The need for medical care while overseas can be daunting. (Courtesy photo)

Medical care while traveling and during the days of COVID-19

Primary care physicians sailing in same uncharted waters as patients

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The need for medical care while overseas can be daunting, even if it is something not terribly serious. In addition to potential language barriers there is of course the question of cost and whether your stateside medical insurance will cover your overseas encounters with the local medical community.

Generally speaking, travelers will need to pay for services rendered while overseas – which are often less costly than at home – then submit their claims to insurers with documentation upon returning to the U.S.

Over the years while traveling, I have had occasion to see various physicians. On an idyllic South Pacific island I once needed several stitches when I opened a supermarket refrigerator door and a bottle of soda crashed to the floor and defying geometry, shards catapulted into my ankle. In northern Thailand, an exhaust pipe burned my leg when the motorcycle I was driving landed on me after I hit a rock and fell. On a tiny Grecian island, a door unexpectedly swung into my face and I chipped a tooth. In New Zealand, I developed a nasty eye infection, and many moons ago while driving towards Titograd – today Podgorica – not far from the Albanian border, I got severe food poisoning ostensibly from fruit juice.

While annoying, none of these events required hospitalization, though the food poisoning made me believe for an incredibly long 10-day stretch that death was imminent. In each case I was fortunate to receive good medical attention where I was and fully recovered.

Many avid travelers and most journalists, including myself, carry medical evacuation insurance. Like many insurance policies, you pay the premium and then pray you will never need to actually use it. That said, premiums for the medical evacuation insurance are fairly reasonable especially given the cost of a medical evacuation from overseas. I recently obtained a new family policy with a five-year term for about $1,500. A veritable bargain, as an uninsured medical evacuation while abroad can be far north of $100,000.

What about when you need routine or other medical care in the U.S. during a pandemic?

If you are generally healthy and are scheduled for a routine annual exam, many physicians are suggesting that those be postponed until the current situation abates for two reasons. First, they don’t want healthy patients to be in a waiting room with potentially sick individuals especially if you are over 60 or immuno-compromised. Second, it’s better that physicians be available now for those with acute issues or those who need their immediate attention.

But what to do if you have, say, a nasty rash that is driving you crazy, or a runny nose that persists? While many of us are under lockdown and working from home via Zoom web conferencing, many physicians are now turning to Telemedicine as an effective way to deal with just these types of problems and treat their patients without potentially exposing them to coronavirus or other illnesses.

“Like many medical practices, we have had to rapidly adapt to remain available for patients” says Dr. Eric Sue, an internist in Los Angeles. Dr. Sue noted that “Telemedicine has allowed us to continue to field questions, provide guidance and counsel and address both COVID-19 and non-COVID-19 concerns, all in a virtual world where a familiar face can in and of itself be comforting. And patients have been appreciative of being able to communicate … from the comforts and safety of their own homes.”

In a recent essay, entitled “The doctor is in the house,” Dr. Susan Mandel, a primary care physician also practicing in Los Angeles, wrote the following:

“In the era of coronavirus, I am much more than my patient’s physician.

I’m sitting in my dining room FaceTiming my patients. I see a rash, a swollen leg, review lab results, discuss cholesterol counts and listen to concerns about chest pains, stomach ailments and symptoms sounding like the COVID-19 infection. It may sound like any other day in the office of a primary care physician, except that it most certainly is not. And by saying this I do not mean it’s because the office visit is conducted virtually.

I am now a fellow human soul on the same ship sailing these same uncharted waters. We have common concerns regarding our personal safety and those of our loved ones. We lie awake at night worrying if funds in the bank are enough to cover our rent and mortgage payments. We ask ourselves, ‘Can we keep our business going, practice our livelihoods, follow our passions?’

Shared, collective experiences change the nature of relationships. There is a newly established connectedness and intimacy. While my medical training encouraged empathy, there was no book to be read that could teach me how to cope as tragedy struck my own family when my brother was diagnosed with cancer. This led me to better anticipate my own patients’ needs. I was able to offer pearls of wisdom that included stories of bravery, optimism, and the bearing of witness to a miracle.

I am Marcus Welby, M.D. now. I am the old-time physician in one of Norman Rockwell’s many paintings depicting doctors. I have become what most of us aspired to be when we submitted our medical school applications.

I watch my patients as they carry their phones and computers into different rooms in their homes. I wave to their children in the background. I wear less makeup and even though they can’t see them, my feet don UGG slippers.

My colleagues and I are struck by how each of our patients expresses gratitude and appreciation for us and our profession. They reach out to us simply to thank us for being there. We can do our part – even if it’s small – rising to the occasion in this moment of global crisis as we live the Hippocratic Oath we solemnly pledged to uphold. In the most tragic and frightening of times we are watching the bravery and heroism in real time on the front lines at a level not experienced by our generation – nor younger generations — of physicians.

We see the restoration our professional ethics, dignity and pride. We have the honor of serving as genuine healers for our patients. When this nightmare is behind us, I believe this will, at a minimum, be one thing for which we can all be grateful.”

In these uncertain times, both as travelers and as world citizens, we are reminded not only of our mortality, but must be reminded of our shared collective humanity. If you are healthy, social distance and deeply thank the heavens and the physicians who keep you well. If you are sick or compromised, as you strive to get well, take a moment if you can to reflect that the physicians, nurses and medical staff around you are absolutely our most important un-caped national heroes.

While now only virtual hugs are possible, when this is behind us as it one day shall be, those un-caped heroes will more than deserve a real one. Several in fact.

Julie L. Kessler is a journalist, attorney, legal columnist and the author of the award-winning memoir: “Fifty-Fifty, The Clarity of Hindsight.” She can be reached at Julie@VagabondLawyer.com.

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