How do nomads handle chronic health conditions?
February 10, 2020 10:14 AM   Subscribe

I'm looking for blogs, articles, etc. that explain how a "digital nomad" handles chronic health conditions.

This is NOT about health insurance or how to find a doctor or dentist in an urgent situation.

But say you have high blood pressure, or high cholesterol, or diabetes - how do you handle always being a "new patient", consistency of care, getting refills of your regular medication when you can only get a 6-month prescription, etc.? Assume health insurance or ability to self-pay. Domestic and international locations. No regular fixed address.

I'd prefer blogs or detailed stories from people with experience please. Thanks.
posted by Ms Vegetable to Health & Fitness (9 answers total) 7 users marked this as a favorite
The blog Legal Nomads is about one woman's decade-long journey travelling the world while working remotely. She has a whole section about illness and chronic pain she dealt with while living abroad and working.
posted by caveatz at 10:26 AM on February 10, 2020 [3 favorites]

Are you interested in my personal experience or only written articles?

(Also, huh, I should definitely write about this on my blog!)
posted by mkuhnell at 10:31 AM on February 10, 2020 [2 favorites]

Response by poster: @Mkuhnell, both, just not speculation about what-ifs.
posted by Ms Vegetable at 10:48 AM on February 10, 2020

Hmm. At least in my limited experience doing a limited form of this so far in the U.S., with residences in multiple cities, frequent travel, and a different chronic condition than those listed that nonetheless requires daily medication and fairly frequent check-ups and assessments, I've made a lot of use of my insurance's listing of in-network docs. Some of those doctor choices have been strike-outs (I chose one specialist's office with poor bedside manner and a terrible office staff, and another specialist who turned out to work with mostly geriatric populations, who hand-waved my concerns, didn't pay attention to my chart, and prescribed me a medication containing an ingredient to which I'm allergic). But for the most part it's worked out OK. I've managed to establish some good relationships with doctors in the two cities I'm in most often and done check-ups when I'm in those cities, as well as gotten referrals to new docs as needed and as possible from them. I have digital nomad friends who do something similar, scheduling doctor's appointments and checkups when they'll be in their home base. As the story in caveatz's link noted, it is useful to have a city you consider a home base for this reason.

I definitely have to be proactive in tracking the state of my condition myself to be able to provide up-to-date info to the provider I'm seeing at any given time. There's one follow-up test that I've needed to do for months that got held up at first by waiting on a transfer of records from a former provider, then by scheduling around my travel, then by the condition itself acting up in a way that precluded definitively scheduling the test. I need to follow up on that... Another follow-up test is awaiting availability of a specialist at the practice I've started going to in my current area; I wasn't able to get an appointment until the spring. One optional procedure I got estimates for would have required being in the same location for some time, in addition to some other potential inconveniences, so I decided not to consider it at this time.

It's definitely a pain when my condition acts up when I'm traveling, as it did recently. I'm fortunate that mine isn't a condition that causes a lot of pain, but rather discomfort and inconvenience.

My ex also has several chronic conditions that cause severe pain and other debilitating symptoms, which is one reason why our separation has lingered, because having my insurance has theoretically provided him with a better quality of life. We currently live in different cities, and I feel like that's probably going to be an interesting special case when it comes time for open enrollment this year (my company is distributed, with insurance choice and coverage that's based on what is listed as a home address). So that's a source of some ongoing anxiety and difficulty, to be sure.

What I don't know is exactly how this is going to go as my travels begin to include longer stays outside of the U.S., in places where U.S.–based insurance isn't accepted. I'll also be following this thread with some interest!
posted by INTJ at 11:07 AM on February 10, 2020 [3 favorites]

There are lots of online pharmacies you can have a doc send a script to and have them fill and ship it to you.

A euro friend of mine living in canada with type I diabetes just goes to walk-in clinics with her insulin script and gets refills as needed. She has also had insulin shipped.

If you're bouncing around a lot, try to circle back to your main doctors twice a year. Have them forward all records to you so you have them on hand to show to other offices you might go to.
posted by ananci at 11:48 AM on February 10, 2020 [1 favorite]

Check out e-visits - most major health systems do them now. I have a great PCP with whom I can schedule a video visit if need be following establishment of in person care, plus email and mail order pharmacy options. YMMV as it’s policy at many locations that they have to physically see you for a visit once a year, but maybe look into concierge practices which may be willing to waive this after an initial visit, or do the yearly around a visit home.
posted by OneSmartMonkey at 11:59 AM on February 10, 2020 [1 favorite]

My experience is that health care outside the US is far more centralized and standardized (with a few exceptions, hello germany and your weird obsession with homeopathy). Also medicines and treatments are often available otc. So therefore it is actually simpler as anywhere you go you'll largely receive the same treatment and meds in a standard way And of course the prices are much more transparent.

I traveled quite a bit with a friend with type 1 diabetes and he could basically just walk into any clinic or pharmacy to get supplies or treatment anywhere in the semi-developed world and would encounter a well trained person to help him. Same for things like birth control, migraine medicine etc.

The US is really only best for hospital based treatments or very medication intensive conditions imho.
posted by fshgrl at 12:04 PM on February 10, 2020 [2 favorites]

I spent 7 months living in a tiny camper and traveling around the US. I had a doctor in place in NC and I went to see him before I left - I went ahead and got the mammogram, the dermatologist check, all that kind of thing. I honestly don't know how you would do that without a home base of some sort. Getting prescriptions filled was hard. I had two monthly prescriptions and every single one was kind of a giant pain. No pharmacy would give me more than a 30 day supply, even if I was paying out of pocket, even with a prescription from my doctor in NC saying I could have three months worth. And this is a water pill for blood pressure, not, like, morphine or something. My insurance also declined to pay for anything outside North Carolina. So that was fun.

Finally I figured out that once you are established as a patient at CVS they will allow you to fill prescriptions at any CVS - with the caveat that it will take 24 to 48 hours to get them filled. That time is not counting the hour or so you will have to wait in line and then explain your situation and explain it to their supervisor and then wait for them to call and then explain it again to somebody else and then repeat all this the following day. So what I would do is find a CVS near my travel path and plan on staying near it for a couple days beginning on a Monday so I could be sure to get them filled. Seriously I did this once a month for seven months. Fortunately, I never had to go see a doctor; I can only imagine how impossible that would be. Probably the best bet would be to go to a doc in the box or minute clinic at a pharmacy or something. I got a flu shot at a Walgreens in Pasadena and that was simple even though I had to pay $40 for it.
posted by mygothlaundry at 1:07 PM on February 10, 2020 [2 favorites]

I have bipolar disorder and generalized anxiety disorder and having been a "digital nomad" for most of the past 5 years.

I have generally made sure to come back to the States (and my super-understanding doctor) every 6 months. I carry around a lot of prescription drugs, which I feel lucky that no customs people have gotten grumpy about. It's a good idea to carry a letter (on letterhead) from your doctor listing the drugs you are carrying.

We've had two stints outside the US of over 6 months. One time, I had a friend pick up my refill and bring it to me. The other time, I had my doctor write a letter and prescription and took it to a pharmacy in Europe, where they happily filled it while apologizing that they would have to charge me full price (which was less than a quarter of the US price).

Also, a lot of drugs that are prescription-only in the US are available at regular pharmacies in many countries. I know other folks who have relied on that.
posted by mkuhnell at 6:56 AM on February 11, 2020 [3 favorites]

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