MALAYSIA MEDICAL TOURISM & HEALTHCARE 29-30 March 2010, Kuala Lumpur, Malaysia

 Medical Challenges in Health Tourism

DR. LEE MOON KEEN

Consultant Neurologist Director, Alpha Specialist Centre

Petaling Jaya, MALAYSIA

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Synopsis

1. The patient is not a tourist

2. Obtaining medical history - information gaps

3. Social history - a Black Hole

4. Time constraints and long term follow up

5. Cultural issues

6. Medicolegal implications

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The patient is not a tourist Co-ordinating the travel arrangements Expectations from medical treatment Needs / priorities of travel companions

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Obtaining medical history: Information gaps

Language - lost in translation Incomplete recall by patient Lack of background reports Non-disclosure - insurance considerations,

etc.

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Social history - a Black Hole

Catching the patient at one point in time Lack of prior rapport Cultural hurdles in understanding 

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Time constraints and long term follow up

A consultation can’t be rushed Medical tests need processing time Specialised investigations need pre-arrangement Patients need time to consider treatment options Recuperation after treatment Follow up review

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Cultural issues (1):Cultural sensitization

Soft-skills training social and customer handling skills cultural sensitization of staff to other cultures

Globalization much touted but less prevalent than it seems

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Cultural issues (2):Culturo-Religious Taboos and Flashpoints

Religious beliefs Belief systems in relation to ill-health - concepts of health

and illness causation Fatalism Norms of modesty

Cultural sensitivities Attitude of respect Forms of address  Taboo behaviours

Patient’s interaction with Doctor Deference to authority figure Avoidance of confrontation

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Cultural issues (3):

Impact on Treatment and Hospitality Food

Proscribed by religion Dietary preferences

Medication  Proscribed by religion  Socially unacceptable  Belief systems

Interference by home / homeopathic remedies

Meshing with Alternative / Native Healing Systems

Unconventional healing practices: taxonomy with examples

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Anne Fadiman (1997): The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

Winner of the National Book Critics Circle Award for Nonfiction

When three-month-old Lia Lee arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally a close-knit and fiercely people, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee Entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication.

Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness and healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, qaug dab peg -- the spirit catches you and you fall down--and ascribed it to the wandering of her soul. The doctors prescribed anti-convulsants; her parents preferred animal sacrifices.

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Medicolegal implications

Trans-national medico-legal statutes Indemnity coverage for doctor and hospital

across borders Judicial rulings in different countries / regions Patient awareness of legal rights

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Factors impacting on Clinical Outcome and Patient Satisfaction

Work flow Culture-sensitive staff A “Happy” experience in the host country

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Conclusion

Medical Tourism is not the same as “Healthcare As Usual”

--- applied to a tourist