Since the pandemic, many people have been dreaming of travelling the world to far-flung and exotic places. People often choose to travel in common interest groups - from school trips to the continent and pilgrimages to religious sites, to major expeditions to remote tropical destinations and treks across inhospitable terrain.
To assure the health of group members when far from medical facilities, doctors are regularly asked to accompany these groups to provide medical care should the need arise.
This is potentially exciting work and encompasses a wide variety of activities - but there are several questions and considerations for medics who might be considering taking on such a role.
What do you know about the operator?
Is it a well-established company with a good reputation? We have seen cases where negative experiences of logistical aspects of a trip, such as transport or accommodation issues, have had an impact on the doctor accompanying the trip. Make sure you're satisfied with any risk assessments that have been undertaken.
Are you suitably qualified?
Consider your own competence and experience and what is required of you as the 'medic'. How has the travel company marketed itself in terms of medical cover and are you able to meet these requirements? Is it basic first aid or much more?
If you provide reassurance that there is a doctor present, you need to be able to deliver if the worst happens. Putting yourself forward as the 'medic' without the necessary skills could lay you open (at least in English law) to claims for clinical negligence or (in extreme cases) a criminal charge of gross negligence manslaughter.
Where are you going?
Think about how isolated you might be. Are you the sole medic? Is there back-up if you need it? For example, some companies have central expedition doctors available by phone or video link. What do you know about the availability of local doctors/hospitals? What are the emergency evacuation arrangements?
Although most of the work is intended to be for minor injuries, you need to be sure that you have the expertise and equipment to deal with most reasonably foreseeable medical emergencies and common local diseases - whether that might be snake bites and tropical diseases in the jungle, or altitude sickness when mountaineering. Familiarise yourself with the presentation and treatment of these conditions before you go.
If you provide reassurance that there is a doctor present, you need to be able to deliver if the worst happens.
Management of medicines
We have seen expedition companies ask travellers to obtain prophylactic antibiotics from their own GP. We've also seen requests for acetazolamide to reduce the symptoms of altitude sickness for Everest expeditions.
Travel prescriptions are not available on the NHS but can be issued privately if the GP is willing. We would generally recommend that unless a clinician has knowledge of the specific health risks of the activity being undertaken and the area to be visited, the patient should be referred to the trip organisers, who can direct the patient to their doctor specialising in expedition medicine.
If a patient has a condition that usually requires them to have a store of prophylactic medicines in the event of flare ups (steroid medications for asthma or inflammatory bowel disease, for example), it is appropriate to supply them with a prescription for that medication as usual.
It follows that doctors accompanying groups travelling abroad may be asked for advice about medication the patient already has, or that would be available to any lay person without prescription in that country. In some countries, that may be a more extensive range than in the United Kingdom.
It is important to realise that medicines regulations vary widely from one country to another. Possession of medication such as codeine, which is available over the counter in the United Kingdom, may be illegal in other countries.
For each individual country to be visited, it is important to clarify the relevant legislation regarding the importation, possession and exportation of all drugs - and especially controlled drugs.
What do we need to know?
If you seek MDU indemnity for an overseas trip like this, each request is considered individually by our underwriting team, who will need certain information to make the process go smoothly. This might include:
- your destination(s)
- the name of the organisation you are working for/going with
- if you are not on the GP or specialist register, details of your qualifications and experience and any supervision arrangements
- suitability of participants.
The company may be able to offer guidance on registration, assuming they have run operations in the country before. The embassy or consulate of the country, or countries, you will be travelling to may give advice on their individual registration requirements.
In some cases, full registration may not be needed, but you are strongly advised to satisfy yourself if there is a requirement to register temporarily with the country's registration body.
It is also worth noting that there are significant differences between countries in respect of what is expected of a doctor. In the United Kingdom, for example, there is an ethical obligation to assist in a medical emergency, rather than a legal one. Ensure you are aware of the legal and ethical requirements that apply in each of the individual countries to be visited.
Indemnity is needed to ensure a patient who has suffered harm as a result of malpractice is able to receive appropriate compensation. A doctor with no indemnity may leave themselves exposed to significant personal cost in relation to any claim or other investigation, such as a complaint to the GMC.
It's worth clarifying whether you can get indemnity from the institution where you are working (for example, the overseas clinic or the company employing you). Bear in mind that our worldwide indemnity for good Samaritan acts wouldn't be sufficient here, as being a good Samaritan means you happen upon an incident as a bystander, rather than in the planned role of a medic.
Non-disclosure of health information can be common. Patients sometimes ask their own doctor to endorse their participation in an expedition/extreme sport, but the doctor may not fully understand the rigours of the event.
Use your own judgement about the fitness of participants and don't rely on others' prior assessments. Participants have often paid large sums of money for these 'trips of a lifetime' so will not be keen to hear your concerns about their fitness to participate. Likewise, you may feel conflicted advising one member of a team to pull out mid-expedition if it compromises other team members' participation.
Think how the story will sound to a lay person at home or how it could play out in the media if something goes wrong.
Problems on the trip
Things can and do go wrong, and we have seen anything from claims for frostbite to issues such as patients developing appendicitis in the middle of the jungle and acute deteriorations during evacuations.
If you do need to provide medical care to someone it's important to keep good notes. While these might not be the comprehensive electronic records you'd be able to make at home, you should try to write the salient points down as soon as you can.
Be very careful about patient confidentiality. Groups travelling together can get to know one another well but it's important not to breach confidentiality in potentially unfamiliar situations - such as needing to use radios when planning for emergency evacuation.
Also, think about yourself. Make sure you are fit enough to do the trip and consider what arrangements are in place if you fall ill. Usually, with careful planning, all goes well, and you will have the opportunity to enjoy a great adventure.