I am American by birth, culture and nationality, but I haven't lived there for 19 years. In 1988, chasing adventure and work, I left the states. Since then, I have lived all over the world moving every few years. Currently, I live in Singapore.All in all, I have had very good luck with the docs I have seen over the years. Of course, except for having a baby, I haven't developed any medical conditions requiring care – just the odd flu or injury etc. It has been my experience that physicians the world over are a learned and caring group. The problems seem to arise because of communication (or lack there of). Many doctors have been taught to diagnose and treat, but not explain to the patient the details of their condition. So it's up to the patient to be informed enough to ask.

Every place has its own healthcare system, with unique organizational structures and standards of care…some extremely good and easy, like Singapore, and some not so good or easy. My last assignment was a small town in Borneo (yes, the place that used to have head hunters!). There were good doctors there but it was up to me to find those that I could work and communicate with.

Over the years, I developed a system where I would go to a doctor, get a diagnosis, read about it in the Merck Manual, research the web (more recent years), then go back to the doctor and ask more questions. The system resulted not only in the expansion of my knowledge about me and my family's health, but also development of close connections to my physicians. I am sure most of them thought of me as either an overly enthusiastic patient or generally an annoyance – but I got attention!A while back I was reading an article by Barbara Morris, the author of "Put Old on Hold", where she talks about how Americans in what she calls second middle age (60, 70's and beyond) need to take an active role in their own healthcare and prevention. So, it's not just an issue for someone who moves around a lot….

It's important for each of us to be fully informed of any medical conditions that we might have, what the side effects of medications that we are prescribed might be, what allergies we have and the genetic predispositions that we might have (like a parent with diabetes or certain cancers). It's also crucial to be very candid with a new doctor about one's medical history and such.

Since I left the states 19 years ago, the American medical system has changed to "managed care". This is a system that I am not familiar with, but it looks like it requires much more patient involvement than the medical system of 20 years ago. Also, I would speculate that doctors have learned to be much more specific in explaining to patients about their care and medical conditions because of this. In my opinion, this is a good thing as patients know more they can make informed decisions and action on prevention and treatment.

I wonder, though, has the "managed care" way of doing things resulted in patient cost savings – its original intent'I recently renewed my medical insurance policy. I was given 2 pricing options for the SAME coverage. One was for people who spend the majority of their time in the U.S. or live there and the other was for people who live and spend most of their time anywhere else in the world. No kidding – the U.S. coverage was 4 times as expensive as the non-US. 4 times!!Wow…no wonder healthcare costs in the US make international news.

I will get off the soapbox now and let someone else talk. Take care of yourself and your loved ones!