{"id":10653,"date":"2023-04-08T05:55:01","date_gmt":"2023-04-08T09:55:01","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=10653"},"modified":"2024-06-26T07:18:30","modified_gmt":"2024-06-26T11:18:30","slug":"travel-clinics-and-a-travel-history-to-beat-all-travel-histories","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/travel-clinics-and-a-travel-history-to-beat-all-travel-histories\/2023\/04\/08\/","title":{"rendered":"Travel Clinics and a Travel History to Beat All Travel Histories"},"content":{"rendered":"

\"\"Dear All,<\/em><\/p>\n

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.<\/em><\/p>\n

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.<\/em><\/p>\n

Thanks everyone for reading, and helping me keep this a useful, supportive, and I hope educational place.<\/em><\/p>\n

Paul<\/em><\/p>\n

Confession:\u00a0 I have mixed feelings about travel\u00a0clinics.<\/p>\n

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\u2019s a place for sensible\u00a0counseling:<\/p>\n

Don\u2019t eat street food! Don\u2019t play with the stray dogs!\u00a0Don\u2019t swim in the Omo\u00a0River!<\/a><\/p><\/blockquote>\n

Travel clinics offer a cornucopia of vaccines \u2014 yellow fever, typhoid, hepatitis A, rabies. A good travel doctor or nurse \u2014 optimally an experienced and enthusiastic traveler themselves \u2014 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\u00a0case.<\/p>\n

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\u2019s hard to pass them\u00a0up.<\/p>\n

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.<\/p>\n

All good so\u00a0far.<\/p>\n

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\u2019ve seen all of these examples come through our\u00a0doors.<\/p>\n

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 \u2014 \u201cLook, if it were me, I wouldn\u2019t go.\u201d No doubt he was responsible for a high volume of canceled first-class\u00a0airfares.<\/p>\n

Last, some of the people who really need travel clinics can\u2019t access them because, as mentioned, insurance often doesn\u2019t cover it. This creates a two-class level of care analogous to traveling business vs. coach, but since it involves healthcare, is far more\u00a0disquieting.<\/p>\n

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\u2019s one of the\u00a0original writers for\u00a0The Simpsons<\/em>, among other credits<\/a>), Mike loves to\u00a0travel.<\/p>\n

Or more accurately, Mike\u2019s wife Denise loves to travel, and Mike is totally smitten with Denise and will do whatever she\u00a0wants.<\/p>\n

Let me emphasize that \u201cloves to travel\u201d barely begins to describe their enthusiasm. They\u2019ve now logged well over 100 countries, travel regularly to places you have not been (trust me on this one<\/em>), and have had some remarkable experiences \u2014 many of which Mike details in his podcast,\u00a0What Am I Doing Here?<\/a>, which I highly\u00a0recommend.<\/p>\n

Mike chatted with me recently, and our conversation is incredibly funny \u2014 that\u2019s because everything Mike talks about is incredibly funny! Listen here at the bottom of this post, or\u00a0wherever you get your podcasts.<\/a>\u00a0You won\u2019t want to miss it. His travel history reads like a parody of an ID certification exam\u00a0question.<\/p>\n

And Mike, here\u2019s some friendly advice \u2014 if you don\u2019t want to go to a travel clinic, here are the big four I\u2019d recommend for a traveler like you, easy stuff you can get from your primary care doctor:<\/p>\n

    \n
  1. Get the hepatitis A vaccine. Two shots, you\u2019re good for a lifetime.<\/li>\n
  2. Typhoid vaccine if indicated — either the shot or the pills.<\/li>\n
  3. Take some azithromycin with you in case of severe traveler\u2019s diarrhea.<\/li>\n
  4. If you\u2019re going to a malaria hotspot, take malaria prophylaxis.<\/li>\n<\/ol>\n

    Even better, check out the CDC’s travel web site.<\/a> I use it all the time.<\/p>\nhttps:\/\/www.buzzsprout.com\/2019912\/12608740-a-travel-history-to-beat-all-travel-histories.mp3<\/a><\/audio>\n","protected":false},"excerpt":{"rendered":"

    Dear All, 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 […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5,8],"tags":[],"class_list":["post-10653","post","type-post","status-publish","format-standard","hentry","category-infectious-diseases","category-patient-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/10653","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=10653"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/10653\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=10653"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=10653"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=10653"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}