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Expatriate Travel Health

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Choosing a Physician in Your Host Country
-- Frank Gillingham, MD

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Establishing a comfortable relationship for each family member with a qualified primary physician is a step every expatriate should take before arrival in their host country, if possible. Assignees who do so will avoid significant worry and stress -- and possibly treatment delay or medical complication -- when a bronchitis, ear infection, or more serious illness occurs. Using HTH's Doctor Search, expatriates can now search for a physician and review his or her credentials before they leave home. In many cases it's even possible for the expatriate to email the HTH physician before they leave home, to introduce themselves and their families.

After selecting a physician, the expatriate should arrange an introductory appointment as soon as possible, before they become engrossed in the day to day challenges of life abroad. An HTH physician in Brazil explains why this visit is so important:
"The newcomers should go to the doctor upon arrival, before they have any illness, to become acquainted with the doctor and acquire confidence when judgment is not impaired by pain, fever or despair." HTH General Practice Physician, Sao Paulo.
If the visit is a success, the expat should leave the doctor a copy of their medical records. Otherwise, the expat should select a new physician and begin the process again (see below). "Choosing a physician for each family member can be time consuming, but when illness strikes the payoff is enormous."

This is what you should ask during the introductory appointment:
  • Bedside Manner. Assess the doctor's style, level of empathy, and his facility with your native language.  
    "Please note that many of the Japanese doctors who 'mention' that they speak English do not speak fluent or decent English, especially when it comes to daily conversation." HTH Internal Medicine Physician, Tokyo, Japan.
  • Health Precautions. Ask about water quality, disease prevalence and other precautions necessary for the host city and country. The doctor will be more knowledgeable than the sources that were available to the expatriate prior to departure. 
    "How often have I seen [unnecessary] health recommendations suggesting, for example, Malaria prophylaxis for persons who travel to...Sao Paulo." HTH General Surgeon, Sao Paulo, Brazil.
  • Hospitals. Ask the names of the hospitals to which the doctor would admit you,or your family member, to in the event of serious illness. Using a tool such as HTH's CityHealth Profiles, or through contact with experienced expatriates in your host city, confirm that these hospitals have a reputation for quality. 
    "Make sure [the doctor] is accredited at the major hospitals that are suitable for your needs" HTH General Surgeon, Sao Paulo, Brazil.
  • Contact Information. Find out how to contact the physician after hours: 
    "Keep the physician's home telephone number, handphone and page number with you all the time. ...In Korea, the family physician who is able to speak English fluently will make arrangements for specialist and E.R. visit " HTH General Practice Physician, Seoul, South Korea.
  • Cultural Differences. During the appointment the expatriate should remember that doctors are different around the world and should begin to determine how well their own needs will be met by the physician-patient relationship that's traditional in the host country. An HTH physician based in Tokyo explained one such cultural difference:  
    "Regarding the Japanese doctors, most do not appreciate comments and ideas from the patients but expect a lot of respect and esteem from the patients." HTH Internal Medicine Physician, Tokyo, Japan.
    Another cultural difference: payment expectations. The expat should bring cash to the first visit, as cash payment is expected in some countries.

  • If the visit doesn't go well. Patient-physician relationships are very personal, both here and abroad. The expatriate who isn't comfortable with a physician should select another and schedule another introductory appointment. This is another reason for scheduling an introductory appointment before arrival: switching can be much more difficult once evaluation and treatment of an acute condition has begun.

    Choosing a physician for each family member can be time consuming, but when illness strikes the payoff is enormous.