Recently I read Abraham Verghese's new book, Cutting for Stone, a novel in which he describes a young Indian man's growing up in Ethiopia -- actually mostly in a hospital compound--and his subsequent move to the US when he himself became a doctor. It is a wonderful, passionate book. It is also a psalm, a hymn, a prayer -- about what practicing medicine should be. Verghese's mission is the noblest: to call doctors back to their art and to their compassion.
So recently we went to our doctor in Xalapa for an annual checkup, my first in three years. In fact, my first visit to a doctor who was not an obgyn in three years. He is an internist who was trained at the University of Guadalajara. He is a warm, formal, ever so slightly authoritarian man, perhaps in his mid-forties. As is generally the case, he doesn't have an desks and rooms and counters full of assistants and accountants and nurses. He shares two receptionists with three other doctors in a minimally decorated suite of offices.
We went into his office together. Jim had seen him a number of times, I never, though I'd always accompanied Jim (translation needs). He examined each of us in the presence of the other. He took our histories. Mine is rife with people who have or who have died of heart disease or strokes. Great longevity is not so normal, though my dad's mom and one of my mom's sister made it into their nineties. He gave us physicals. He thunked my back and searched for glands and felt my thyroid. He pressed my sinuses and my belly and listened to my lungs and heart and looked at my legs and my feet and my hands. He looked into my throat and made me say "aaah" and he looked into my eyes. Then he took my blood pressure. Both arms. And listened to my heart some more. And then he said, "Your blood pressure is high. Is it always high?" I said, "No. It's usually under 120/80. It's probably just nerves." But the last time I knew what it was was three years ago. Now it was 156/94. We sat across from each other now, at his desk. "Am I so frightening?" He smiled. "I don't think I am. Does this happen often? Your blood pressure goes up when you are nervous?" I had to admit, "Not too often."
So he sent me home with instructions to have my blood pressure monitored at least three times at different times of the day and on different days. A friend lent me his blood pressure monitor. I followed the directions scrupulously. I sat quietly for five minutes, then I sat perfectly still, the monitor at just the right level. And of course I measured it many times, not just three. Surely it would go back to the low levels it had been. No luck. My blood pressure was lower than in his office, but the diastolic pressure seemed especially fond of lingering around 90. Too high for a person with my family history.
Then we went to get our lab work done in Coatepec. As usual, the lab gave us the results for us to take to the doctor. I was shocked, literally. Jim, who at times seems to me to shovel butter into his mouth by the spoonful had no cholesterol abnormality. I had not a shockingly high reading, but high enough. Not fair!
So we went back with my readings and my (sob) cholesterol results. And he carefully read them and quietly pointed them out. And took my blood pressure and listened to my heart and lungs. And he took it skillfully, by habit, holding my arm so it rested on his. And he took it twice in both arms and he listened. It wasn't a nurse or an assistant who did it.
And it was still high.
So I am taking a small bit of a diuretic, on orders not to eat any animal fat, not to eat pork (I thought it was supposed to be the lean meat!) and OF COURSE not to eat sausage and bacon and to eat only very lean beef (which is very easy to find here) and chicken sans skin and to keep salt intake low and to walk at least thirty minutes a day, and so on and so on.
I suspect he's not used to computer-savvy patients, but for all that, he pretty much jibed with what this computer-savvy patient had found out. He's not a perfect doctor, and I had questions after I left which I will ask next time. But I'm pretty sure he'll recognize me and remember my name.
So what does this have to do with Abraham Verghese? Our doctor scheduled us each for an hour for each visit. AN HOUR! We didn't take quite that long, but close. And he listened to our bodies and looked at them and touched them. He depended on his own ears for the blood pressure. He asked us questions. He thought. He related what he learned by physical exam -- by touch -- and by history with what he'd learned from the lab results. And he was, of all things, relaxed and friendly. There was no wall. He was a Verghese model of a doctor.
And what did this cost? Five hundred pesos for each of us for each visit, maybe $38 US dollars. We could go to IMSS, the Mexican health system with which we have coverage. It is also good with good doctors, like a US HMO: not today's version of an HMO in the States, but the kind we experienced in Minnesota some thirty five years ago, which was not-for profit, which was when Minnesota was considered progressive.
To have such attention from a doctor: it's worth the cost. IMSS will be there for hospital coverage. IMSS is available for a little less than half the Mexican population: all those with jobs in the formal economy. Many can also visit doctors privately as we do, if they are in that less than fifty percent of the population. And they can get private insurance, but we don't at this point feel the need to. We still haven't come close spending what we did on the monthly premiums we paid in the US, and we have come nowhere near our annual deductible, not to mention the copays.
We now have Medicare, at least Part A. We screwed up applying for Part B. I assumed that you applied for it when you applied for Social Security. But there are enrollment periods and we missed them. We will have to wait a year and pay a slightly higher premium. I can tell you the people we dealt with for our social security were not relaxed and friendly.
There is a move afoot to bring Medicare to Mexico. I think it already can be used in Canada. The US government would save itself money if that happened, and a lot of USAers would be very happy.
Here is a link to Verghese's current article in The Wall Street Journal. Read it even if you don't read his novel.
And here is a link to his website.
AND he is a correspondent at The Atlantic Monthly. His posts are definitely worth reading here.