"You don't want to lose that trust that you've built with this patient...": (dis)trust, medical tourism, and the Canadian family physician-patient relationship.

Valorie A Crooks,Karen J Jacob,Neville Li,Judy Illes,Shafik Dharamsi,Jeremy Snyder,Shelly Benjaminy

doi:10.1186/s12875-015-0245-6

Valorie A Crooks, Karen J Jacob + Show 5 more

Open Access

https://doi.org/10.1186/s12875-015-0245-6

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Abstract

BackgroundRecent trends document growth in medical tourism, the private pursuit of medical interventions abroad. Medical tourism introduces challenges to decision-making that impact and are impacted by the physician-patient trust relationship—a relationship on which the foundation of beneficent health care lies. The objective of the study is to examine the views of Canadian family physicians about the roles that trust plays in decision-making about medical tourism, and the impact of medical tourism on the therapeutic relationship.MethodsWe conducted six focus groups with 22 family physicians in the Canadian province of British Columbia. Data were analyzed thematically using deductive and inductive codes that captured key concepts across the narratives of participants.ResultsFamily physicians indicated that they trust their patients to act as the lead decision-makers about medical tourism, but are conflicted when the information they are managing contradicts the best interests of the patients. They reported that patients distrust local health care systems when they experience insufficiencies in access to care and that this can prompt patients to consider going abroad for care. Trust fractures in the physician-patient relationship can arise from shame, fear and secrecy about medical tourism.ConclusionsFamily physicians face diverse tensions about medical tourism as they must balance their roles in: (1) providing information about medical tourism within a context of information deficits; (2) supporting decision-making while distancing themselves from patients’ decisions to engage in medical tourism; and (3) acting both as agents of the patient and of the domestic health care system. These tensions highlight the ongoing need for reliable third-party informational resources about medical tourism and the development of responsive policy.

Highlights

Recent trends document growth in medical tourism, the private pursuit of medical interventions abroad
In this article we examine the roles of trust and distrust in decision-making, information exchanges, and health care in the context of Canadian family physicians who are faced with addressing questions about medical tourism from their patients, or who are treating former medical tourists in their practices
Of the 22 participants, 20 had direct experience caring for medical tourists in their practices while all had heard about medical tourism prior to participating in the focus group

Summary

Introduction

Recent trends document growth in medical tourism, the private pursuit of medical interventions abroad. Media-generated hype further complicates the landscape of endorsement, portraying some interventions as imminent and risk-free cures, and often focusing on the financial costs of procedures rather than possible risks [14,15,16]. This often hype-driven, biased information is commonly used by prospective medical tourists when deciding on whether or not to pay for private care abroad [17]; though other sources of information, such as the opinions of their regular physicians at home, are taken into consideration [18,19]

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