Mexican medical patient

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I had my first brush w/the Mexican medical system as a patient this last week. Although this is somewhat personal, I’ll say that I was diagnosed with iron deficiency (microcytic/hypochromic) anemia a few months before I left for Mexico. The doctor I saw in Texas put me on iron pills, but it was pretty apparent that not much progress was being made by the time I left. This is something of concern, as men my age rarely have this kind of anemia. It can pretty much be one of two major causes before you start scratching your head and looking for the extremes: 1) malabsorption of iron and/or dietary deficiency or 2) a GI bleed somewhere. The former is not likely, since this is recent problem and my diet hasn’t changed. However, I don’t know for sure.

I met this doctor through someone at school who is a grad from UAG and teaches a few courses here. I know he can’t be that old just by looking at him, but many students in Mexico start med school at 17-18, so who knows. I made appointment to see him in his consultorio. After a bit of getting lost and searching around, I find his place. I had the description, address, color, etc. but I think I would have still missed it if I hadn’t seen him outside, because I would have mistaken it for a shack. I parked across the street, and entered a room covered only by a curtain (and a gate, but that was open) to the outside, no bigger than my bedroom. In this patient room was his desk, a patient table, a filing cabinet, and a small stand where some rudimentary medical tools, injections, etc. were stored. The bed and a few other things were draped in blue cloth.

Now when I was deciding whether or not I wanted to go to med school for real, I logged quite a bit of time with my friend and mentor who is a surgeon, both in the OR and in his office seeing pre/post-op patients. At least at that hospital, blue meant sterile (perhaps others use green). As a med-student larva circulating around the OR with the nurse, it was made very clear: don’t touch anything blue! I had a small flashback to that as I sat there, knowing very well that there was nothing sterile about the cloth on the bed or anywhere else.

He took my vitals, I made a joke about IPM (our pre-clinics course where we learn the basics of physical exams) as he was checking my ears, etc. knowing he had to do the exact same thing I was doing when he went to school. He reviewed my labs which I brought and basically told me what I already knew and that we needed to start with new, current labs. I agreed. He wrote out a script for the labwork, and he commented that here in Mexico, they don’t order “panels” like the US; rather, every specific test is spelled out explicitly. All in all, we spent 40 minutes or so talking, explaining things both about my situation and about medicine in Mexico in general. I won’t tell you what the bill was, but even taking into account that I know he was giving me a discount from being both a friend’s referral and knowing that I’m a student, it was so low I was embarassed not to give him more but I didn’t want to insult his generosity. I realized then what a different planet I’m on with respect to medicine here.

One could have easily been put off (I sure was!) by the ramshackled exterior of the building, the slummy neighborhood, the lack of polish and glitz that Americans almost make synonymous with physicians (doctor = money). Before I walked in, I was introduced to a friend of his who is also a doctor (who also teaches at UAG, because I’ve had her for IPM), and she was just sitting there on the street yacking it up with my doctor’s brother, who runs the pharmacy next door (also a closet-sized operation). It was 6:15 or so when I got there and almost 7:00 when I was getting ready to leave, and she was still there. It’s not that they are lazy or don’t want to make a buck or are so horrible that they don’t have business–it’s just a plain simple truth that life, even in medicine, is just slower here. A doctor here is almost like any other working stiff–highly specialized and respected, but there is no managed care to drive them to ever-increasing volume, no malignant, litigious environment to cause them to refer to 3 other doctors and run $1000s of dollars worth of tests just to cover their asses. It’s also why so many doctors do what these do and just teach for some steady money, seeing patients during off hours or working shifts at hospitals. It’s totally customary that if a doctor wants a few hours off, they don’t schedule anything and they go do what they want to do. This obviously wouldn’t work for a surgeon or for someone who is actively working a shift at the hospital, but for private, degree-on-shingle-type general doctors, they just make their own lives as best as they can. Only the most sought-after grads get jobs with the government hospitals because it’s a steady check, even if you have to work harder. It’s completely the opposite in the US. It’s neat and depressing all at the same time, because you think, “You can do more than this,” to which a lot of them would reply, “Why?” It’s just a fundamental clash of core values as to how one defines “success.” That difference in the value of time is also what allows doctors here to be truly counselors to their patients, not having to mill them at 5 minutes a consult. Their time may be worth less by comparison to US physicians, but the people here are the beneficiaries of it. The lack of electricity with Hurricane Katrina forced many physicians to delve back to their roots, diagnosing in its purest form, without the need for an MRI/CT/etc. to back up their assessments. Here, the kind of hands-on diagnosing is the norm, with specialized tests only given when necessary or when traditional methods fail.

As for me, I’m trying to figure out how I’m going to get my labs done, fasting, when I have to be at school at 8am every day and lots of labs don’t open until 7-8a. I went to one lab and they wanted $120USD for the tests, I told them I could get cheaper elsewhere, and I can. The problem is the university hospital is a ways away, but I’ll figure it out. Unless something radical changes, I’ll probably have a date with an endoscope in my near future. That will certainly deserve another post.