An ongoing dialogue on HIV/AIDS, infectious diseases,
April 8th, 2023
Travel Clinics and a Travel History to Beat All Travel Histories
I’ve received some very helpful and quite critical comments about the original post that was here. Having re-read the original, I’m acknowledging my mistake and want to apologize to my colleagues, many of whom do travel medicine with true expertise, excellent intentions, and for the benefit of travelers everywhere. My bad for not emphasizing this fact in the first part of the post.
Awaiting input from my editors, I temporarily removed it yesterday, but now have replaced it below. There are some edits to parts that I especially regret, but the essence is there.
Thanks everyone for reading, and helping me keep this a useful, supportive, and I hope educational place.
Confession: I have mixed feelings about travel clinics.
On the one hand, they provide a useful service to people who might be unaware of the dangers of the exotic places they plan to visit. It’s a place for sensible counseling:
Don’t eat street food! Don’t play with the stray dogs! Don’t swim in the Omo River!
Travel clinics offer a cornucopia of vaccines — yellow fever, typhoid, hepatitis A, rabies. A good travel doctor or nurse — optimally an experienced and enthusiastic traveler themselves — really knows the risk of Japanese encephalitis on your 3-week trip to Myanmar. They also have wise advice about malaria prophylaxis and other treatments to take along, just in case.
Plus, falling outside of many insurance plans and serving a generally well-to-do crowd, travel clinic is one of the few places ID doctors generate revenue in the outpatient setting. These money-makers are so few and far between for us that it’s hard to pass them up.
We have an active travel clinic, and the patients are really happy to have this convenient, one-stop service. They love it! And our travel clinic providers are great. Demand is sky-high, showing a reassuring return to pre-pandemic travel.
All good so far.
On the other hand, travel clinics sometimes cater to the worried well, offering dubious value if the destination is simply a long trip, the planned activities not so risky. Does the business traveler to Bangkok or Johannesburg, the honeymooner to Fiji, or the tennis enthusiast going to a resort outside of Buenos Aires really need to go to a travel clinic before their trips? Of course not, yet I’ve seen all of these examples come through our doors.
Additionally, the education component can paradoxically make the worried traveler feel worse. A recently retired ID doctor here in New England regularly did travel clinic at his hospital, but so hated to travel himself that he sometimes bluntly told his patients — “Look, if it were me, I wouldn’t go.” No doubt he was responsible for a high volume of canceled first-class airfares.
Last, some of the people who really need travel clinics can’t access them because, as mentioned, insurance often doesn’t cover it. This creates a two-class level of care analogous to traveling business vs. coach, but since it involves healthcare, is far more disquieting.
Travel clinics are on my mind because I recently had the distinct pleasure of reconnecting with a college friend, Mike Reiss. Professionally a comedy writer (he’s one of the original writers for The Simpsons, among other credits), Mike loves to travel.
Or more accurately, Mike’s wife Denise loves to travel, and Mike is totally smitten with Denise and will do whatever she wants.
Let me emphasize that “loves to travel” barely begins to describe their enthusiasm. They’ve now logged well over 100 countries, travel regularly to places you have not been (trust me on this one), and have had some remarkable experiences — many of which Mike details in his podcast, What Am I Doing Here?, which I highly recommend.
Mike chatted with me recently, and our conversation is incredibly funny — that’s because everything Mike talks about is incredibly funny! Listen here at the bottom of this post, or wherever you get your podcasts. You won’t want to miss it. His travel history reads like a parody of an ID certification exam question.
And Mike, here’s some friendly advice — if you don’t want to go to a travel clinic, here are the big three I’d recommend for a traveler like you, easy stuff you can get from your primary care doctor:
- Get the hepatitis A vaccine. Two shots, you’re good for a lifetime.
- Take some azithromycin with you in case of traveler’s diarrhea.
- If you’re going to a malaria hotspot, take malaria prophylaxis.
Even better, check out the CDC’s travel web site. I use it all the time.