Health Care: The Specialist

Ruyman’s lung doctor appointment was this morning at 8:30. We got there closer to 7:30 and a bunch of people were already waiting. It was overcast this morning and since government buildings are the only ones with air conditioning, I was freezing. Around 8:30, a nurse called Ruyman’s name over one of those loudspeakers they use at bus stations - the ones that garble every other word. Since Ruyman didn’t have the correct paper in hand precisely when asked, they made him wait another 30 minutes, though he found the paper two minutes after it was requested.

The pulmonologist’s office was much like the general practitioner’s from last week: desk, computer, exam table behind a curtain. Added to the room was a nurse who’s sole responsibility seemed to be to fold and stamp the paperwork spread across a large table. Apparently, they aren’t too big here on confidentiality because I could read every one of the reports she was stamping.

As before, there was no preliminary exam. Ruyman simply told the doctor he had sleep apnea and needed a new machine, as well as regular Xolair shots like he was getting in the States. The doctor took a cursory glance at Ruyman’s medical records and agreed. Ruyman’s CPAP machine arrived that evening and his shots are scheduled for Oct. 6.

I asked Ruyman about why there’s no exam at any of his doctor’s appointments. He says the doctors are a lot more trusting and will usually take you at your word. This made me wonder about prescription drug abuse, but Ruyman wasn’t aware of any problems in that area. 

What I don’t see is the curiosity you hope to find in American doctors - that need to solve the puzzle of what’s wrong with you. It could be because Ruyman is so certain of his needs that there’s no mystery left to solve. Or it could be because health care here is all about efficiency, something that surprises me because people in the States often talk about the waste that occurs in socialized systems. The real test will be when one of us goes to the doctor with an illness we can’t diagnose ourselves. Will the doctors take the time to ask questions and explore, or will we be just another cow in the meat packing plant?