How to compare the quality of facilities and physicians.

It’s important you understand how to tell how good one facility is when compared to another or how good a physician is compared to another. There are many different measures currently available throughout the globe that compare medical services and health care facilities. As a layperson it may be difficult with the hodgepodge of confusing alphabet soup organizations that deliver comparative metrics to distinguish the significance of an evaluation or a grade given by these entities. So, what are some of the easily understandable and reliable ways to compare physicians and institutions across cultures and countries from a safety and quality standpoint.

The Joint Commission International (JCI) Accreditation Standards for Hospitals manual describes JCIs approach to improving quality and patient safety concerns and thereby reducing the risk to patients and to staff. The JCI Standards define the performance expectations, structures comma and functions that must be in place for a hospital to be accredited by the JCI. Although the JCI is recognized as the global gold sealed of approval, there are many other organizations that offer quality certification. JCI is responsible for accreditation of academic medical centers, ambulatory care facilities, medical transportation organizations and primary care centers. The JCI clinical care program certification (CCPC) Talking about we don’t care provides protocols for quality patient care in specific areas of expertise (Such as heart related diseases eg. acute heart attack, kidney disease , heart failure, HIV , diabetes , cancer all types etc ). Other organizations such as the LeapFrog Group, World Health Organization, The National Association of Healthcare Quality (NAHQ) and on an international front – Temos International and others.

Health care quality indices used to rank countries include The Commonwealth fund, Legatum Institute Prosperity Index, The Health care Access & Quality (HAQ) Index.

What is a benefit of accreditation to a patient?

Generally, a facility with accreditation provides a level of confidence to the patient that the facility or other health care environment has met strict criteria in patient safety, delivery of clinical care, overall patient support and more. We will give you some tips used to measure quality by JCI and other organizations to compare in these areas:

  1. Patient centered care/ Patient-Centric.
    1. Patient safety.
      1. What is done ie what processes and procedures are in place to prevent harm and to prevent complications as a result of your procedure or surgery.
      2. What checklists are used doing surgery anesthesia, and do the nurses have a process to notify physicians of a changing condition, complaints or side effects.
      3. What is the process for double checking accuracy of medications and blood or fluid transfusions.
      4. Are you given a name bracelet and is that bracelet tracked every time a new personnel or clinician approaches you or when blood is drawn or medications and tests are given or done?
    2. Patient satisfaction.
      1. You usually get a patient survey to complete and this will include things like how do you like the food , the nursing staff and other staff attitude towards you , how comfortable you were in the hospital /facility , how easy it was to get around.
    3. Communication, documentation and ability to contact.
      1. Does the staff explain your care, potential side effects, expected outcomes, and what the plan is after the treatment or procedure?
      2. Who will be covering in the original physicians absence.
    4. Care follow up.
      1. What is the physician and the hospitals’ plan to take care of you after the procedure or tests.
      2. Is this plan written out in a language that you can understand?
      3. Is there follow up with your physician at home?
      4. Is there an integrated plan meaning a nurse, social worker, dietitian, wound care specialists etc?
  2. Health care organization management.
    1. Facility quality, quality-of-care and processes.
      1. What is the facilities’ Process during the admission process, billing process, claim submission, collections- Fees paid upfront or a payment agreement.
    2. Physician training, quality.
      1. What is the training of the physician and team , their credentials -are they board certified and from where is the board certification (not all are legitimate).
      2. How many procedures have they done and what are the outcomes of the procedures.
      3. Who will be assisting your doctor with the procedures and what are the qualifications of these people/conditions.
    3. Timeliness.
      1. Do you get test results and follow up recommendations back timely within a few days?
      2. Do the clinical staff respond to your inquiries and calls within a reasonable amount of time or do you have to place multiple calls to get a response, how rapidly are you seen/is care delivered eg in the ED/ER?
    4. Effectiveness.
      1. This measure indicates that the physician and practices adhere to best-practice care guidelines and achieve expected outcomes when compared to his or their peers.
    5. Transparency.
      1. Is there willingness to share information and share data with other physicians, other facilities and with you?
    6. Integrated care.
      1. Integrated Care – Is there collaboration and a team approach to the care or is the position of one (wo)man show and not willing to consider other options or suggestions?
    7. Interoperability.
      1. Is their computer system able to talk /communicate with other computer systems such as your physician and hospital or all the positions in your care for example?
    8. Efficient use of medical imaging.
      1. Is there an excess amount of xray & related test being done eg. chest X Rays done every day while in hospital?
    9. Mortality.
      1. What is the outcome of the surgeries and other procedures that are done? – these are questions that need to be asked up front and hopefully there is written documentation to support any claims. There is usually comparisons with like specialties and among peers that are publicly available

Should I quit my job and travel? What do I need to think about?

Many dream of traveling at will, traveling without need to worry, but worry if it’s the right decision? When is the best time? How will you finance it and a host of other valid concerns.

There are a lot of stories on the web recounting personal experiences, pros and cons from anecdotal experiences but none that carefully detail all that needs to be considered. So here we will give you some pointers, pros and cons for you to consider before making this life changing move.

  1. Take time alone to think.
    1. Think about where you are in life now.
    2. Do you know where you want to be in the future?
    3. Are you aware of your happiness factor?
    4. Do you feel fulfilled in your life?
    5. What are your goals.
  2. Consider your reason for wanting to travel.
    1. Are you trying to keep up with the Joneses, your friends maybe?
    2. Do you want to get away from something – family or relationship turmoil, changing mood such as depression?
    3. Is there a do-good outcome possible?
    4. Is this for religious reasons?
  3. Your job.
    1. Are you stagnant, not challenged, not fulfilled?
    2. Is it the wrong job for you – do you know the right job, what you want to do?
    3. Are you earning a good salary?
      1. Consider the fact that if you leave your position you may not be able to command the same salary on returning, and are you OK with this.
      2. Could you earn more and need to retool, and earn more skill sets to become more competitive.
    4. Weigh the pros and cons of a sabbatical, leave of absence vs quitting.
    5. Have a conversation with your boss and superiors as to your options.
      1. Maybe there is an option for working remotely if you like your job.
      2. Maybe there’s an option for getting a different position in the company which is remote and that offers flexibility.
      3. Think carefully how you would phrase this to your boss for concern of being terminated prematurely or retribution.
      4. Try not to burn your bridges behind you as you may need a reference on return.
  4. Do you have enough money?
    1. Do you have any savings, rainy day account? 401K, HSA or IRA?
    2. Establish an emergency fund – regardless of your income, could be 5%, 10% or 20% of your income.
    3. Establish a budget and solicit help if you are unsure of how to do this GoGirl Budget Planner
    4. Be realistic and minimalistic with regards to estimated expenses while traveling.
    5. Look into lodging ahead of time and make temporary plans.
    6. Have an idea of exchange rate and the strength of your money.
    7. Look up volunteer opportunities as you may be able to get free lodging.
    8. Apply for 2 or 3 credit cards, but make sure you have the provisions to pay the balance.
    9. Try to plan and save money at least a year ahead of your travels.
      1. Reconsider your current living expenses.
        1. Do you own your home?
          1. You could sell your home and add the proceeds to your savings.
          2. You could rent your home out and live with family or possibly rent a smaller place to live.
        2. Are you currently renting??
          1. Consider moving into a smaller unit.
          2. Consider moving in with the family.
          3. Consider getting a roommate to cut the expense.
    10. Do you need to get a second job or a side gig to help save more money?
    11. Consider selling your furniture and other items that may not have sentimental feelings attached.
    12. Reassess your needs vs wants and try a minimalist lifestyle if able.
  5. Networking and Name Association – If your career is set.
    1. Consider trying to secure a job with your current employer upon returning.
    2. Network extensively among peers and competitors to get your name out which will facilitate re-entering the job market.
    3. Get involved in activities such as volunteer or extracurricular to get people familiar with you and your name.
    4. Have a going away party for yourself with the objective of breading familiarity Amongst your peers and superiors.
    5. Not only send a letter of resignation but a letter of thank you to your boss and superiors detailing your appreciation for what you learned and also how this travel opportunity will enhance your job skills (you are setting the stage for a possible rehire or reference).
  6. Confused and lost – if your career is not set.
    1. Have a candid discussion with your superiors prior to advertising your leave to identify your weaknesses and strengths.
    2. Network amongst peers and competitors in your current job field and different job fields.
    3. Look at job boards to see what kind of jobs are available and what are the criteria needed for these jobs.
    4. Seek out possible jobs (lifeguarding, teaching other sports eg. Soccer/football, etc, teaching languages or other subjects, marketing opportunities, IT/computer related fields, blogging, tutoring on-line, consulting jobs on-line, etc ) and establish ahead of time what you plan to learn from these odd jobs based on identified weaknesses and or strengths bearing in mind the need to build your resume upon return.
  7. Family.
    1. Have an honest discussion with family explaining why your decision is being made and what you hope to get out of it.
    2. Establish who is foreign who is against you going and their reasons, try to assuage those against but be aware that they may never understand your reasoning.
    3. Consider a tracking device on your Phone (FamiSafe, Family Tracker, Geo Tracker, life 360), which comes in handy in times of emergency so your family can track you.
    4. Reconcile your life changes with loved ones, current relationships and prior relationships – reconcile all relationships in your mind and be comfortable with your decisions.

Travel young or older: pros and cons.

There’s much debate about when is the best time to travel, is it better to travel when you’re young or is it better to travel when you’re older. although the exact age is that qualify for a description of “young” versus “old” can be left up to individual interpretation. At either age most are searching for Happiness and personal fulfillment to some degree.

Traveling young < 30 years old.

  • No responsibility – You have fewer responsibilities and obligations, financial and otherwise. This is a perfect time to travel on a slim budget, stay in hostels and couch surfing with likeminded people. It’s great not leaving anything behind that could lead to consequences if unattended.
  • School’s out! – You have finished school – high school and college and possible second degree. You don’t have to think about deadlines or requirements or expectations. This is a great time to evaluate your education and possible next steps with a mind not bogged down with a to-do list.
  • No career yet – You have not established your career nor a network. Sometimes it can be difficult to abort a career that is on a trajectory and so having the chance to travel before this occurs should be seized.
  • No babies, no kids, no spouse! – You do not have young children or spouse to consider in your plans. This is a no-brainer, you are free to travel!
  • New friends – Exposure to other cultures at an impressionable age. Meeting people from different cultures during your travels who are either local residents or other travelers can provide eye opening experiences with exposure to different ways of life, diets, styles of communication and even relationships that can be lifelong.
  • Finding you! – Development of self-awareness and your personal identity. All of the above reasons given can help to contribute to your having a better understanding of who you are.
  • Character and personality work – Development of humility and tolerance from exposure to other cultures. With exposure to other cultures, through understanding an appreciation of differences you learn tolerance, and empathy which can greatly impact positively your future relationships and negotiations.
  • Exposure and clarity of mind – Exposure to environments, relationships and cultures that can contribute clarity in life decisions. New exposures and unhindered freedom to be, can help you to see and understand experiences and declutter your mind.
  • Funky attitude be gone – Helps with working through personal challenges such as depression, loss or grief. Having clarity of mind without obligations can you help you to process your thoughts and emotions.
  • Real life experience – Provides real life experiences and tools for development of your careers. On returning to start or resume your career, these experiences are invaluable and make you very competitive and desirable for employment. In this global environment that we live in, this could increase your chances of a remote job or a traveling job.

Real Stories from Young Travelers Abroad

Traveling older >45 years old .

  • Time on your hands – You may be newly empty nested and have more time on your hands. When you’re not soccer mom anymore, not cleaned house not making dinner you realize you have no social life it’s out of your kids and you have no idea what to do with your time. This is a great opportunity to start fresh on a new slate.
  • Mid-life changes – Your career may be stagnant, and you need to consider a career change or maybe retirement. This is a great time too set goals, evaluate your past accomplishments, happiness factor and dreams.
  • Mindfulness & Self-discovery – You may be recently divorced or otherwise single, on a search for self-discovery. It’s time to re-introduce yourself to yourself, and learn more about your likes and dislikes, learn how to treat yourself for what you deserve to have and be. It’s time to learn to be present and in the moment and realize that self-love is not selfish.
  • Self-actualization – may need time away for rejuvenation, mindfulness, renewed spirit. practicing yoga, meditation, mindfulness and enjoying being present in the moment helps with personal growth and development.
  • Bucket list items – Have a long list of Bucket List places to see and go. Meeting people with a new sense of purpose, worth and value can open your eyes to experiences you would never previously have imagined. Be open!
  • Enjoy life – You have saved enough and it’s time to enjoy life. You have planned and saved and now it’s time to enjoy your life. It’s no time to reinvent the past, nor ruminate on the past, nor beat yourself up about missed opportunities or stack up regrets.
  • Step outside of your comfort zone – Push your boundaries and push yourself can your achievements. Pushing your boundaries beyond your comfort zone will give you a phenomenon you sense of accomplishment find achievement and personal value.

Best Friends (Real Friends)

Drinking and traveling alone.

Definition of “alcoholism”, now called “alcohol use disorder“ is an addiction to the consumption of alcoholic liquor or the mental illness and compulsive behavior resulting from alcohol dependency (Oxford). it is a long-term addiction to alcohol and generate the person with this condition does not know when nor how to stop drinking. they usually spend a lot of time thinking about alcohol and cannot control how much they consume even if it causes serious problems at home, work or financially (Medical News today). Some people can be classified as high functioning Alcoholics , meaning that you can have a lot of activity going on uh from an outside life and be able to hold wow well-paying job down and function at home and within family and relationships adequately despite drinking excessive amounts of alcohol . A functional alcoholic could be very responsible and productive and high achiever but generally is in denial of his or her condition because there ‘vision ‘ maybe obscured by the fact that they’re able to hold down a good job pay bills have a lot of friends and seemingly function well , they usually provide a lot of excuses for their drinking and play the comparative game with other people who also drink and may not be as functional . heavy drinking can be considered for women to have more than 3 drinks per day or more than Seven in a week and for men more than 4 drinks per day or 14 per week, it’s considered that if you drink more than the daily or weekly limit you’re at significant risk.

Traveling alone often requires a certain degree of responsibility, vigilance, and awareness of your circumstances in addition to the ability to interpret cultural differences and variation and nuances in interpersonal relationships. Although in some cultures drinking can be accepted as a social norm in particular in some of the Asian cultures during formal and informal gatherings, being inebriated to the point of lacking the ability to be responsible for oneself does not bode well in any culture.  Additionally, drinking excessively from a female perspective and losing ability to monitor, manage or control one’s actions can be misinterpreted in different cultural environments.

Other concerns have to do with health-related matters in other countries. detoxification and treatment of the consumption of excess alcohol may not be treated as rapidly in a foreign country , may not be thought of as important as other medical conditions, and treatment options available in more developed countries may not be available you know they’re less developed countries. as such negative effects and consequences of being inebriated could become more pronounced. Additionally, the concern of mixing are there medications even as simple as Tylenol or acetaminophen could result in negative consequences.

Lastly, problems with Immigration and Customs could result if law enforcement from any culture is required to intervene or assist with any condition arising as a result of alcohol excess. Visa applicants can be found inadmissible to the United States and other countries due to physical or mental disorders with associated harmful behaviors to themselves, others, or property and alcohol abuse is considered to be one such mental disorder even if addiction or alcoholism is not present. (Berardi Immigration Law). According to the Foreign Affairs Manual (FAM) Title 9,40.11 N11.2, alcohol abuse itself is not enough to cause a finding of inadmissibility according to immigration rules. One may be required to be examined by one or a panel of physicians according to guidelines provided by the CDC, and based on the discretion of the panel an immigrant  waiver from the CDC, ( not the US customs and Immigration Services), can be issued. In order for a waiver to be granted, the applicant may need to arrange to report to a mental health facility in the US in advance of entry and must prove how this treatment will be paid for. This process can be difficult, lengthy and expensive. Of note these decisions can be appealed and a medical review board can be convened to refute and investigate any decisions made. of note a visa applicant may also try to contest the findings of the panel physician and an applicant outside of the US may have the counselor officer file a request for an advisory opinion with the CDC. However, it is noted that if the council officer refuses to file the advisory opinion request, nothing can be done further as the CDC rarely overturns the decision of the panel physicians.

Understand post abroad depression and Reverse Culture Shock.

Why is it important, essentially the same definition. What can you do about it?

Reverse culture shock is emotional and psychological distress suffered by some people when they return home after several years overseas. This can result in unexpected difficulty in readjusting to the culture and values of the home country, now that the previously familiar home has become unfamiliar. (source: Investopedia).

Post travel/study abroad depression is real. No one at home will understand you and no one will get you and what you’re going through, it’s like you’re fighting it alone. The thrill of adventure that comes with travel feels completely lost upon returning home, can make you feel like you’ve taken a step back. Online travel groups will help but only for a short time. Sometimes you feel that coming back home isn’t really like coming home at all, as your new adjusted home has been one of new experiences, new people and the unknown on the road. You feel a sense of being unsettled, what you previously thought was a secure landing is no longer. You sometimes feel you have no secure landing. All you can do is think about the next travel and the next journey away.

As Benjamin Button said:  ‘it’s a funny thing about coming home. Looks the same, smells the same, feel the same. You realize what’s changed is you.”

Here are some of the symptoms:

  • Spending a lot of time searching for opportunities abroad.
  • Comparing everything to your experiences abroad.
  • Criticizing the way things are done and how people live their life in your hometown calling them “close minded”.
  • Talking constantly about your travels and experiences and sharing pictures.
  • Not wanting to leave your home and losing interest in things you previously enjoyed and feeling distant from friends and family, Not wanting to meet other people.
  • Fear leaving home because you don’t feel welcome and feel different as if you don’t fit in anymore.
  • Feeling “stuck” or worried that you will never be able to travel again.
  • Not wanting to commit to relationships or work or job for fear of being stuck in the same old grin.

What is a remedy and how do you treat this:

  • One of the important steps to preventing this before going is to train your thought process to understand that the experience is going to be temporary (unless it’s not!), framing your expectations for your return.
  • First step is to recognize and to educate yourself on the symptoms and the diagnosis/condition. Know the stages:
    • The initial shock stage – feeling as if you are not able to return to your old ways handle things.
    • The depression stage – feeling down, anxious, insomnia, and not able to get thoughts of your travel out of your head.
    • The tantrum stage – you hate everything and everybody and all your experiences.
    • The substitution stage – searching for familiar foods and experiences and locations to “trick your mind” into thinking it hasn’t really left.
    • The realization stage – understanding the process and putting things into perspective.
    • The acceptance stage – accepting that the experience was temporary and appreciating it for what you learned and your personal growth.
  • Make a travel goal and plans for your next trip as something to look towards.
  • Share experiences with your friends and family such as cooking, dancing or other cultural activities.
  • Get involved in international communities (International citizens’ group –, InterNations – ).
  • Volunteer in international communities eg.with refugees such as teaching English or assisting with cultural awareness an acclimation.

Does traveling help depression?

There are many people who suffer from depression whether it is chronic depression or situational depression or postpartum depression, but the symptoms are by and large similar. Depression is one of the most common mental health problems affecting more than 300 million people worldwide according to the World Health Organization (WHO). “Mental health issues are among the leading causes of ill health among travelers and psychiatric emergency is one of the most common medical reasons for air evacuation along with injury and cardiovascular disease” according to WHO. Many people enjoy traveling. Some of these same people who enjoy traveling also feel depressed from time to time. Sometimes the depression is so bad that it interferes with traveling and often-times we consider – will traveling help my depression or not? If you are struggling with depression, it doesn’t necessarily mean that you cannot travel.

It’s important to realize however that travel is not a cure for depression and although it may improve the way we feel temporarily, returning to prior environments or situations can prompt depression feelings again.

What are the symptoms of depression?

  • Mood changes such as anxiety, loss of interest or pleasure in activities, mood swings or sadness, feelings of guilt or general discontent and hopelessness, apathy and sometimes even anxiety.
  • Behavioral changes such as agitation or excessive crying and irritability, restlessness and even at extreme level social isolation
  • Sleep changes and cognitive changes can occur such as early awakening, excessive sleepiness, insomnia or restless sleep, lack of concentration and slowness in activity and even at extremes thoughts of suicide.
  • General symptoms such as excessive hunger and fatigue or even loss of appetite, with weight gain or weight loss.

Tools for preparing to travel.

  • Plan your trip, so you will know what to expect as unknown events, unrealistic expectations and surprises can increase stress and anxiety.
  • If you’re not an experienced traveler, start with small adventures and possibly local travel before embarking on multiple leg international travel.
  • Make prior arrangements and give yourself time – decrease stress.
  • Planned downtime in your travel and after your travel is complete – helps to reduce stress and anxiety from transitioning.
  • In planning your itinerary consider avoiding high stress and congested, busy confusing and complicated towns and cities. try to focus on relax locations.
  • In planning consider including locations that offer meditation and yoga, give yourself breathing room to relax.
  • Try to maintain a routine by forcing yourself to get up and get about, start your day around the same time is a good idea.
  • Try not to push yourself too much and try not to compare yourself to others. Some people find that exploring new places helps their depression symptoms while others discover that the stresses of jet lag and being in strange places can make their feelings worse. Take your time and be gentle with yourself and give yourself permission to feel & be in the moment.

Medications while traveling .

  • Make sure to take your anti-depression or other medications with you on your trip, avoid changing the dosages around the time of your trip.
  • Pack medications in carry-on bag not your checked bag.
  • Always take medication in the original labeled bottles with the original prescription written on it, and the doctors name/address/phone number.
  • It’s important to note however that many psychotropic drugs used to treat depression are restricted or even banned in some parts of the world so it’s important to review sources such as your local travel clinic, CDC, the visiting country Immigration and Customs website.

Things you need to know when buying travel insurance.

Before embarking on travel, it is recommended to secure travel insurance, even for local travel but definitely for international travel. Travel Insurance can arrange medical treatment in an emergency, monitor your care, serve as interpreters, help you replace lost passports and so much more.  There are many pointers that you should know and there many facts you should find out prior to travel. A few things you should know about travel insurance:

  • Benefits vary by plan. It’s important to choose a plan that fits your needs, your budget and your travel plans. Here are definitions of all available travel insurance benefits.
  • Coverage – Travel insurance can’t cover every possible situation. Allianz Global Assistance offers named perils travel insurance, which means it covers only the specific situations, events, and losses included in your plan documents, and only under the conditions we describe. Travel insurance is designed to cover unforeseeable events— not things you could easily see coming, or things within your control. If, for example, you wait to buy insurance for your beach trip until after a named hurricane is hustling toward your destination, your losses wouldn’t be covered.

First before leaving your country take some time to review your own local insurance policy. Consider calling your insurance representative if you’re not quite sure about what or how much your coverage allows. Also it’s important to note the difference between travel protection, Which includes coverage for a trip cancellation, trip interruption, travel delay benefits, baggage loss or damage or delay, change fee, frequent travel loyalty plan coverage  and travel  insurance, which is akin to health insurance coverage and includes travel protection. The following items are worth checking:

  • Does your local insurance provide medevac transportation from out of state or out of country locations?
  • Does your local insurance cover for emergent care in foreign countries or out of state?
  • If your local insurance provider does not directly pay out of state or foreign countries, do they allow you to provide a claim for reimbursement once returning home?
  • Does your local insurance provider offer reciprocal coverage in other countries, this is because some local insurance carriers have a global presence?
  • Can your local insurance carrier suggest preferred physician clinics or hospital organizations in foreign countries that they would recommend for care if needed?

Secondly, you need to review your travel style and plans for travel Because it’s impacts your cost:

  • Are you a careful planner where you need to have every aspect of your vacation preplanned including hotels, tours etc.
  • Are you a spontaneous adventurous risk-taker traveler, more of a free spirit with flexible travel plan dates with frequent extension of your visits and changes to your return date?
  • Are you more concerned with saving money?
  • Where are you more concerned with preserving your Peace of Mind and prefer to save well established hotel chains etc.
  • Does your trip have multiple segments?
  • Do you plan on taking multiple trips in a 12 month period?
  • Will this be a solo travel, travel with a partner or a stranger, travel with children?

Some recommended insurance carriers for international travel:

Allianz global assistance (owned by Allianz SE)

Generali global assistance – Parent cpy The Europ Assistance (EA) Group

Seven corners

Travelex (Australian owned parent company Cover-More Group)

Travel guard (Parent company)

World nomads

MedjetAssist – medical evacuation membership, has access to over 250 private air ambulances that evacuated hospitalized patients

Healthcare beyond borders