Health Care that Works

Last Saturday I visited my dermatologist to have a few troublesome spots frozen on my head. Such is the downside of my grooming choice. If you've never had this done it's a simple procedure with liquid nitrogen in an aerosol container that removes possible pre-cancerous areas before they have a chance to become problematic.

There was no charge for this service. Why? Because I had paid for my office visit earlier in the week at his other facility and this was included. Let me explain how the medical system for normal situations works here, and as I do compare/contrast with your personal experiences.

When we want to visit a doctor we call him on his cell phone to find out when he will be in his office. That's right, his personal cell phone. You can already guess this story is going to be interesting.

The doctor says he will be in the office after 3 this afternoon and asks you to come then. Come today? This afternoon? Really? You never have an actual "appointment." You just show up and wait your turn (if you want to be first you can always get there before the doctor arrives, which is often sometime after when he told you to come).

There's a lady at a desk who coordinates the traffic flow of patients for all the doctors on the floor. You tell her who you're there to see, she writes your name down and asks you if you're there for a consultation or followup. If it's a consultation, the fee is $25; if a followup, it's free. Then she either gives you a piece of paper with a number on it signifying your turn or she periodically takes the list to the doctor.

Cynthia didn't know any of this her first time out. When she happily located the correct building and office she bypassed the people curiously sitting in chairs along the hallway and burst through the door. Oops. A classic, "Toto, we're not in Kansas anymore" moment. Right inside said door the doctor was at his desk interviewing a patient. You see, here the doctor's office is truly an "office"--no waiting area (it's the hallway with the chairs), no receptionist (that was the lady when you got off the elevator), and no staff. Just a desk and chairs with an examining room in the rear.

Embarrassed, she closed the door and took a seat in the hallway with the others. But wait a minute--where was the dreaded clipboard? You never go to a doctor without filling out sheet after sheet of personal information and medical history, do you? No clipboards, amigos. The physician simply wants to know why you are there and what he can do for you. If he needs other information he asks.

You have your visit. If you need medication he writes it out for you. Not because you actually need a prescription--almost any drug can be bought over the counter. Cheaply. For instance, a statin drug I take costs me $6.40 per month OTC. No, as a courtesy he writes everything down just so you have all the information to show the pharmacist. And you keep the paper for next time.

Once Cynthia didn't have enough money to pay for something she needed. No problem. The pharmacist just opened the box and cut off the number of pills she could pay for then. I've seen people purchase a single tablet from a full box.

Should it be necessary for you to visit a lab he'll write up the test required and tell you where to go. You show up there, get your test done immediately, pay (a nominal amount), and return to your doctor with the results that same day. In this case you get to go to the front of the line since you've already seen him once.

As I mentioned earlier, followup's for the same condition are free. That's why my second trip last weekend cost nothing. My dermatologist does consultations in one place and procedures in another. Why? Remember, regular readers, you don't ask why. What difference does it make?

Oh, and if you're really sick and can't come to the office many doctors here still make house calls. We fortunately haven't needed this service, but I think it costs $35 instead of $25. An outrage!

Overall the system, if it can even be called that, works really well. Instead of the reams of paperwork, bloated staff to handle the paperwork, delays,and exorbitant prices, health care in Cuenca, at least, is focused on good service, low costs, and simplicity.

What a concept!