A Clinic on Before-You-Go Medicine

Travelers headed overseas often seek out a travel medicine clinic or their family doctor as an efficient, one-stop source of immunizations and advice. But not everyone providing travel medicine advice is competent.

Two studies presented at a meeting sponsored by the International Society of Travel Medicine in Acapulco last month illustrate some of the challenges of finding good travel medicine advice.

* One survey of 548 primary care physicians in Atlanta and San Diego found that the doctors often recommended unnecessary immunizations for foreign travel and did not take individual health risks into consideration.

A research team from the Centers for Disease Control and Prevention, Emory University and the San Diego County Health Department sent questionnaires containing three travel scenarios to developing countries. Only one physician gave correct immunization advice for all three destinations and 40% did not give correct immunization advice for any of the destinations.

* Another survey, conducted by a Canadian research team, showed that information on travel health from the Ontario Public Health Departments had improved since the same survey was done in 1986 but that providers still had room for improvement. Only nine of the 42 public health department officials responding to their 1994 survey, for example, mentioned an ongoing plague epidemic in India.

Complicating matters for both doctors and clients, there are no guidelines for travel medicine, said Dr. Jay S. Keystone, director of the tropical disease unit at Toronto Hospital and president of the International Society of Travel Medicine. Physicians from a wide range of specialties can call themselves travel medicine specialists, explained Keystone, who participated in the Ontario survey.

Keystone said his society is in the process of developing what he hopes will be a solution: Practice guidelines or standards. No date has been set on when they might be issued, he said.

Until those guidelines or practice standards are developed, travelers should take a caveat emptor approach. There are several key questions to ask before making an appointment with a travel medicine clinic or physician, said Dr. Terri Rock, a Santa Monica family practice physician who often provides travel medicine services.

“Try to get some information on the phone,” she said. Ask for the name of the physician, his background and training. Travel medicine physicians are often trained in such areas as internal medicine, family practice and emergency medicine.

Consult the “Directory of Medical Specialists,” available at many public libraries, to determine if the physician is board certified in a specialty and where the physician was taught and trained.

Call the CDC Traveler’s Hotline before going to an appointment. The telephone service (404-639-2572) provides information, by a recording or fax, on vaccine recommendations for specified areas, disease risks and preventive health measures. Experts suggest using CDC recommendations as a starting point for consultations.

While some travelers try to avoid such a consultation, Rock contends it is time and money well spent. Even though fees for consultations vary greatly and some clinics do not charge for consultations “people want the cheap way out,” Rock said. “People think they know what they need,” often after reading a travel book or brochures. One of her recent patients proves the folly of such self-diagnosis, she said. The patient thought he needed several different immunizations. “What he needed was a consult and one shot,” Rock said.

“It takes 45 minutes to an hour (to complete a consultation) for most destinations in Africa and Asia, if the person is staying a couple weeks and doing both urban and rural travel,” Rock said. “It’s not possible to do a good job in a short time because there are so many variables.”

“If you’re going in and they’re giving you shots and not information, that’s not a travel clinic,” Keystone said.

Dr. Gerald Looney, medical director of the Centinela Hospital Airport Medical Clinic, said it is also important to ask where the clinic gets its information.

If it’s from a book only, Looney said, the chance of outdated information is much greater than if the origin is a computer source, such as Travax--a compilation of information from the World Health Organization, CDC, U.S. Department of State and other resources that is updated regularly.

Travelers should expect a variety of information and printed material from clinics, experts agreed. The Centinela clinic, for example, gives travelers a report customized for each country on the itinerary.

Travel medicine providers should also ask about underlying health problems, Keystone added, and inquire about their clients’ specific travel plans. A business traveler who journeys from air-conditioned hotels to meeting rooms has very different risks, Keystone said, from a vacationer bent on exploring rural areas in a developing nation.

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The Healthy Traveler appears the second and fourth week of every month.