As a patient myself first, I saw the importance of medically appropriate post operative care from day one as absolutely essential to the Medical tourist/recovering patient of ANY surgical procedure. Poor wound evolution, wound infection and necrosis is something that can occur with absolutely ANY open wound on a patient, and with, ANY surgical procedure, including something as “insignificant” as a laparoscopic incision.
I heard a radio advertisement from Athena Blue Cross of California mentioning the shortage of nurses in our state. It was a report on how they had invested money in local Community Colleges in an effort to supplement and improve their nursing programs, and the increase in admissions and RNs it generated. They started the ad with the following statistic: Before Florence Nightingale joined the Red Cross, the mortality rate for the soldiers was 60% and after she joined it dropped to 2%, thus showing the value of a nurse.
That being so beautifully illustrated, I will now address medically proper and appropriate post-op wound care, along with the psychological support the recovering patient requires. Although aftercare is essential to ANY recovering patient, we are specifically addressing the “Foreign Patient Experience” as the number of patients traveling abroad for surgical procedures continues to increase.
As a patient myself in the US, after my laparoscopic gastric bypass procedure, I experienced first hand, the need to know how to properly care for the wounds, as small as they were. Although I received many written forms and post op instructions on what I could and could not eat after my surgery, the surgeon, his nurse, and the hospital neglected to provide me with post op wound care instructions. I had a plastic drain with a long tube hanging out of one side of my abdomen.
This tube was bulky and represented an opportunity to be pulled out if I got too close to something (including my 18 month old toddler!) And was also a fitting site for infection. My small lap incisions were not even stitched closed and were simply covered with white surgical tape. I had no idea if I could bathe and so I was afraid to get them wet. I had a million questions: should I take them off first? How to clean them?
What would I use; alcohol, peroxide, Neosporin, water? I was beside myself, when I did call into the surgeon’s office, the instructions I was given over the phone were to go ahead and shower, and use peroxide to clean before putting surgical tape back on.
It turns out that the peroxide only served to impede the healing of the incisions and the surgical tape was beginning to irritate my skin with red welts on both sides of the incisions. I was truly at a loss and frustrated for the first ten post operative days. I was actually feeling “recovered” from the gastric bypass surgery but the wound care was proving to be trying. On the tenth day, hardly draining anything by then, I called the office and was told to come in and have it pulled. I gladly made the two hour drive to the surgeon’s office in anticipation.
Once there the drain was pulled, the nurse was able to assess my incisions (which hadn’t closed yet) and finally informed me of proper wound care. I was told to discontinue peroxide and she explained why it wasn’t helping, she also told me that I didn’t need the surgical tape anymore. She taught me how to dress the wounds and how fast they should now close with proper orientation.
She warned me that the final scarring might be a little more noticeable than they could have been had they been treated and closed properly. She even dressed my incisions for me before leaving, which made me feel so much better as I left the office that day. My wounds healed promptly after the nurse’s instructions; however, they are a little more visible than I would have liked.
Poor wound evolution, wound infection and even necrosis is something that can occur with absolutely any incision or wound on a patient, therefore, any surgical procedure – including something as “insignificant” as a laparoscopic incision can cause more agony and psychological trauma to the patient than the actual surgical procedure itself. Proper orientation of what to expect and appropriate medical attention must be given to the patient, preferably in printed form, easily referenced for questions, either as pre-op orientation or immediately following the procedure.
Demonstration of sterile dressing changes should be encouraged to be watched by the patient before being discharged so that it can be continued after returning home to finish healing. Medical tourism, due to its cost-effectiveness and low labor costs in foreign countries, can facilitate just this kind of ideal and superior patient support system.
You may ask why wound care and daily nursing visits/Medical Concierge Accompaniment would interest an insurance company sending their patient abroad and why they should make this investment in their subscriber and consider this a necessary expense as part of the package of services as they negotiate contracts with
Other Medical Tourism facilitators and / or hospitals. If it is not included through the providing hospital or surgeon, it should be contracted on behalf of the patient, by the entity sending the patient abroad.
On a Micro-scale, the feeling that they are truly benefiting by accepting going abroad to an already unfamiliar and perhaps “less-respected” location by this daily personalized medical care is priceless and serves to reduce the discrimination towards medical services abroad compared to our own. Medically, and on the Macro-scale, the opportunity for the nurse to be the eyes of the surgeon between office visits, and the ability to accurately document the daily evolution (as a medical document) of a patient, including medications usage and effectiveness, rates of complications, healing issues, helps to gather many important statistics that can be important on many levels of information gathering and can be provided to the patient upon returning to the USA for addition to the patient’s medical records for any follow up or continuance of care that may be needed.
As a patient myself, I saw the importance of medically appropriate post op care from day one as absolutely essential to the medical tourist/recovering patient of any surgical procedure. Poor wound evolution, wound infection and necrosis is something that can occur with absolutely any open wound on a patient. This does not only affect the “patient experience” but, the length of stay required, includes post op therapies or treatments.
In short, it now affects the savings the insurance company planned on in sending the patient abroad in the first place. Below I will illustrate just how and why it can often be avoided or at least its severity diminished with medically proper patient management.
Obviously, an ounce of prevention is worth a pound of cure, especially when it comes to medical tourism. Since the insurance companies and other B to B prospects are looking at saving money by sending patients abroad, let me tell you that the patient that experienced this particular complication, suffered physically for weeks after surgery – unnecessarily because her own surgeon did not promptly address the situation at the first signs of its progression, and then refused to administer the proper therapy for this particular patient because it was not considered accepted/normal protocol.
The surgeon also hesitated because of her lack of experience with healing compromised patients such as most post-bariatric patients with intestinal malabsorption procedures and not being familiar enough with how they evolve in the immediate post op period. This seemingly simple hesitation or “professional conservativeness” on the part of the surgeon, caused the patient not only pain and suffering, but compromised and delayed her healing, became an extreme financial burden and resulted in loss of time.
She had to stay more than two months longer than originally planned in order to address the healing issue, she had to undergo several treatments per week for debridement, under anesthesia, at the costly Albert Einstein Hospital, it caused her stress, pain and a total bill of almost US$100,000 – twice what her initial budget was for a two month stay and a complete body reconstruction. She was not able to finish the initially planned upper body reconstruction, so she still has half of her reconstruction to complete and pay for.
Her experience has totally compromised her results and although she actually had to have another surgery to try and CLOSE the wound, it was not totally successful and she will need scar revision later at more out-of-pocket expense, not to mention healing time out of her busy life. Again, this can happen ANYWHERE after ANY surgery. In fact, things like this are common and occur because there is not medically adequate follow up care, like Home Health Care Nursing (aka: Medical Concierge Support).
If anything, we can show that Medical Tourism while showing a huge “savings” in the actual cost of the procedure and hospital fees, it affords the patient true time to recover and paid aftercare support to facilitate the healing that they would not get when their surgery is performed at their local hospital in town. The same procedure performed in the USA goes like this: The patient is discharged as soon as possible after the surgical procedure (so as to save money) and is sent home to be with their family and recover and be “nursed” back to health by anyone but skilled and educated nurses.
Basically, in the Medical Tourism model (especially in Latin America, again I will speak about what I know, only) this structure needs to be implemented, preferably by the discharging hospital seeking to secure and show excellence in this market.
According to the long awaited McKinsey Report on Medical Tourism, although price is definitely a driving factor for everyone in looking at Medical Tourism, it is still first and foremost a service industry and people are willing to pay for value and service combined with medical treatment. The overall success of Medical Tourism is that it is a service-based business and the client, the patient, MUST be satisfied.
Christi DeMoreas is the owner of Mednet Brazil. As a consultant, Christi specializes in assisting medical tourism facilitators with setting up their concierge business as well as assisting international patient departments in setting up systems for aftercare. She may be reached at: Christi@mednetbrazil.com
