I saw a patient in the office for a weight loss consultation the other day. For the sake of discussion, let’s call her “Kate.” Kate meets all of the criteria for bariatric surgery, being just over five feet tall, with a weight in the low 200 lb range. She also has a fairly large hiatal hernia and severe acid reflux, in addition to some other medical problems that put her at high risk for sleeve gastrectomy. On the other hand, she is a great candidate for a gastric bypass with hiatal hernia repair, a larger, more extensive operation, but one which I perform quite frequently.
Unfortunately, Kate’s insurance does not cover bariatric surgery.
I explained the self-pay system that we have built into our program, which includes contingencies for unforeseen complications, but this very well-educated, financially stable patient stated, “That’s okay, I’m going to go have it done in Mexico.”
Please don’t get me wrong, Mexico has some outstanding Bariatric Programs, with excellent surgeons. The problem is the lack of follow-up for American patients, and the need to return to Mexico should anything go awry. When I raised the aforementioned issues to Kate, she replied, “You can take care of me if anything happens.” Unfortunately, Kate, that puts me in a very difficult situation. Fixing another surgeon’s complications is fraught with danger. Each surgeon has a different way of doing a procedure; and suture material, stapling devices, and hernia mesh used in other countries may not meet the guidelines of the FDA, which can end up creating a huge and complicated mess inside the abdomen.
I have now repaired, revised, or performed what we refer to as “damage control” on over 40 cases that were performed in Mexico and other countries, and I was featured in a newspaper article about some of the problems from other countries that I have had to correct. Medical tourism is a prolific and lucrative industry, but it should be discouraged in the setting of procedures that can be performed safely and effectively by surgeons that have a vested interest in following their respective patients.
The Hippocratic Oath of “Do no harm,” is not a universally applied principle. Developing and maintaining a long-term relationship with patients is one of the reasons I chose bariatrics as my specialty. Weight loss surgery is one of the few surgical disciplines that enables a surgeon to follow patients forever after surgery. In fact, the Center of Excellence designation requires us to follow our patients long-term after surgery, and we are held accountable for lack of follow up and/or complications. Our data demonstrate that the more points of contact a patient has with a bariatric program (surgeon, dietitians, mental health, support group, nurse practitioners, physician assistants), the better he or she will do long term.
Going to another country to save some money might make sense if having a minor procedure, but a laparoscopic roux-en-y gastric bypass, with a simultaneous hiatal hernia repair, does not qualify as a minor procedure. Please folks, and especially “Kate”, think about the reasons you or your loved one is considering bariatric surgery. You want to get healthy. You want to be around for your family. You want to enjoy life, and get rid of a bunch of medications. Don’t throw everything away to save a few bucks, and then hope that someone back home can fix an unnecessary surgical disaster. Find a local, board certified, Center of Excellence Bariatric Program to take care of you. Do it right the first time, and let’s get healthy together.
Let’s get healthy together!
Dr. Matt Metz, MD, FACS
Bariatric and Aesthetic Surgery Associates