When Canadian patients travel abroad for care

Why do Canadians seek care abroad?

Medical tourism refers to patients travelling abroad to obtain medical services. Canadians may engage in medical tourism as an alternative to lengthy wait lists, or to obtain treatment that may not be covered by their provincial or territorial health plan, or to undergo procedures that may be unavailable domestically. Patients may choose to travel abroad for a wide range of medical services including cosmetic procedures, diagnostic examinations, organ transplants, in vitro fertilization, cancer and neurologic therapies, and bariatric surgery.¹

Medical tourism can have an impact on patient safety. It may also raise potential medico-legal issues for Canadian physicians and bring unexpected challenges when patients return to Canada for follow-up care.

Before the patient travels

Physicians should respect patients’ autonomy in seeking out-of-country procedures and other decisions regarding their healthcare. When there is an existing doctor-patient relationship, the physician is obligated to provide reasonable care, irrespective of where the patient intends to seek the treatment or has previously received treatment.

If a patient chooses a treatment that will be administered outside of Canada or requests a referral to an out-of-country specialist, consider the following:

• If you feel you do not have the knowledge to provide an opinion on a particular treatment, or you are unfamiliar with a specific physician or facility providing the desired service, inform the patient that you do not have sufficient information to recommend the service. It is then up to the patient to investigate and arrange for the treatment.
• Continue to advocate for the patient and be cooperative with the out-of-country care providers to help ensure a smooth handover and continuous care of the patient. This includes providing pertinent information in the patient’s medical record to the patient. This information may be communicated in the form of a letter summarizing the patient’s condition, which the patient may deliver to the out-of-country care providers as they see fit.
• Discuss with the patient ways in which they can reduce the health risks of receiving medical care abroad, such as getting vaccinated before travelling, or allowing sufficient recovery time before the patient makes the trip back home.
• Document your discussions concerning the nature, benefits, and risks of out-of-country medical services in the patient’s medical record.

If you are involved with a patient who seeks out-of-country care, this may create a duty of care and thus include you in the coordination of care. If the patient experiences poor health outcomes as a result of the treatment, you may be exposed to the risk of a legal action being brought outside of Canada. This could raise questions about your eligibility for CMPA assistance. Owing to the way the CMPA is structured, the CMPA does not generally assist with legal actions commenced outside of Canada.

After the patient returns home

Patients who return home following out-of-country procedures are likely to seek continued care from their Canadian physicians. The goal remains to provide continuity of care to the extent possible. Existing doctor-patient relationships generally remain in place, together with the duty of care that obliges physicians to appropriately treat patients in accordance with accepted standards of practice in Canada.

After the patient returns to Canada:

• It is appropriate for you to request that the patient provides you with information about the out-of-country medical care, including from the medical record of the care provider in the other country. Such information can assist in providing follow-up care.
• Continue to use reasonable care and diligence in treating the patient within the limits of your knowledge and resources.

See also:

• “When patients make special requests, how should you respond?”
• “Helping patients make informed decisions”
• “Providing your professional opinion concerning patients outside Canada”

Note

1. 1. 
   This article is intended to address situations where a patient chooses to pursue care outside of Canada. This must be distinguished from situations where a provincial/territorial government requires a patient to be sent outside of Canada for care that cannot be provided in Canada (often owing to a lack of resources). Members are encouraged to contact the CMPA for advice in these latter situations.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.