By Deborah Bickel
A friend called me after seeing her long-term physician. At 70 years old, she is seldom ill but recently has been short of breath and fatigued enough to stop her daily long walks. She’s been going to the same likable English-speaking physician for routine care with no complaints. I asked my friend to tell me about her doctor’s diagnosis and his plans for testing, but what followed was a deafening silence. With five unexplained and indecipherable prescriptions to fill and laboratory orders to be presented at an address not given to her, she was lost.
In Mexico, the experience of leaving a doctor’s visit with far too many new prescriptions and little understanding of what the physician is thinking is a common experience for well-educated expatriate baby boomers who are otherwise likely to question authority. I think this reflects significant differences between north-of-the-border and Mexican medical cultures.
The seismic changes over the last 30 or more years in medical care and its associated culture north of the border have been slow to penetrate below the border. Physicians in the north are under tremendous economic pressure to see more patients in fewer hours and order ever more “screening” and diagnostic tests to protect themselves against any poor outcome. With that comes the need to “educate” the patient, which often takes the form of lengthy diagnostic explanations that patients are poorly prepared to understand. As the testing is very costly and often only reveals what the problem “is not,” the physician is in the awkward position of needing to enlist the patient as “an active partner” in their own care.
She is required to spend precious time with the patient to explain her thinking and get agreement for further testing and perhaps different medications. Add to this the growing complexity and expense of treatment options for her boomer-and-older patients, and one begins to understand the American medical system. Many, if not most of us above the age of sixty, reel from encounters such as these, technically mighty but often bereft of those human interactions that are known to heal.
Mexican and U.S. medical systems differ importantly in other ways, not always to a patient’s benefit. Mexican physicians in private practice are seldom obligated to chart their patient’s treatment outside the hospital, and in rural areas many keep no records at all. It’s also possible that your Mexican M.D.’s income is augmented by referral fees paid out by laboratories, pharmacies, and diagnostic centers. While this practice may enable inexpensive office and home visits, it may come with a degree of lost objectivity.
Still, in small towns such as San Miguel and throughout most of Mexico, medical care remains consistently personal. Physicians are available and approachable in ways that are simply not possible in the north. For instance, home visits for those too ill or too fragile to venture out are the norm, not the exception.
So, medical systems everywhere have their pros and cons. Our adopted culture relies less on technology and that’s not always a bad thing. After all, who doesn’t benefit and indeed heal simply by seeing a physician who cultivates the art of careful listening?
Follow this column for more information that can help you improve your medical experience in Mexico as well as help you better coordinate care here with that in the north.
*Contribution from Deborah Bickel, PA MPH, Bewellsanmiguel.com patient advocacy services for the community of San Miguel de Allende. Deborah lives full-time in San Miguel de Allende and has practiced medicine as a physician assistant in the United States as well as many countries in Latin America and Africa. She trained at Stanford University Medical School and has a master’s in Public Health from UC-Berkeley.
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