Tips for getting better health care on both sides of the border

In my last column I discussed some of the differences between health care in the north and here in Mexico – more specifically, here in San Miguel. As I stressed in that column, there are many things we appreciate about health care here – the doctor and patient relationship gaining highest marks. The difficulties arise for many when we begin to have more complex health complaints.
Because physicians in private practice keep few clinical notes it places the burden on you, the patient, to remember what was said about a diagnosis, what testing was done and if any treatment was recommended.  This can be particularly challenging when there are multiple medical problems. Another common, but certainly not universal problem, 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) a challenge for patients is understanding what the physician is thinking and why. These shortcomings place a burden on you, the patient, to adapt or suffer the consequences.
The following are ways to improve the quality of care you receive here and in the north:
– Ask those you know and trust to recommend a physician they trust. I also offer free referrals by phone or email.
– Prepare for your appointment by making notes about your problem. When did it begin? Has it been treated in the past? Are you taking any medications for this complaint or for any other reason? If you have medical records from past treatment, review them for understanding and bring them to your appointment.  
– Consider taking a friend, family member or patient advocate with you to an appointment to serve as note-taker during the appointment.
– When the physician offers a diagnosis be certain that you understand her reasoning.
– When medications are prescribed ask what each medication is for and ask about common side effects. If medications are particularly expensive or combine more than one drug, question the physician about less expensive non-combination formulations.
– If expensive diagnostic tests are ordered make sure you know what they are for and why they are needed.  
After you leave your appointment it is 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 that day.