A Bit of Health Care

Joel had a lump on his neck that we thought should be looked at to be sure it wasn’t anything to worry about. I started by calling Mae Lewis Hospital to find a doctor we knew from when she gave Joel’s mother outstanding care. The receptionist routed me to her secretary who gave me a phone number to call. Who’s phone number is this? The doctor’s number.

I call, and the doctor herself answers! Sure, she would be happy to help but she is on vacation until January 20th. I could hardly believe it. The doctor answers her own calls even when she is on vacation?! Never, ever in the US did I have a doctor’s cell phone number, and I was a nurse for decades. We had to call the office, give a message to the secretary who would pass it off to the office nurse, and eventually we’d get a call back with the answer. After hours we called the answering service and hope to get the doctor, not someone covering who didn’t know the patient. But here, some unknown person asks for an appointment and gets sent directly to the doctor herself. I was totally amazed!

But, we didn’t want to wait a month, so we went to Hospital Chiriqui to find the doctor they originally sent us to when Joel needed the document for his drivers license. His secretary wrote his cell phone number for us so we could contact him for an appointment. But wait, the other doctor could come in right now if we prefer. Before I could say anything the secretary was dialing his number with her cell phone, which she handed to me. His wife/secretary says they have a repairman at the house but if I don’t mind waiting, they will come in as soon as he is finished. I ask if tomorrow would be easier, and we decide on 10am. This is the same doctor who did the drivers license document Errands and Renewing the Driver’s License I wasn’t impressed but I figured we’d see him again and see how it went.

We arrive at the appointed time and wait while he attends to a person before us, and then we are ushered into his office. He looks at Joel’s neck and carefully feels everything, and then says he doesn’t think it’s anything to worry about but he wants to do an ultrasound to be sure. We were instructed to go to the public hospital at 7:15 am Thursday morning. He writes his name, office number and some other basic info on a piece of paper and carefully explains to me where to go and who to ask for help in finding the right building. We give him $50 (which includes the upcoming ultrasound) and he adds it to the other cash on his desk.

This is our first experience with the public hospital system and the huge medical complex on the west side of town. We show the paper to a security guard who directs us to the first of the three tall and identical new buildings and tells us the entrance is in the front. We go in and are met by a lady in a blue vest who looks at our paper and directs us to the first floor (which for us who count the ground floor as first, would be the second floor). When we arrive we are greeted by another lady in a blue vest who directs us to sit in a waiting area full of chairs.

It was interesting to see how things work here. A nurse would come to the waiting area from one of the hallways and ask for anyone who is waiting to see Dr. (whoever). A handful of people would approach her and she would write down their names. We also saw nurses going to the reception/office area in the front to pick up folders of what must have been medical records. Then, the nurses started calling patients one by one and taking them back down the hallways. Our doctor came out himself and told us he was seeing one man and then he would be back for us.

Everything was white and new looking, no pictures on the walls, no colors, but totally comfortable and functional. There were huge windows behind us looking on to the parking area and the sun was streaming in. The doctor’s office was the same, all white, a small desk and one chair inside, and then behind that a slightly bigger room with a large window, an exam table and the ultrasound machine. He carefully scanned Joel’s whole neck and snapped some pictures so he could show Joel was he was seeing on the scans. There was a large, dark thing that looked like a round bubble. He explained that it was a fluid filled cyst. There are no 100% guarantees in medicine but he was quite sure it was nothing dangerous. He could surgically remove it (though it might come back), drain the fluid with a needle (hard to do with the thick fluid and it would likely refill itself) and or just leave it alone. Joel opted to just leave it alone.

Throughout our time the doctor was extremely gentle and careful with Joel, especially getting him up off the table and making sure he wasn’t dizzy. He carefully explained everything to me in detail and made sure I understood what he was saying (he speaks very little English, and Joel very little Spanish so I was the go between). Both of us were very happy with the care and the health system in general.

The biggest differences I see between here and the US is the relaxed and caring attitude. I’m not saying US doctors aren’t caring, but they are stressed and very busy and have to keep the line moving and the money coming in to cover their multitude of expenses. Here you feel like you have the doctor’s time and attention for however long it takes to be sure you have everything you need. The other big difference I see is the lack of CYA paperwork and questions. The doctor focuses on the problem you bring to him, and it’s your responsibility to tell him anything else he needs to know. He only asked Joel his age, nothing about medications or other health problems (thankfully there are none). I imagine he saved Joel’s basic info and scan pictures in his laptop, but there was no paperwork.

People pay into the public health care system here and I have no experience with that, but I imagine it’s uncomplicated. And, judging by the folders being picked up, I imagine people with ongoing care have records with their information and history. I do know first hand that doctors in the US have piles of paperwork and staff who’s whole job is submitting claims to insurance and Medicare and jumping through hoops trying to get paid. Ugh. Myself, by the time I retired from home health, I was spending 50% of my time at my desk, not with patients, and we had a whole office staff who did nothing but paperwork and office work. If everything wasn’t exactly perfect they would deny the whole case, and appeals took many months. If we didn’t get paid we couldn’t keep the doors open and provide care for anyone. It felt like a smaller and smaller amount of care and time was going to the patients because we were so focused on paperwork. I worked for one company that was totally computerized and another that was totally paper, and they both took the same amount of desk time so computerization didn’t seem to help. I am very thankful to be away from all that both as a nurse and a consumer. It’s such peace of mind to know that care here is so accessible and affordable, and given with such heart as if you were a family member. Thank you Panama.