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Your first... travel cancellation scenario

Dr Melanie Wynne-Jones advises how to avoid potential pitfalls in this unpleasant situation

Dr Melanie Wynne-Jones advises how to avoid potential pitfalls in this unpleasant situation

Telling patients they should cancel a holiday is one of the downsides of our job; the patient is disappointed, and filling in the claim form can cause problems.

Patients don't usually consult us before booking a holiday or taking out holiday insurance, and many later claim they were not advised to declare existing illnesses or warned about exclusions that render their insurance invalid.

So if any patient asks you about possible future travel, take it seriously. Warn them to read the small print and to check what is covered. Failure to declare a quiescent condition could jeopardise a claim for an unrelated problem. However, pre-existing conditions may be excluded; Macmillan Cancer Support says that people who have had cancer are often charged higher premiums, or refused cover altogether.

Fit to travel

Your other responsibility is to advise whether patients are actually fit to travel, and this is not always easy as it depends on the nature and stability of their condition, their mode of travel, their destination, and planned activities. People with anaemia, heart or lung conditions may not cope with high altitude, strenuous holidays or even aircraft cabin pressure; a remote island is not advisable if you may need urgent care.

British Airways provides useful advice on fitness to fly for a number of conditions. If you advise a patient they are fit to travel (or not), as far as you are aware, you should document it, together with any provisos, and tell them to consult again if their medical situation changes before departure.

Last-minute plans

A common scenario is the patient who ignores longstanding symptoms such as chest pain on exertion, then consults, saying 'by the way, I'm off to Greece in two days' time'.

Assessing the risk of travel and deciding whether to advise cancellation is not easy, and you are accountable to the patient and the insurance company if you get it wrong. If patients need to make a claim, you will probably be asked to provide a medical report. The request may come as an urgent fax from somewhere exotic claiming that the patient will not be treated without it. Beware – the laws regarding disclosure of medical information apply, and consent from an unconscious, confused, intoxicated or coerced patient may not be valid.

Also, you may face the patient's anger if their claim is refused because you have disclosed something that they have not (for example, that they are waiting for an operation), or in a way that could be misinterpreted. So check that their permission to release information is valid, and that they understand the implications (ask the patient to telephone you, or contact your defence society if necessary).

Paperwork

More commonly, patients ask you to countersign their form after the event. The insurers will want to know when the holiday was booked, when the insurance was taken out, when symptoms first appeared, whether they were related to an existing or previous condition, when cancellation was advised, and whether the patient booked contrary to advice. This may involve a trawl through the practice records and hospital letters.

You may realise that the facts may not support the patient's claim, or that the patient had consulted with symptoms that appeared minor but turned out to have a serious cause. The patient could lose a lot of money if the claim is turned down, and may press you to produce a favourable report.

Point out that it is a legal document and that you have a duty to be completely truthful, although you can include extenuating circumstances. Keep a copy if you think there may be queries or repercussions.Completing these forms is often time-consuming and is not an NHS service, so you are entitled to charge for your time.

Dr Melanie Wynne-Jones is a GP trainer in Marple, Cheshire

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