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To get a full appreciation of how easy it was, and how much my experience contrasted with most U.S. hospitals, let me recount the process.

As Easy as 1, 2, 3

I showed up at the private hospital emergency room at 10:30 P.M. on a Sunday night with no advance notice. The Kiwi had swimmer’s ear and needed to get it drained prior to his flight, and I wanted to cover the costs of the trip at the same time. The easiest option: take MRIs of all joints with residual pain from sports injuries.

I asked The Kiwi’s doctor if I could have MRIs taken, and she informed me that I needed to speak with a supervisor, whom she called in. The list price was $600 per MRI. I asked for her best volume discount for five MRIs: she responded with $2,400. I told her I would pay in cash (credit card) instead of insurance if she could do $2,800 for seven MRIs, or $400 per MRI. She agreed. The entire transaction was cordial and pleasant.

The supervisor authorized the MRIs in five minutes and had a car service sent to pick up technician Edwin, who was at home, and bring him to the hospital. I would not be charged for the pickup. The doctors, realizing we had some time to wait, invited me to sit down with them and share their favorite indigenous fruit, called jocote (Red Mombin), which I’d never tasted.

I then asked them what else I could do to fill the remaining 60 minutes of time. Urinalysis? Blood tests? Two doctors pulled out a list of tests I could order and we went through them together, ticking off 25 boxes I wanted, as well as a few the doctors suggested as often-neglected but important. They priced out each item for me, I had blood drawn 10 minutes later, and they promised results from the lab within three hours. Three hours?! This amazed me, as I usually wait seven to ten days for blood test results in the United States.

Then I remembered: I was in the ER. It was a far cry from the UCSF Parnassus equivalent, where I’d once been chastised by a doctor because I looked at my own chart after waiting for more than three hours in an empty room: “That’s property of UCSF. Patients aren’t allowed to look at charts. Give it to me.”

This spotless and friendly environment in Nicaragua felt so much like a private club that I’d forgotten I was in an ER. I was the only person there.

Edwin came in, we completed the MRIs, and, at his insistence, we then took several X-rays for reference images, which I was not charged for. He handed me all of the images and showed me back to the front desk, where I had my blood test, urinalysis reports, and a glass of water waiting for me. The supervisor explained that there were few cabs at this late hour—around 3:00 A.M.—so she ordered a car service, at the hospital’s expense, to take me back to my hotel.

She gave me a hug and wished me safe travels.

Back in the U.S., when I began to reverse more injuries with the help of MDs (the last chapter), the MRIs from Nicaragua were invaluable. Each saved me expensive imaging orders, as well as guesswork that would have led to weeks of inappropriate therapies. Sadly, the 11-minute visit average per patient in the United States produces a lot of mistakes, but most MDs will not order just-in-case images to prevent them. Why? Because, as a clinic or doctor, ordering a lot of images increases the likelihood of being audited by insurance companies. In my case, if a hasty diagnosis was made in 11 minutes, I was now able to pull MRIs out of my bag and say, “Let’s make sure, shall we?”

This, I believe, is a very prudent thing to do.

Putting off those white sand beaches you’ve fantasized about? Consider treating yourself to some relaxation and defraying the costs with a visit to a clinic or two.

You might even get some tasty jocote.

TOOLS AND TRICKS

Patients Beyond Borders by Josef Woodman (www.fourhourbody.com/woodman) The most comprehensive print guide to medical tourism. This 400+-page book contains 40 of the top medical travel destinations, lists hundreds of hospitals around the world, and has an index that