Thursday, December 18, 2008

Madrid blog--Different Perspectives on Medicine

House-calls

One of my most pleasant surprises here in Madrid is the discovery of a pediatrician who not only gives you his cell phone number (that he picks up), but who will make house-calls. With four children, one of whom is in his first year of preschool, can I say what a life-saver this is.

Dr. J is probably way over-specialized to be dealing with my children's flus and sniffles (he's also a neonatologist), however, he never makes me feel bad when I call him, even one time when the school secretary sent my daughter home saying she had conjunctivitis and it turned out to be a pimple on her eyelid. I am under no illusions that tending to my progeny's medical needs has much to do with what he studied in medical school, however since the morning portion of his work is related to social-security and making the rounds of day-cares, I feel like a relative prize--something along the lines of Mrs. Pumphrey with her pampered lap dog Tricky Woo from the BBC series "All Creatures Great and Small," about a Yorkshire veterinarian in pre-war England. Or, at least someone who pays full cash fees for quick and easy work. On that note, I need to think of Christmas present to send to the nice Dr. J. to express my gratitude to him.

The Great American Medical Factory

I really like my children's pediatrician in the US, but his office, part of a multi-doctor practice, feels like Grand Central Station. He's a good doctor, very in demand. To make an appointment with him for something like an annual check-up requires a minimum of six weeks advance notice. The children have to be really sick for me to be motivated to take them in because this requires a drive to a medical building with inconvenient parking, followed by a 45 minute wait with a bunch of other snotty-nosed children. You wonder what they're there for, and hope you won't be back in the office one week later with something far worse than the original illness. The American medical visit is truly a triumph of process engineering, with its supporting army of receptionists, medical techs, lab technicians, nurses, back office accounting and insurance professionals, its shiny medical buildings, disposable paper covers for examination tables, in-house testing with immediate results and its various protocols. By the time you go through the whole experience, the doctor is the person with whom you will spend the least amount of time.

I have the television series House, especially the clinic duty segments, to thank for the uncompromising vision of exactly how our doctors must view us: an endless procession of whiny patients with the same uninteresting complaints. Every time, Dr. W patiently explains the same thing to me. "Mrs. Fleury pretend that this is 1907 and I'm here with my little black attache case. There is nothing I can do for your child: it's a virus." I reply: "Yes, but he's had this for more than two weeks and he's not getting better," to which he replies: "He probably caught a second virus." Meanwhile, he's got some urgent communication from the nurse, which, from the little I can gather, involves a diagnostic tour de force along the line of "sarcoidosis with Colonel Mustard in the Billiard Room."

First Madrid experience, in the Office of Dr. "R. G. de L."
Same flus and colds, same forty-five minute wait with snotty-nosed kids, different hours, different decor.

Before I discovered Dr. J., I used to take the children to another doctor, whose name I got out of the health insurance booklet. Dr. "R.G. de L." is the only pediatrician in our neighborhood on our private health insurance plan (everybody else they will re-imburse at 80%). His hours are from 5pm to 9:30pm. His receptionist doesn't even know how to contact him during the day, so if you can't wait until evening, your only option is to go to "Urgencias," the emergency room, which everybody here seems to visit at the drop of the hat, whether it's because they can't see their regular doctor or they don't want to go to various different labs and wait one week for the results of a strep test. In fact, none of my Madrileno friends has ever heard of a strep test. If the child has white pus in the back of their throat, the doctors assume they have a throat infection and give you antibiotics.

Dr. R.G. de L., an older and very dignified person, reminds me of my childhood pediatrician, which is to say he says the same things as Dr. W, but with the the bedside manner of a mortician. "Madam, since this is your child's first year in preschool, you might as well expect for him to have a runny nose all the way through May. The cough is a healthy mechanism because it gets rid of the mucous in the lungs. If he wasn't coughing, he'd get a bacterial infection for sure."

His office isn't in a medical building at all, but in an elegant nineteenth century residential apartment building. As for the inside of the office, it looks like something out of a period movie from 60 years ago with reproduction antique furniture and books whose publication date probably coincided with the Spanish Civil war. Exactly nothing in the place is child-friendly, from the bay windows with low handles that my 2 yr old wanted to open and pitch himself out of, to the antique looking type-writer on the floor with loads of intriguing electrical wires. Ironically the only concession to juvenile furniture---plastic Ikea kid stools, posed the biggest problem. My 2 yr old proceeded to steal them from other children. Then he discovered that it was more fun to throw them on the floor and watch their legs and tops pop off. This was before he started to climb on the adult chairs and try and pull down the oil paintings (conveniently within the enterprising child's reach) and reach for handfuls of the random pamphlets with information about aloe vera hand creams, "sexo con seso" ("sex without stupidity?") for adolescents, even though I've never seen a child older than 9 at the office, and Parkinson's disease (in a pediatrician's office?) Needless to say I spent the whole time trying to control my little American savage, cowed by the disapproving regard of the other parents and, later, Dr. R.G. de L.

The one time I did bring all 4 children to his office, it was total chaos. The children brought balloons and proceed to run around tossing them to each other, screaming and fighting. My children not only stand out because of their unruly behavior, but also because of their number. With the exception of immigrants, the average Madrileno my generation seems to have one, at most, two children. I couldn't tell if it was with pity or disapproval that Dr. R.G. de L. told me, after our first vist "Usted tiene muchos hijos" "You have lots of children." At that point, I was so exhausted and worn down, I couldn't think of anything better to say than "Pues alguien tiene que tenerlos" "Well, somebody's got to have them..."

5 comments:

Bill Pyne said...

From what you've seen so far, are American children really more rambunctious than their European peers? Or, is it just that > 1 child is more chaotic?

Marcf said...

bill,

Yes it seems we don't enforce the same discipline the US. It can be seen in the schools were people need 15 kids max and here they run at 25... the difference is discipline

Nathalie said...

Obviously not all Spanish children are perfectly well behaved, but I would say that there is a lot more of the old-fashioned "children are meant to be seen, not heard" attitude" here--in Spanish "Los ninos oyen ven y callen." As for larger families, there are particular challenges related to the age and gender breakdown (mine are relatively young and the youngest three are boys); then there is the change from a suburban American life-style to a more urban city setting, to which the children have had to adapt.

Of course, in spite of all this, some people are more successful at controlling their chiildren's public behavior than others...My hat is off to them.

Maurice Prout PhD said...

It really is true that people possess different behavior to various situations, and this must be understood when communicating with many different individuals. The level of care must also be taken into account within the different environments and situations we are placed in. The Tone Scale theory is interesting and looks like it has some great value to it; I have also been looking at some great work on human behavior by Dr. Prout, who has studied human behavior in relation to diagnosis and treatment. Obviously he looks into a particular situation, but I find this to be the most interesting as it shows humans behavior in their most fragile states and therefore a lot can be learnt for how an individual behaves towards particular diagnosis and treatments. I recommend that if you wish to further study human behavior, look into Dr. Prout’s extensive work, at www.mauriceproutphd.com for his full reference of publications and articles.

James Morgan - Puritan Financial Advisor said...

Then he discovered that it was more fun to throw them on the floor and watch their legs and tops pop off.