Getting good health care on both sides of the border

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 has been going to the same likable English speaking physician for very 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 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 particular disconnect is a reflection of significant differences between northern and Mexican medical cultures.

The seismic changes over the last twenty five or more years in medical care and its associated culture in the north have not penetrated into the hinterlands below the border in Mexico.  Physicians in the north are under tremendous economic pressure to see more patients 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 more often than not 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 ever so weak in human interaction that heals.
Mexican and North American medical systems differ importantly in other ways and not always to a patient’s benefit. Mexican physicians are not obligated to chart their patient’s treatment and many keep no records at all. It is also possible that your Mexican MD’s income is augmented by referral fees given by laboratories, pharmacies and diagnostic centers and while this may enable inexpensive office and home visits this practice 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, and home visits remain the rule, not the exception, when one is too ill to venture out. So, medical systems everywhere have their pros and cons. Our being part of a culture that relies less on technology is not always a bad thing. After all, who doesn’t benefit by seeing a physician who cultivates the art of careful listening?
In my next newsletter I will discuss ways to improve your medical experience in Mexico and how to better coordinate care you are receiving here with care in the north.