Madison is here to see you before returning to college.
‘Maddie’ has something she needs and she doesn’t know how to ask. She waits until you are all done examining her and clicking through all the required boxes on your computer screen.
Then she says it….the four most dangerous words in a medical encounter:
“Oh, by the way…..”
And you wait to find out why she is really here, and wonder how you will stay on time yet still help her with her ‘real’ problem.
You have known her since she was a baby, helped her when she couldn’t breath with an asthma attack and guided her parents as they sought to raise a happy child. You are delighted she is doing so well in college, and getting ready to launch.
What could it be? She seemed so healthy today?
She sits up and with a false bravado half asking, half announcing:
“What shots do I need? I’m going to study abroad in Ecuador.”
“ What will you be studying?”
“I want to examine the causal relationship between central economic policy and opportunities for women in rural Ecuador!”
You think to yourself: Wow, this new generation is ready to take on the world and such audacious plans! You don’t remember anyone at your college doing anything like this, but that is a time long ago and far away.
“Didn’t they tell you what you need at school?”
You are punting now; you never really studied travel medicine and have to figure out a plan, and quickly. You now see this is whole reason she came in today.
She is biting her lip, “No, they said to ask our doctor”
It’s really not your fault that you don’t know the answer.
Despite the rapid growth in study abroad opportunities there has been a dearth of educational opportunities to learn travel medicine. If only you’d been paying better attention when they were discussing malaria medication in school.
What will you do? How will you help Maddie?
There are several ways doctors solve this problem. None work very well. I know because I have tried them all.
Have you ever believed one of these myths?
I can do this without specialized training.
Well, you think, I’ll just check the CDC traveler’s website and do what they suggest. How hard can it be?
That’s a good start, but when you check you realize it’s not robust enough. The site emphasizes which vaccines, but you have her so well immunized she only needs a typhoid shot.
What she really needs is anticipatory guidance, tailored for patients who study abroad. The advice needs to be contextualized and given in such a way that she can make real behavioral changes.
The CDC doesn’t tell you how to do that.
Besides, it’s not your style to do things when you haven’t been properly trained. You want her to be healthy and really enjoy her travels.
You want Maddie to have the best advice available. You feel like a fake, giving advice you read off a website that you really don’t understand.
I’ll just send them to the health department or other travel clinic.
Sometimes you have a community resource that offers full service travel medicine. You can find them through ISTM.org. However, most likely there isn’t one in your community.
Our local health department only gives vaccines, no medications, no advice. Many commercial clinics or pharmacies do the same. Lots of vaccines, not much advice.
Besides, Maddie doesn’t want to go to someone else, she trusts you. After all you’ve helped her so many times in the past. Remember the time she came in with a severe asthma attack gasping for air and you sent her home smiling and comfortable? She is asking for your advice.
I can start my own travel clinic.
You often hear that the only way to be paid for travel care is to start your own clinic: “Patients will love it.”
They want their regular doctor to help them get ready for travel abroad. And besides, do you really have time to run a second business?
I know because I tried this. Not only do you barely break even, it’s distracting to have two medical practices.
But worse patients don’t like it. When I had a separate travel medicine practice patients kept asking why their regular doctor can’t do this,?
In my region of the country, not many of the parents have traveled out of the state, much less the country. But they want their children to be successful, to be a members of the global community. So they encourage them to study abroad.
And they want their pediatrician to keep their children safe. Someone they know and trust.
I won’t get reimbursed for my time if I do the counseling.
That’s simply not true. And it holds a lot of general practitioners back.
I realized my faulty thinking when I went for my yearly mammogram. My radiologist offers enhanced screening, a practice recommend by the American College of Radiology, but not covered by my insurance. They simply asked me to pay the small difference between regular and enhanced mammograms.
It was an epiphany for me: I was happy because I received the preventative care I wanted, from my trusted provider. They billed my insurance for covered services and I paid the rest. I’ve noticed that dermatologists use this method too.
Since I started using this technique for travel medicine in my general pediatric clinic I have found that my patients are delighted to get medical care in a comfortable setting from their regular doctor. And using proper coding techniques, I found that many insurance companies actually do pay for this service. Patients are always happy to get refunds. 🙂
Take the time to add travel medicine services to your existing general medical practice. It’s not as difficult as you think, but like most things, there are a few techniques you can learn which make it easier.
Maddie will be delighted when you teach her to stay safe and healthy while studying in Ecuador. And you will be proud helping her through complex medical decisions. By taking the time to learn travel medicine, you are able to provide effective counseling, based upon a rich body of knowledge.
You will realize that your patients value your expertise in vaccines and anticipatory guidance. You can really help your teens make complex health decisions, ones which affect their current travel plans.
More and more of your patients are traveling.
It’s time to learn a new skill. Keeping you head in the sand and pretending that it’s OK to ignore travel health issues will not only cause frustration for your patients but it will leave them vulnerable.
When you don’t offer travel health services patients don’t go anywhere else for healthcare, they just cross their fingers and hope they don’t get too sick when they travel. It’s simply not acceptable.
But, when you add travel medicine to your skill set, you will serve a growing need in your patients. They’ll thank you for it.
Oh, and by the way…..
Did I mention that travel medicine is really fun? When was the last time you added something fun to your medical practice?
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