How to be your own best advocate: A few simple and easy tips for improving your health care experience

By Deborah Bickel 

In my last column, I discussed some of the differences between healthcare north of the border and here in Mexico, specifically here in San Miguel. As I stressed in that column, there are many things we appreciate about healthcare here, with the doctor–patient relationship gaining the highest marks. However, difficulties arise when we begin to have more complex health complaints. 

Because physicians in private practice in Mexico often keep few notes on their patients, you, as the patient, must carry the burden of remembering what was said about a diagnosis or what testing was done, or if any treatment was recommended. This can be particularly challenging when there are multiple medical concerns. Another common but certainly not universal problem here is a tendency to prescribe more medication than physicians in the north. Mexican pharmaceutical companies produce far more combination drugs, and keeping track of the dazzling variety of names for the same drug is daunting at best. Finally, in general (and again, by no means universal), one of the most significant challenges for patients anywhere in the world is understanding what the physician is thinking and why. 

These shortcomings place a burden on you, the patient, to adapt or suffer the consequences. A recent posting to a popular group list targeting expatriate residents of San Miguel describes a patient’s experience of receiving overpriced and, more worrisome, a potentially unwarranted intervention. The patient chided herself for not questioning the physician about price or even the rationale for an urgent, overpriced intervention. If this patient, who described themselves as an experienced hospital administrator, had trouble advocating on their own behalf, you can imagine how difficult it might be for the average “civilian” to negotiate a similar situation! 

The author of the post was able to identify well-qualified specialists offering the same intervention for a fraction of the price in a nearby city. She chided herself for not doing her homework BEFORE seeking care. 

Here are some ground rules to consider well in advance of seeking any type of health services anywhere: 

• Ask those you trust for a physician they trust. 
• Prepare for your appointment by making notes about your problem. When did it start? Have you had care in the past? If you have medical records from past treatment, review them and bring them along. Have you ever had treatment related to your current complaint? Are you taking any medications for this or any other reason? 
• Consider taking a friend, family member, or patient advocate with you to an appointment to take notes during the appointment. 
• When the physician offers a diagnosis, make sure you understand the rational. 
• When prescribed, ask what each medication is for and about common side effects. If medications are particularly expensive or combine more than one drug, question the physician about cheaper non-combination formulations. 
• If diagnostic tests are ordered, especially if they carry any risk of complications or are associated with a high rate of error, make sure you know: 1) what they are for, 2) why they are needed, and 3) how much they cost.

Finally, after you leave your appointment, it’s a good idea to compare what you heard and understood with whoever accompanied you. Keep those notes on hand and accessible. They may be the only records of your care.