Saturday, June 28, 2014

Finding a Doctor (part 2)

We began our search for a pediatrician shortly after Amely bled from her ear and the insurance coverage we had sent us on a wild-goose chase. It was difficult because most of our Dominican-friend base works in education, and therefore was either covered (and content) with the teacher's insurance program or had also just left the system and were in the same situation as us. I also have ex-pat friends, but the criteria "speaks English" is not important for me - there are few English speaking pediatricians in Santiago, and just because the Americans use them, doesn't mean that they are quality.

English not being a requirement, I have a list a million miles long of what I need in a pediatrician. I am a bit ... demanding, and, because of Amely's ear problems, we wanted someone who could deal with that and not ship us out to an ENT every time there was an issue.

to be fair, this happened on vacation in the
states. but, it's clear - amely needs a doctor.
and i'm a terrible blogger because i have no
picture evidence at all of any of our
There are a number of private clinics in Santiago - the good, the bad and the ugly. The system is different than in the states - you don't go to a doctor's office. You go to a clinic, where the doctors have private consult areas, there is in-patient treatment, diagnostics areas (imaging, labs, etc...) all in one building.

After I chose the clinics that I could deal with, I started looking for suggestions. Oh, the suggestions came. I have a list 2 pages long of the the best and brightest and most dedicated doctors in the area.

And that's when I found out that it's not really the doctor's that are the problem.

Attempt #1. Highly recommended, Christ-loving, young(ish), female pediatrician in a favored clinic. Arrived at 8:30am, not really sure what this doctor's hours are. (very few doctors work on appointment schedules - it's first come, first served). The secretary is chatting away with the security guard. I stand at the desk for about five minutes before she even acknowledges our presence. She then tells me that the doctor arrives at 9am, on-the-dot, every day. At 10am, on-the-dot we were still waiting. When the doctor arrived, the secretary pushed two other patients up on the list. Amely threw up on the floor.
I actually really liked the doctor. Enough so that I was willing to try again last week. Bad idea. When I entered the waiting area, she was on her cell phone, talking to a friend and didn't acknowledge our presence at all until I scooped Amely up and carried her out... and even then it was to tell me that pregnant women shouldn't carry heavy things. No questions as to whether I had been waiting to see her doctor or not.

Attempt #2. Samil had a pretty persistent fever and was throwing up, so I grabbed my list and headed out to try a new doctor. I know that this inconsistency in their treatment is not helpful - but my kids are pretty healthy, so until we find a fit, I'm not that worried about it. The doctor from my list wasn't available in the morning, so I asked the secretary to put me on the list for the doctor who typically arrived the earliest. Unfortunately, that's how it works. No appointments. Just a list. And sometimes the doctors show up on time and sometimes they don't. This day, she didn't. I almost left - again because of secretarial crap. The doctor usually arrives at 9. By 10:30, she still wasn't in. When someone asked the secretary, she responded that "she's on her way, she had an emergency" and then stage whispered to her co-worker that the doctor was getting her nails done. So professional of the secretary to announce that. When she finally did arrive, and we were ushered into the office, I was told to turn my phone off. Weird. She was an older woman. I don't tend to like female doctors, but I really did like this doctor. She sent us for some tests to make sure there was no parasite, and when we returned in the afternoon she wrote a prescription for a BRAT diet and some pain relief. No unnecessary antibiotic (because it was a virus) and no crazy long list of meds. The secretary even called a few days later to make sure Samil was okay. (**this is probably the pediatrician we'll stick with)

Attempt #3. Not really an attempt to look for a pediatrician, but it fits - Amely got sick at school, threw up once and then threw up in the afternoon. She was fine, really, but her dad is reactionary and took her to the ER (which is a whole other post in and of itself). They took blood and pee samples and everything basically came back normal, except a very small amount of bacteria that the doctor called salmonella (eventhough on the lab result paper it just had some generic title). Even the ER doctor agreed that there was nothing wrong with her, if she wasn't still throwing up and wasn't dehydrated, she just needed to rest. HA! Until he called the pediatrician on call for permission to release her. The pediatrician insisted on coming in, and writing a prescription for anti-vomitting medicine (she threw up twice in the whole day), re-hydration whatevers (she just had an entire bag of saline), and some heartburn medicine (because she was obviously having so much reflux). I just kind of shook my head. Amalio got the medicine and the next day Amely was covered in chicken pox.

half-attempt (not really a pediatrician). Amely has a distended stomach. But only sometimes. So, after much complaining of snakes in her tummy, I researched out a pediatric-gasteroenterologist. She did a battery of lab tests - parasites and amoebas, blood disorders and pee testing, anemia - normal stuff in these parts. What I liked was that she prescribed on two papers - one, all of the tests that our insurance covers and on another the 2 tests it doesn't (a certain amoeba and a stomach bacteria). She was great, and had a gentle hand. I don't even want to tell you how much I loved her because it makes me sad that she doesn't do normal pediatric stuff. Also, nothing wrong with AMely's belly.

Attempt #4. And probably the final, disappointing craziness. There is a crazy illness going around town, and both of the kids got it in the past week. High fever, sore throat, sluggishness, and, apparently, mommy my shoulder hurts and mommy my eyeball hurts. It was Friday afternoon, of course, so I quick found a substitute for the uni and headed to the clinic. For some reason, I tried to go back to doctora number 1, but was reminded quickly of her secretary - and headed to the ER to take Amely's temperature - if she had a high enough fever, they'd run an IV of fluids and give her medicine right there. She didn't have a temperature (of course, not), so I asked for the doctor who arrives earliest for the afternoon shift. It was a male doctor, with 40 years of experience and not an ounce of bedside manner. I think he might have said hello and then proceeded to check out Amely. No questions about what might be wrong with her. She had no temperature, normal everything - except her throat was inflamed. He starts writing on his pad, checking a million boxes for lab tests ranging from her thyroid glands to parasite tests to blood typing and a sickle-cell analysis. "Um, sir? y todo eso?" Is there a reason that you're prescribing all that. Oh, it's just standard procedure. For a throat infection. Her blood type is A+ and she doesn't have sickle cell. To which he responded: "I can't trust your word on that, I need to see these recent lab results in order to know if it is true."
With that, I asked for the prescription of medicine he had written and went on our way. She was better the next day. (and then Samil got the bug). Considering that the doctor just assumed he'd be our new ped, but asked me zero questions, I wasn't too impressed.

I think we've found one (attempt #3) that I can deal with - and she takes our insurance. It only took two years - we'll see what happens.

Life on the island isn't always sunshine and rainbows - we live in a developing nation. I have received numerous emails from people asking for advice. There are forums and facebook groups and other blogs. Life here is a great, but there are some realities that are very, very different and take some time. The medical thing (and education) have been my two biggest roadblocks and that's why I'm writing about it - not because I'm a Negative Nelly trying to make you feel bad for me and my family or to convince people not to come here. I have a few more posts about medical care - like how cheap medical imaging and dentistry are - that are fairly positive.

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