A plea to control medical tourism.

The growing phenomenon of patients seeking medical procedures abroad (MPA), formerly known as a medical tourism, is discussed. The dark side of the trend is exemplified by the tragic case of a 31-year-old Swedish woman who upon seeing a web advertisement went to Gdansk, Poland, to have breast augmentation. The operation was performed in an old hospital quite different from the modern hospital depicted in the ad. As a result of the grave mistakes in anesthetic care and lack of a postoperative recovery routine, the patient sustained severe brain injury because of prolonged hypoxia. Now, 6 months after the fateful operation, the patient is decorticated and has only vegetative functioning of the left side of the brain. Firm managers, who do not have any medical training, entice patients to believe that the doctors and the facilities abroad have the same technical and safety standards as at home. We question the gap in the law that allows a lay person to screen the candidates for surgery and decide who will operate and in what kind of environment. The trade in human organs is internationally banned but brokering operations on organs goes uncontrolled. Twenty other patients were operated on abroad at different facilities, but all told the same story: lack of adequate postoperative care, unfriendly nursing staff, and the feeling of abandonment upon the return home. The four facets of the ISAPS Patient Safety Diamond--the patient, the procedure, the facility, and the surgeon--are described. ISAPS decided to support the MPA policy with prescreening of the prospective patient, travel and medical insurance for the patient, and surgery abroad, but only if the surgeon is an ISAPS member in a fully accredited facility. This policy will be available first for UK residents who travel abroad for surgery, and later for patients and ISAPS surgeons worldwide. Many plastic surgeons have seen or heard of various tragedies or disasters following medical treatments in foreign countries. We propose to raise the plea for the introduction of legislation forbidding lay persons to trade in or act as an intermediary or broker of medical treatments abroad.