Expertise with integrity

To the Editor of The Times

Sir
Re: The Risks of Healthcare Tourism

This weekend I turned to your Travel section to discover, according to some advertorial content on page 21, that Budapest is the dentistry capital of Europe, and that the streets are paved with the finest, and most affordable, dental implants.Before packing my bags and seeking my fortune on the banks of the Danube, I thought I’d do a little delving. Afterall, having spent 30 years as a dental implant specialist with a passionate commitment to the well-being of my patients, I was concerned that your readers should receive adequate care were they to be inspired to visit the Budapest Clinic.

I feel compelled to voice my doubts. Dental implants are fraught with possible complications. Travelling overseas for such treatment, where legislative and disciplinary protocols may vary considerably from our own, is a deeply worrying prospect.

There are 13 clinicians identified on the Budapest Clinic website. Seven of these are general dental practitioners. Only one has three years of formal specialist training in restorative dentistry. Three call themselves ‘oral surgeons’, but one of these is a general dentist with only an interest in oral surgery. Two of them call themselves ‘endodontists’, but this is wholly irrelevant to patients undergoing dental implants. Only one of the clinicians is a periodontist.

Dental implants require the combined skills of restorative dental specialists and dente-alveolar specialists in oral and maxilla-facial surgery or periodontics. The assessment and prescription of patients considered for dental implants should always be undertaken by a specialist in restorative dentistry. Such a clinician should assess the diagnosis of tooth replacement. The pros and cons of each option are then discussed and considered. If dental implants are the optimum choice for a patient then the definitive tooth positions are established by the restorative dentist who may then direct the patient to another clinician for surgery.

If a patient has a lump, the general medical practitioner considers the possible diagnoses and refers to the appropriate specialist consultant for investigation and treatment. The patient should not decided who they need to see, or what surgical treatment they need, even if their own reference to Doctor Google says so.

If a patient presents to a specialist in restorative dentistry, ALL the options for tooth replacement must be considered. But if the layperson self-diagnoses implants, I can guarantee any of the general dentists in this clinic will prescribe dental implants. Why wouldn’t they? It’s an earner.

Corporate institutions may entice patronage with attractive financial offers, slick advertising and ‘spa clinics’, but have your readers considered the action involved if things don’t work out?

When a patient attends a practitioner here in the UK, there are clea protocols in place to protect them from an adverse outcome. If something goes awry they have access to legal litigation.  If there has been any failure in duty of care, there are compensation processes which allow for remedial treatment to be provided. UK-based patients have clear legal rights that allow them to pursue a course of action that is well rehearsed. Ultimately, the miscreant practitioner may be referred to the General Medical Council or General Dental Council if the safety of patients is considered at risk.

What if it all goes wrong in Hungary, or elsewhere abroad for that matter? To whom or to which institution do they refer if the outcome isn’t as expected? Do they know the protocols for complaint handling? Do they know the law? Would they be able to pursue legal action in the language of the country that they have visited? Would they even know where to begin? Would they have the tim to attend court themselves, or afford legal representation in their absence? How practical would it be if they had to return repeatedly for the management of any complications? Do they realise that it is the individual clinician who is wholly accountable for any treatment provided, not the institution? What would they do if the clinician involved has moved on without a forwarding address?

I am sure you sense a duty of care to your readers, just as I do to my patients. What measures might be taken to at least warn them of the very real dangers of this sort of healthcare tourism?

Yours

Toby R Talbot BDS MSD FDS RCS