Thinking Outside the Syringe:
Opportunities for Travel Health Care Practitioners Networking with other specialists in the community

Gary Podolsky, MD

Travel medicine practitioners function within their own well-defined niche within a community. And they coexist with numerous other health care professionals who also have their own well defined niches. And each specialty is becoming more sophisticated in the services they offer, making it a more complex operation.

As practitioners become more focused on their own areas of expertise, they often lose sight of the broader picture. As a result they may fail to see the many possibilities that exist for complementary benefits for their clients/patients and for themselves by understanding the objectives, strengths and needs of practitioners in other subspecialties, and how communicating and working together can be mutually beneficial.

For example, travel clinics are ideal for assessing last minute travelers needing immediate immunizations and medications. Many clinics also perform physical assessments of patients (pre-trip physicals and assessment of medical problems just prior to travel). Why not extend such services to other patient populations?

Helping surgeons. In some communities surgeons need immediate preoperative physical exams on their patients as operating room time suddenly becomes available. Travel clinic physicians may have flexibility in their schedule to accept such cases. This can only help increase access of their other services and leads to a high level of both patient and referring physician satisfaction. "When we realized that many pre-op patients were desperately seeking last minute physicals, we remembered that years earlier we observed that last minute travellers had the same issue, so we started our travel clinic. We began offering immediate preoperative physicals and found the response overwhelmingly positive. This has helped us in our slow seasons," says a manager of a large multi-specialty clinic.

College and university admission requirements. Many institutions now require pre-matriculation immunizations. Requirements may include tetanus-diphtheria, hepatitis B and meningitis vaccines, for example. Anticipating acute increases in demand (currently meningitis vaccine, for example) can help clinic clerks maintain a proper reservoir of stock and avoid shortages. Clinics may anticipate the need for appointments near the start of school terms and allow for students to have quick access.

Influenza immunization clinic. The annual flu vaccination may serve as a "gateway" vaccine allowing patient to consider other vaccines - provided the immunization is delivered professionally and explained correctly. Also many medical clinics are moving into the business setting to administer vaccines and other services to employees. According to another clinic manager, "Flushots@work became the motto of our at-work immunization program. We found that in the workplace setting people were more approachable to getting a vaccine. This suggested that immunizations were more tolerated at a familiar site than in our institution. We decided that it was important to go onsite to facilitate the acceptance of immunization with select groups."

Educating business organizations about immunizations. It recently came to the attention of a municipal hydroelectric company that many of its servicemen performing maintenance work on downtown sewers were encountering needles and syringes discarded by IV drug users. These workers were mostly involved with electric wires and their job description did not include hazardous waste exposure. The company decided to initiate a hepatitis B immunization program to deal with this unanticipated problem.

Aestheticians (cosmetologists) and body art workers are becoming aware of the need for hepatitis B immunizations because of the hazards from sharps in cosmetic settings. Similarly many restaurants are now immunizing their employees with hepatitis A vaccine to protect the employees and patrons - and also their business's reputation.

We found that by attending the trade shows of the aesthetic community (beauty salons, tattoo clinics) and the food and hospitality industry, we could inform more people who were still part of our target demographics for immunization but had been left out by traditional public health initiatives.

Reminding patients of other health services. Many young women traveling overseas will not have access to routine medical care and may miss important regular health examinations (pap tests, for example). Most travel clinics will be unable to accommodate them. However in many communities there are easily accessible facilities where women can receive such tests. Displaying a poster in the travel clinic reminding women travelers of such services will be helpful. Similarly, travel clinics can inform family practitioners and obstetricians/gynecologists that they will administer Gardasil, the new human papilloma virus vaccine. Many OBs/GYNs and GPs do not stock such vaccines. But travel clinics have the expertise to do it, even though this is not a "travel vaccine". Ditto for Zostavax, the vaccine against herpes zoster.

Here is an example of a poster we use to direct women travellers to services outside our travel clinic:

We recognize that many of you will be away from Canada for more than one year. While traveling you may not have the advantage of seeing a regular family physician. This is worrisome as cervical cancer screening with a pap test is important. By leaving the country for a long time you may delay screening. We encourage you to visit your family doctor before you go to see if you need a pap test. Our clinic does not provide this service but many do. A pap test can be done at your doctor's office, community health clinic, or nursing station in your area. We have compiled a list of such facilities for you.

If you need a Family Doctor, call… for a referral

In conclusion, these are only a few examples of how travel medicine clinics can find extra work in their area without changing the focus of their practice. As centers specializing in service they may be able to integrate new ideas into a traditional immunization practice that will also keep their clients healthy.