docB

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In my ER I am running into more and more of these people who have gone to Mexico for elective surgeries. The latest seems to be this Swedish band adjustable gastric banding procedure to lose weight. In the past it's been all sorts of other cosmetic stuff. My understanding is that the surgeons are usually Americans or Europeans who are doing this in Mexico to avoid the FDA, malpractice and they do it on a cash fee basis. My issue with it is that when these people come back and have complications they come to the ER. It's almost impossible to get a surgeon to come and see them. They are told by their docs (in Mex) to just "Go to the ER." which is a growingly popular phrase in general. I think it's unethical to do surgeries like this and not provide any follow up other than "Go to the ER." I'm guessing lots of us in the southwest see this. Thoughts?
 

Jeff698

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1) I think it is absolutely unethical. I suspect the surgeons do too and that it isn't just the FDA they're avoiding in Mexico.

2) I can't really blame the US surgeons for not wanting to get involved. EMTALA aside, there doesn't really seem to be an upside to these gastric abortions for them.

3) EM is, once again, stuck in a crappy situation that isn't likely to change anytime soon.

How's that for some happy thoughts?

Take care,
Jeff
 

kungfufishing

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Sessamoid might have some related stories. I know that when I rotated through where he trained, I saw some people who had purchased some crazy ass "treatments" in mexican pharmacies.
 

beanbean

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My in-laws are retired gringos living in Costa Rica. My mother-in-law used to do catering for a Plastic Surgery clinc run by an American doc who has "retired" to Costa Rica. The procedures are much less expensive than having them done in the US even when the airfare and lodgings are calculated in. Lots of Dental Cosmetic work is done down there as well. However,the real cost is made clear if you have complications. while San Jose doesn't have the worst healthcare in the world, it certainly often isn't on par with the care you would receive in the US.

Go to Costa Rica to see the cloud forest and the beaches, not to get your cheeks done!
 

Sessamoid

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We had a fair number of surgical complications from across the border during residency, but not as many as you would have thought. Friends of mine who also worked in the hospitals on the other side of the border noted that it went the other way too. They saw some of our complications because that's just where the patients happened to be when things went bad.

The most notable such story I heard about didn't involve Mexico at all, but an elective sex change operation done in another country, perhaps it was Russia? The complications involved fairly concerning post-op bleeding from the newly created genitalia. Nobody, and I mean nobody was willing to come even evaluate the patient much less admit or take to the OR. Surgery said they didn't do gynecology. Gynecology said it's not really female and thus not their patient. Plastics said they were not qualified to deal with this kind of reconstruction. Urology said they don't work on female parts. Medicine said we're not touching the patient since it's a surgical issue. The patient basically lived in the ER for almost three straight days before one of the trauma surgeons took pity on us (not the patient, really) and agreed to take the case.

Living across the border, the thing I got to become familiar with was the amazing variety of crap that Mexican pharmaceuticals can stuff into a single pill. NSAID, anticholinergic, antihistamine, opioid, blah blah blah. Whatever you can stuff into a single pill, they will. I learned how to get around the Mexican version of the PDR pretty well.