Thursday, June 13, 2024

A real relationship with healthcare professionals is sadly lacking

My paternal grandmother lived to be 92 years old and was in excellent health for most of all of her long life save that last tiny sliver.

Much of this was a result of lifestyle: she was a vegetarian, had no addictions or vices, exercised regularly, and did yoga way before it was cool. Unlike many women of her generation, she had the right combination of strength, privilege, and resources to get out of an emotionally abusive marriage and had the family support to “start over” in a strong economy that provided her later with a healthy pension and good health insurance throughout nearly 30 years of retirement.

But most of all, I attribute her excellent health to a bit of hypochondria. Any little tickle in her throat, any extra few seconds of heart-pounding, any strange itch that didn’t go away after a day of cortisone cream and off to the doctor she’d go. Treatment in hand, she’d write out the instructions and follow them religiously, often setting alarms to remember to administer it exactly on time. My sister and I would roll our eyes a bit at this, but in the end, it seems she got the last laugh.

Unlike my grandmother, who really seemed to have come into her own in the 1970s U.S., the world I live in as an adult is markedly different. She had strong, employer-provided health insurance, an ample sick-day policy, and dedicated doctors that she knew by name, something that nobody I know has nowadays. In the case of an emergency, she knew exactly what hospital she’d go to and how it would be paid for.

When I get sick and don’t get better within a few days, my first stop is usually a doctor at one of the Farmacias de Ahorro, a popular pharmacy chain in which you can see a doctor for free. Obviously the doctor there is different each time. I assume they’re just as underpaid and overworked as most professionals and of course, they don’t have access to your medical history.

It’s a fair option in a pinch and certainly better than nothing, but all the medical talent in the world can’t make up for the absence of actually being familiar with the terrain they’re working on (basically, you). They don’t know you, you don’t know them. And they’re not Dr. House either who, let’s not forget, is a fictional TV character.

As a freelancer I don’t have state-sponsored insurance, and as a young(ish) healthy adult haven’t felt the need to sign up for it. My surface justification is that I can afford to be treated privately if something non-catastrophic comes up and I don’t want to clog the already overtaxed system that’s meant for those truly in need with no other options.

My just-below-the-surface one is that I don’t quite trust these institutions to give me the care I’d need, not because of inferior talent, but because they are already severely understaffed and understocked.

While private insurance could be an option, my pay — especially in Covid times — varies too greatly from month to month and most companies are loath to provide services to people that don’t have a steady (and high) regular paycheck coming in. Requirements for gaining access to steady and guaranteed private services are the same, but the benefits that most jobs provided in order to qualify for those services have been on sharp decline for decades now in both of my countries.

All this said, I’ve got it pretty good. Many people don’t even have my undesirable options and, like me, would not be quite sure what to do in the event of a true medical emergency. Even if they are covered by Mexico’s public health system, it’s even more overtaxed than usual.

The reality is that the sickest patients, in many cases, are refusing to go until they are literally already dying (for an excellent analysis of this phenomenon, see the New York Times article Id Rather Stay Home and Die” from August 10). More often than not, then, they do die there in the hospital, which becomes “evidence” to back up the suspicion that people are “doing alright” until they get to the scary hospital.

Give it some gas with alarming WhatsApp forwards with seemingly-logical but fantastical connected dots, and you’ve really got a problem of legitimacy. It’s not helped by a long list of problems at public hospitals that existed before all this started.

Like most professionals in both Mexico and the U.S., doctors are overwhelmed even when we’re not in the middle of a pandemic. There are a lot of people in need of care, and not a lot of people able to care for them.

The absence of streamlined medical care and prevention, of course, has not simply eliminated the need for medical care in an ever-increasing population. The result, now, is that fewer and fewer people actually have relationships with one single doctor or a handful of them who know them, their history, and their cases well.

Put them in a situation in which they’re very sick, scared, alone, and surrounded by stressed-to-the-max medical personnel who’ve probably slept less than three hours over the previous three days and also have never seen them before, and it’s amazing that anyone is making it out of there alive.

A real relationship with healthcare professionals is necessary to get the best care that you can. The more information they have about you, the better they can treat you. If they have no knowledge of your medical history — conditions you’ve had or currently have, allergies, whether or not you’re fully vaccinated, past surgeries, chronic conditions or even suspected chronic conditions — how can they successfully treat you?

This is exactly the type of situation a sizable portion of the population in Mexico has found themselves in: they don’t know who’s treating them, and fear and mistrust are high. The public system is by design mostly impersonal, and the private system is simply not available to many people.

My grandmother referred to and talked about “her doctor” all the time. I dream of a time when those of my generation and the ones who follow will be able to do the same. In the meantime, let’s open the ideas forum: we’re going to be rebuilding everything after this anyway. So let’s get some good systemic ideas in for how to make the institution of healthcare work the way it’s supposed to.

Sarah DeVries writes from her home in Xalapa, Veracruz.

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