ON Dec 18, the Australian Broadcasting Corporation News reported on the coroner’s inquest into the death of Australian Leigh Aiple, 31, in 2014.
The medical tourist paid RM109,530 (A$35,000) for a 360° tummy tuck, extensive liposuction, an upper eye lift, a chin tuck, a thigh lift, chest sculpting and lip filler, all done in five days.
The first surgery, done on the 124kg Aiple at a Kuala Lumpur clinic, lasted 10 hours.
He died within 24 hours of his return to Melbourne, his 360° wound having burst open. The cause of death was deep vein thrombosis resulting in pulmonary embolism, meaning clot or clots in the legs shooting off into the lungs.
This news was given scant coverage in Malaysia because Aiple’s death and inquest took place in Australia.
Expert reviewer Professor Mark Ashton, president of the Australian Society of Plastic Surgeons and former head of plastic surgery at the Royal Melbourne Hospital, said there was no regulation of medical tourism, with bundle packages designed for patients to have maximum surgeries in the shortest period of time, irrespective of risk.
Coroner Caitlin English found that the treatment and care Aiple received was “well below Australian standards”.
Medical negligence lawyer Emily Hart said: “The standards in Malaysia were met in this case, but they come nowhere near the standards here in Australia. These companies are putting profit over patient safety.”
These sweeping statements taint Malaysian healthcare services, but who can blame the Australians?
It is understandable that many governments and private hospitals promote medical tourism because it brings foreign exchange to the country and profit to the hospitals. But in the desire to promote medical tourism, clinical practice and common sense must not be compromised.
For example, with bundled packages, healthcare workers are under pressure to treat within the stipulated fee, and when complications arise, may compromise.
Hence, the most suitable procedures for medical tourists are low-risk, non-emergency, elective or “cold” cases, like cataracts.
Even with emergency high-risk surgery, the surgeon should at least ensure that the surgical wound has healed, and the patient can mobilise, eat and drink before discharge.
Private hospitals in Melaka and Penang serve medical tourists from Indonesia. As a physician, I see non-surgical patients with medical conditions. Many medical tourists expect to see their doctors only once.
Often, they would ask for six months’ supply of medicine. Good clinical practice does not acquiesce to this request.
I tell my first-time Indonesian patients that a doctor’s duty of care is not just to sell medicine.
I would like to know if my medicine works, how my patients respond to the medicine I prescribed, whether the dosage needs to be increased or the medicine changed, if there are side effects.
What if they take six months’ supply of medicine and developed an allergic reaction after two doses? The remaining medicine will go to waste.
We then negotiate a follow-up date. If they cannot return for a follow-up due to logistical reasons, I will give them a short supply of medicine and ask them to see a doctor in Indonesia.
I will give six months’ supply of medicine only to stable patients whose disease is well controlled.
The expectation to see doctors only once and to be cured after that is also prevalent among local patients.
Patients should consider the duration of their symptoms. If they have been symptomatic for weeks, months and years, then they are likely to require more than one clinic visit. In this regard, there are many types of diseases. Some, like the common cold, may need only a visit.
At the other end of the spectrum, hypertension, diabetes, coronary artery disease and chronic kidney disease require lifelong treatment.
In the middle are diseases like peptic ulcer, depression and anxiety, where a course of treatment may suffice.
In conclusion, common sense and good clinical practice must prevail, whether we are dealing with medical tourists or local patients.
C.S.Y.
Ayer Keroh, Melaka