they have no option but to sign for the treatment to proceed, so sign they do!
Lack of fully informed consent has been cited as one of the core reasons for patient dissatisfaction and complaints(Skar & Soderberg, 2018). It can lead to litigation and cost for providers. Although litigation is not easy in international healthcare, the risk of complaints and loss of reputation is high. Dissatisfied patients can lose trust in not only the provider but the host country as a whole. They carry their dissatisfaction with them to their native land and are usually motivated to share their poor experience. This can lead to a higher perceived risk of travel to the host country with negative word-of-mouth publicity and reduce the intent to go there for treatment(Farrukh et al., 2020).
It is time that consent for medical procedures is taken seriously by healthcare providers. The traditional way of a paper given to the patient to sign on the day of the surgery should be phased out. In this digital age, the world must move away from a paper form that is bulky, clunky, hard to understand and easy to lose. A digital consent form that covers essential aspects of the procedure or treatment is required. The information should be pertinent to the patient. For example, the infrequent complication of loss of voice after laryngeal surgery is more important for a professional singer than an average person. There is a tendency to put every conceivable risk there, which is a detriment rather than an enabler in consenting. Patients want information which is pertinent to them individually and not generic as it usually is on the current forms. The form should be easy to understand and translated into the patient's native language if required. In addition, patients should be given ample time to read and understand the form before they are asked to sign it. By taking these steps, we can ensure that medical tourists are fully informed about the risks and benefits of their treatment and that they can make an informed decision about whether or not to proceed. A digital consent form can potentially be filled in from the comfort of their own homes, reducing the length of stay, and further incentivising the tourist.
A better consenting system will lead to improved patient satisfaction for that is what they want(El-Wakeel et al., 2006). A satisfied medical tourist is likely to choose the same provider for future needs and can act as a brand ambassador for them. The risk of litigation and complaints for doctors will reduce as well. Therefore, a well-organised and efficient consenting process is in the best interest of medical tourists and healthcare providers. A small investment in this field can lead to rich dividends for years to come.
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Ankur Gupta, Senior Level Executive Contributor Brainz Magazine
I am a psychiatrist by profession and entrepreneur by passion. As a Clinical Director, I have been at the forefront of managing large public mental health services in the UK and in Australia. I am an expert in medicolegal psychiatry and have provided numerous independent examination reports to courts in Australia and the UK. I firmly believe that less is more when prescribing medications and like to utilise functional approaches in treating my patients. I am an angel investor and entrepreneur and have not only helped small businesses grow but have founded three companies of my own.
References:
El-Wakeel, H., Taylor, G. J., & Tate, J. J. (2006). What do patients really want to know in an informed consent procedure? A questionnaire-based survey of patients in the Bath area, UK. J Med Ethics, 32(10), 612-616. https://doi.org/10.1136/jme.2005.013334
Farrukh, M., Shahzad, I. A., Sajid, M., Sheikh, M. F., & Alam, I. (2020). Revisiting the intention to travel framework in the perspective of medical tourism: The role of eWord-of-mouth and destination image. International Journal of Healthcare Management, 15(1), 28-35. https://doi.org/10.1080/20479700.2020.1836733
Foley, B. M., Haglin, J. M., Tanzer, J. R., & Eltorai, A. E. M. (2019). Patient care without borders: a systematic review of medical and surgical tourism. J Travel Med, 26(6). https://doi.org/10.1093/jtm/taz049
Gogos, A. J., Clark, R. B., Bismark, M. M., Gruen, R. L., & Studdert, D. M. (2011). When informed consent goes poorly: a descriptive study of medical negligence claims and patient complaints. Med J Aust, 195(6), 340-344. https://doi.org/10.5694/mja11.10379
Hyder, A. S., Rydback, M., Borg, E., & Osarenkhoe, A. (2019). Medical tourism in emerging markets: The role of trust, networks, and word-of-mouth. Health Mark Q, 36(3), 203- 219. https://doi.org/10.1080/07359683.2019.1618008
Radovcic, Z., & Nola, I. A. (2018). Medical tourism globe-trotting: Features, impacts, and risks. International Journal of Healthcare Management, 13(sup1), 94-100. https://doi.org/10.1080/20479700.2018.1428388
Rahman, I., Martin, D. S., & Liu, S. (2022). Outbound medical tourists: The interplay of perceived quality, length of stay, group-size, post-visit destination image and revisit intention. PLoS One, 17(5), e0267755. https://doi.org/10.1371/journal.pone.0267755
Skar, L., & Soderberg, S. (2018). Patients' complaints regarding healthcare encounters and communication. Nurs Open, 5(2), 224-232. https://doi.org/10.1002/nop2.132
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