By Miriam Drake
Having an excellent primary care physician is a key piece in your expat survival toolkit. This is a professional whom you can trust with your care, and at times with your life. If you don’t have one, I suggest you find one soon and make an appointment! Selecting a competent physician in our town is easier with the help of an R.N.
A primary care physician is a generalist, either in family medicine, general practice, or in internal medicine (specializing in general adult medicine, and commonly referred to as an internist). For children, seek a family physician or a general pediatrician. Medical training for physicians and the way health care is managed here are not what they are in the U.S. or Canada. Some things are better, others worse. Accept the differences, while keeping an eye on your health and the care you are receiving. If you are not pleased with your medical care, find another doctor with the help of your registered nurse consultant.
Do not select a physician based on the fact that he or she can speak your native language. This could lead to problems. You can always hire a translator by the hour or per day to assist you with medical appointments if your R.N. is unavailable to accompany you. And of course, you can always practice your Spanish in these settings and improve your language skills! Why not? It’s kind of fun to practice, and everyone appreciates an expat who makes the effort to learn.
For best outcomes, look for the best doctor in terms of competence and ethics, one who does not lie to his/her patients (not kidding), and make sure he or she does not practice outside the limits of training. Your R.N. will be able to assess this. There are quite a few physicians practicing medicine outside of the scope of their training here and around the world. It seems to be common practice. Use caution.
Additionally, you might find a competent, ethical doctor with whom you do not have rapport or who does not take an interest in your problems, or show respect. In this case, find someone else. When I was caring for my sick husband, I actually fired a specialist.
Within a hospital setting, it’s always helpful to have a physician with prestige among the other doctors and hospital staff who can and will go to bat for you. Do your research. Ask around. It is very likely that your R.N. knows all the doctors in town and their reputations. Ask her for her suggestions based on your medical history and current issues.
As you research the community for a primary care physician, start by determining the caliber of each doctor’s diagnostic skills. This is important. If you are considering a doctor without excellence in this department, move on to the next candidate. Other questions you might ask are: Do a large percentage of his or her patients routinely get better? Does he or she have a good reputation? Is he or she known for certain things good and bad? Look for the “dirt” on the doctor. Does he or hse spend time explaining things to patients? Does he o rshe prescribe appropriately and carefully, or does he or she overmedicate or prescribe inappropriately? Do his or her patients across the board love him? Are the specialists in his referral circle of the same caliber? If you are looking for a specialist, ask: How are his are her surgical and/or medical outcomes? Post-surgical infection rates? Do his or her patients love him? Does the hospital staff respect him o rher and follow his orders? Does he or she work well with other doctors, etc.?
In our case, we were fortunate to have a wonderful trio of doctors who took personal interest in our wellbeing and saved Fernando’s life. I will be forever grateful to these knowledgeable and caring people. Some of what happened to us was grace. The rest was good detective work on our parts. Our main general practitioner was exemplary. Her diagnostic skills were excellent, as were her prescribing skills. She genuinely cared about us and kept us safe. During each emergency room visit, I would dial her number and hand the phone to the ER doctor working with us. She would instruct these young doctors, some of whom were in training, all about the patient’s condition and what she thought needed attention. Landing in the ER without her would have been a high stakes gamble. We also had another marvelous general practitioner who had a subspecialty in microsurgery. We found him through one of his surgical patients who was recovering from a major orthopedic surgery and receiving physical therapy. This doctor had a reputation for fixing problems that other doctors created. And he did so with my husband. And lastly, the general surgeon who conducted the very complicated emergency gall bladder surgery at Moscoso. It was sheer grace that he was doing a rotation at the hospital when Fernando was wheeled in. Had it not been for him, I am not sure what would have happened. Not only did he keep my husband safe, but he was genuinely interested in his welfare.
With regard to hospitals here: A physician once told me that in our town, there is no one hospital standing above the rest in terms of quality. Where you go depends on who your doctor is and where he has privileges. Ultimately, the doctors are the ones who make the system work. Based on our experiences, I heartily agree with this statement. Direction is top down, and if the doctor is less than, so will be the outcome. So, finding the best doctors increases your likelihood of best results (survival).
Summing up, do your homework and put your detective hat on. Complete your medical history, connect with your R.N. consultant, and go to your first doctor’s appointment. And please note: Anywhere around the world, even the best doctors make mistakes, or sometimes there are things that just go wrong with the patient and there is nothing anyone can do to save him. Medicine is complicated. The body is complex and magnificent. All we can do is our best.
May you find a great primary care doctor!
Miriam Drake, M.Ed., L.M.H.C., N.C.C. has experience working in health care administration, and now is a psychotherapist in private practice serving adults via electronic media internationally. Place your order for your copy of the revised 2020 edition of “Expat Medical Emergency Preparation Manual” by writing Miriam at: firstname.lastname@example.org.