What healthcare looks like when you live in four cities

You're in a hospital in a city where you don't live, and someone asks what you're taking. You get four of the five. The fifth one you can picture — small, oval, white — and that's as far as you get.

Elite Traveler recently gave this person a name: the "Betweener," living across three, four, sometimes six homes, packing almost nothing because a version of their life is already waiting in each city. Everything duplicates except the one thing you can't buy twice.

Start with what it costs to get your own file. In the US, a provider has 30 days to hand over your records after you ask, and is allowed one 30-day extension on top of that. Two months, legally, for a document about you. Texas gives providers 15 business days; most states just take the federal ceiling.

Which is why everyone tries to skip the process and email the scans instead. A CT study runs into tens of gigabytes across a thousand-plus images. Gmail stops you at 25 megabytes. That gap is how people end up photographing a printed summary with their phone and handing it to a foreign hospital as a medical history.

A doctor in every city doesn't close it either. A US concierge membership runs $1,500 to $15,000 a year and buys a physician who picks up the phone. It does not buy a physician in Milan who can see last year's MRI.

Europe has already tried to fix one piece of this, and the attempt is worth looking at. Anyone who receives a joint replacement or similar implant in the EU is legally handed an implant card listing the device name and model, its serial and lot number, a scannable UDI barcode, the manufacturer's address, the implanting hospital, and the date — everything a surgeon in another country would need to know what is actually inside you.

It is, in other words, a piece of cardboard the size of a credit card. In a drawer. In one of the four homes.

This stays theoretical until a Tuesday night somewhere unfamiliar, when a doctor who has never met you decides what is safe to put in your arm using only what you can remember under fluorescent light.

It also isn't only a four-homes problem. Six months in one country and six in another does it. A job that relocates you every quarter does it. So does moving once, at sixty, somewhere warmer.

Three things worth doing while nothing is wrong:

• Get your imaging as files — the actual DICOM data, on a drive or in a folder you control. A portal login belongs to the clinic, and clinics close, merge and change systems.
• Write the medication list with doses, and the allergy list with reactions. "Penicillin" tells a stranger very little. "Penicillin — anaphylaxis, 2019" changes what they reach for.
• Photograph the implant card, both sides, the day it is handed to you.

The point of a Private Health Passport is that the answer to "what are you taking" stops depending on what you can recall at the time.