By Elizabeth Ziemba, President, Medical Tourism Training, Inc.

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us,…”.


The immortal words of Charles Dickens from his classic novel, A Tale of Two Cities, are relevant more than one hundred years after they were written to describe the current state of the international medical travel market. The picture painted by Dickens applies to people around the world trying to access the best type of healthcare. Dickens’ words also describe the responses of providers to the demands of delivering healthcare services in a globally competitive market.


Let me share my tale of two healthcare providers from the perspective of the patient/customer experience to demonstrate the application of those famous words.


It was the worst of times…

It was time to schedule an appointment for my annual eye examination with Dr. Manette*, the ophthalmologist who has been conducting this service for me for at least ten years. No reminder came from her office to encourage me to maintain good eye health with a regular check-up. Instead, I reminded myself, – not always the most reliable system despite my efforts to put it in my calendar every year.

Before the visit

When calling to schedule an appointment, I was informed by a recording that all non-emergency visits must be scheduled online through the provider’s website. Not a problem for me but what about for the visually impaired? Or people without access to the Internet?


Scheduling on the website was easy and I selected a date and time that was convenient for me. Shortly afterwards, I received an automated voice message on my telephone confirming the appointment and reminding me to bring my insurance card to ensure proper billing. Two more identical messages were received closer to the appointment date.


*While the experiences relayed in this article are true and my own, the names of all individuals have been changed to protect their privacy.


Too bad no messages were provided reminding me that my eyes would be dilated during the exam and that I should have sunglasses with me to protect my eyes when the visit was done. Also someone should be available to drive me home as I should not operate a vehicle with dilated pupils. Luckily I always have sunglasses with me and could walk home from the doctor’s office. What about first time patients? Or other patients who forget from visit to visit what is involved? They would be sentenced to unnecessary difficulties and possible safety issues.

Checking in for the appointment

Upon arrival at the office, I greeted the receptionist who was hiding behind a tall counter. He did not even look up at me. He asked for my insurance card which I handed over while looking at the top of his head. He wrote down some information, handed the card back without a glance, and told me to sit down. Could the initial impression be any colder?


While seated in the waiting area, I faced the eyeglass store conveniently operating on the premises so that patients could have prescriptions filled immediately and expensively, – convenience versus price. I could shop for less expensive glasses elsewhere if I wanted to invest the time. As it turned out, I didn’t need new glasses so I avoided that choice unless I wanted to indulge my vanity with something new and stylish to replace my current frames. No thank you.


The ubiquitous television was playing “informational” videos designed for captive audiences imprisoned in waiting rooms just like me. Did I want a Botox injection? It is available right now while I wait for the doctor. What am I? A patient for eye care services or a customer for unrelated treatments? Why assume that I need or want Botox? Other services and infomercials played on a loop as I continued to wait 10 minutes, 15 minutes, 20 minutes until finally my name is called. Too bad. I had planned my escape route and was set to bolt out the door in search for another ophthalmologist.

Finally, human interaction!

I was greeting by a young man dressed in scrubs wearing a name tag. He smiled at me, shook my hand (yes! human contact) and introduced himself as Charles Darnay, an ophthalmic assistant to Dr. Manette. Mr. Darnay explained that he would be preparing me for the eye examination. Charles even asked if he pronounced my name correctly and addressed me as “Ms. Ziemba” rather than by my first name or some irritating nickname that Americans are so fond of using.


He guided me into the examination room and explained each step of what he would be doing including putting in eye drops to dilate my pupils. When he was finished, he told me the doctor would be right with me, thanked me for my cooperation, and asked if I needed anything while I was waiting.


Perhaps a glass of water? Mr. Darnay was a healthcare trainer’s model for doing everything right. My spirits were lifted…


Only to be dashed by Dr. Manette who barged into the examination room without knocking, startling me. She then proceeded to mispronounce my name (for the tenth consecutive year) and when I corrected her, she ignored me and opted to call me by my first name. She parked herself at a computer screen and asked me a set of routine questions, inputting my dutiful answers, without so much as a glimpse at me.


At last she spun around on her stool and pulled in front of me, flicking lights on and off, pushing and pulling my face into position on some strange medical torture machine when there was a knock on the door. One of the other doctors burst into the room and accused Dr. Manette of not returning a call from another patient. The two of them proceeded to argue vigorously while my face was propped up in the eye machine with a light shining straight into my face. I shut my eyes and thought of my favorite beach in Barbados. After a few minutes of listening to them, I cleared my throat and Dr. Manette remembered her patient who was becoming increasingly impatient with the lack of attention.


With the examination completed, she pronounced my eyesight in good shape with no need to change my prescription lenses. I felt like a prisoner being released on parole. How did I know whether she was right or not about my eyes? I have no way of knowing about the quality of healthcare services she provides while I certainly know the quality of the patient/customer experience. It is a test of faith to believe she knows what she is doing as an ophthalmologist. Without delay, I bolted for the door.


One more obstacle before I would be set free…

Checking out and (not) paying the bill

Back to the top of the head at the reception desk.


In the crowded waiting room, the man behind the counter proceeded to loudly announce my name and then tell me I owed $35.00 as the co-payment for my glaucoma tests. What happened to patient privacy? Why not shout my social security number, date of birth, and shoe size? I told him that my visit was for my annual examination for which there is no co-payment. He informed me, in a superior tone of voice conveying the nonverbal message that I was clearly an idiot who did not understand why I had an eye examination, that I owed the co-payment.


Overcoming the urge to condemn him to a quick trip to the guillotine, I corrected him once again and stated loudly that the doctor had miscoded the visit to be able to charge a higher amount to the insurance company. He turned his back to me and informed me that he was going to send me the bill for the co-payment if I refused to pay it now. Refuse I did!

Successful escape

My solution to this disastrous patient/customer experience is to find a new ophthalmologist. I will contact several potential candidates and pay careful attention to the skills and tone of voice of the person answering the telephone. International providers will be included in the selection process as a way to compare the potential replacement doctor with an international equivalent.


Clearly this visit represents the worst of times in healthcare. Impersonal or rude interactions. Bombardment with infomercials and sales pitches. Putting reimbursement before patient care. Breach of patient privacy. Lack of information about the quality of care. What is a patient to do?


Like Dickens, two more installments will follow to describe the best of times while the third installment will explore the blurred and confusing distinction between a patient and a consumer.


“A wonderful fact to reflect upon, that every human creature is constituted to be that profound secret and mystery to every other.” – Charles Dickens, A Tale of Two Cities

Copyright © 2015 by Medical Tourism Training, Inc. Newport, Rhode Island, USA. Proprietary Information: All rights reserved. No part of thisdocument may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and recording, or by information storage and retrieval system, without written permission from Medical Tourism Training.

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Elizabeth Ziemba

Elizabeth Ziemba

President at Medical Tourism Training
With a diverse background in public health, law and business, Elizabeth brings a unique set of skills and experience to Medical Tourism Training with services including assessment tools, online and onsite training, workshops, and consulting services for governments, providers, facilitators, associations and others involved in medical travel.