Challenges for international patients and their clinicians
| Scenario | Challenges for the patient | Challenges for the clinician |
|---|---|---|
| A Chinese woman is self-referred to the clinic for treatment of multiple chronic medical problems managed by several providers in China over the last 10 years. The patient speaks a rare Mandarin dialect, has minimal available medical records, and due to mistrust of her home healthcare system, refuses to provide names of prior healthcare providers. | Difficulties with communication in a foreign setting Possibly unrealistic expectations | Difficulties obtaining an accurate medical history Difficulties establishing local care provider for continuity of management |
| A man from India is admitted for complicated vascular surgery. During the preoperative evaluation, he tests positive for tuberculosis and is ultimately diagnosed with multidrug-resistant tuberculosis. | Communicable disease must be under control (noninfectious, on effective therapy) before patients can be allowed to travel (eg, return home) | New diagnosis must be managed effectively before surgery Patient may need to remain at medical center for prolonged time (until no longer infectious) May incur additional costs to medical center and public health Finding expertise to manage multidrug-resistant tuberculosis |
| A Saudi Arabian businessman arrives for his annual physical. He declines to see a female provider and demands to work with all-male staff (from desk staff to nursing staff to providers). | Acclimatizing to different social cultural norms | Accommodate patient care needs without imposing unrealistic expectations on other healthcare staff and medical center |
| A female migrant worker presents to the county health department for a health evaluation and is diagnosed with HIV/AIDS and unstable angina requiring emergency admission to the local hospital. | Need for emergency care in a potentially unfamiliar environment Diagnoses that are life-limiting while away from home Fear of deportation | Potential difficulty disclosing diagnoses and obtaining informed consent Lack of documentation and insurance raises admission and payment obstacles Lack of continuity of care raises ethical concerns regarding long-term management (drug-eluting stent placement; necessity of HIV management) |