10,000 steps with hardly moving

Back in April I suspected that I needed a small surgical operation so I made a doctor's appointment. It was a telephone appointment and my doctor said she needed to see me to make a diagnosis. So we met. She agreed with my self diagnosis and she referred me to a surgeon. That's how the family doctors work here in Spain. They basically act as gatekeepers, dealing only with common ailments, passing patients on for anything at all out of the ordinary. So they don't remove warts themselves, they confirm that you have a wart and send you on to someone somewhere who will remove the wart. Often the second doctor, the specialist doctor, confirms the diagnosis of the first doctor and then sets the wheels in process for whatever the next step is. You say my throat hurts, the GP sends you to the ear, nose and throat department where an ear nose and throat doctor tells you that you have polyps (if you have). You are then given another appointment somewhere where someone will cut them out (or do whatever they do with polyps). Actually you never want to need to go to see an ear, nose and throat doctor because the Spanish word for one is an otorrinolaringóloga (woman) or otorrinolaringólogo (man) which is obviously unpronounceable.

In my case I got to see the surgeon a couple of weeks later. He confirmed the GP's diagnosis and said he would schedule surgery. Something like three months later the health authority writes to me and says they are a bit backed up and that they are contracting out some surgery to private hospitals; would I like to go private? To be honest I don't care whether it's private or state. Good, bad and indifferent doctors work everywhere. Nonetheless I sign on the dotted line.

Later someone rings me from the private hospital and gives me a time to turn up for an appointment. He speaks to me in English. His instructions suggest that I'm going to be the only person at the reception. I can imagine the spotless, gleaming white building and the friendly, smiling receptionist when I walk across the silent entrance way or maybe it'll be like that Cottage Hospital where Alastair Sim uncovered the killers. Cosy with roses around the door.

The hospital in Elche is big and on an industrial estate. There are lots of entrances and lots and lots of people; not particularly gleaming and certainly not cosy. I go to a reception desk. There are three people on the desk all wearing badly tailored corporate grey suits. The man is flirting with the woman to his left. I wait. A little later I tell them who I am and that I have a 10.30. They ask me what I'm there for. The truth is that I don't really know. I was told that I'd talk to a doctor but what sort of doctor was not made clear. I try being generic - it's to talk to someone for the first time about a surgical procedure but apparently that's not enough - I suspect they do a lot of cosmetic surgery and I suppose they do want to mistakenly increase the size of my breasts. So I have to tell them what's wrong with me. Not that they care but I don't really want to share my haemorrhoids, warts, polyps or bowel cancer with someone I've only just met.

I'm sent to outpatients, consultas externas. There they ask for ID and (basically) who is going to pay. A different man in a very similar grey suit at a very similar reception desk sends me to a basement. I'm getting better at this. Before I abandon my spot in front of his desk I ask him what it is that I need to say I'm there for and what the process is when I get to where I'm going. 

"I'm here for pre-operative tests," I say (though I stumble over the Spanish pronunciation of preoperatorio).  I know I'm talking to medical types because they are dressed in white down to their super clean crocs. The blood woman takes no notice when I suggest to her where she will find a vein. After two failed attempts she says "Left hand side you say?". I don't think she understands my joke about personal anti vampire measures either. I'm sent to another room with another woman in white. I ask the woman why I'm getting an ECG. "Your name is Roy something or other?," she asks. When I deny being Roy she pulls all the sticky pads off me and sends me back to reception. I ask which reception.

It's the same man. "Hello again," I say, "where now?". "You're going to speak to a surgeon, wait outside consult room 20, they will call you". The quality of information is improving.

The surgeon takes as long to make her diagnosis as my GP did, as long as the state health service surgeon did, that's two or three seconds. She asks me the same questions too. She gives me a date in November. Not exactly a week tomorrow then. "You'll need to speak to the anaesthetist" says the surgeon, "Go back to reception and make an appointment".

The grey suit and I are nearly old friends now. "The surgeon says I'm to make an appointment with the anaesthetist". "Is this the date of the operation?," asks the man in the grey suit, pointing to the 15/11 scrawled on the top of the information sheet that warns me of the multiple ways I might die or be forever maimed under the surgeon's knife. "Yes", is my quick witted return. It must be the first time he's ever seen that sort of paperwork. "Our booking system doesn't stretch that far into the future. Give us a call in late October and we'll give you an appointment then".

So that's my first taste of private medicine and I can't say that I noticed any difference to the public health systems I'm more used to. The first encounter is always chaotic but you get there in the end and, the second time, you know just a little bit more about where to go and what to do. You can spot the people with chronic health conditions in hospitals, they're the only ones, staff aside, who look confident about where they are going.

Doctoring up

I don't go to doctors much. I don't particularly care for them. Nice enough people I'm sure but I often find that I feel unwell when I talk to them. My habitual worry is that they will tell me that I'm worse than even I imagined. I've been feeling a bit rough recently. Rough enough to go to the doctor. Of course getting to see a doctor at the moment isn't the usual process. The normal routine involves a few key taps on a phone application and then sitting around in a health centre for a long time after your supposed appointment. Not at the moment though, the app only offers phone consultations, so I booked one up. 

I think phone appointments with medical people are a good idea. Nobody has to travel, probably the doctors can deal with more people than usual in the same time and, to be honest, I see no reason why the conversational exchange that leads to a diagnosis shouldn't work just as well over the phone as in person. If a show and tell is needed then at worst talking to a doctor on the phone is an efficient triage system. The problem, for me is that doctors in Spain often speak Spanish. Phone calls, unlike face to face, offer no explanatory gestures, no pointing, no visual examples and no word negotiation. All you're left with is the spoken word. 

The doctor didn't ring at the agreed time. In fact she was 80 minutes late and I'd half given up on her. Fortunately I wasn't naked in the shower or half way up a ladder when she rang but I was raking leaves. Now forty years of sucking down cigar smoke have taken a toll on my lungs and, sometimes, I find myself panting and gasping for breath after the least exertion. Leaf raking must count as exertion because the first twenty seconds of the call didn't go well. Being unable to breathe is detrimental to dialogue. Respiration resumed the call went well. As a process it went well that is. Outcome wise I'm not so sure. Having dismissed the possibility that I may be at all ill she suggested over the counter medicine. All a bit of an anti climax really.