On the power of explanation

It’s the same with almost anything. The first time it’s all a bit hit and miss; the next time it’s usually better. I’ve just realised what you’re thinking about. That’s probably true too, but that wasn’t where I was going. I was thinking more about the tram in Alicante as an example. I’ve ridden on the tram a few times, but it’s nearly always several months, or even years, between the rides. I knew there was a button to buy a ticket for the central zone, but I couldn’t find the damned thing amidst all the text on the machine. It turns out that it’s TAM, Tarifas Zona A Metropolitana. I'd only just worked out the system as we pulled into our destination station. I even wondered about not paying.

Years ago, I had a "neurological incident," and after a few days in hospital, I ended up going to the neurology outpatients department at Elda Hospital. The first time I turned up in the outpatients area, where they have lots of the specialist services, I thought I’d descended into the seventh circle of Hell. There were people everywhere. After a while, though, I worked out the system and, despite the hustle and bustle, I realised that it all made perfect sense.

I had to go to the ear, nose and throat (ENT) department recently. They’re in the same part of the hospital as neurology, and I’d remembered enough of the drill to be completely unfazed by the experience. I just sat down, near the appropriate door, read my book, and waited to be called, quite sure that would be the system.

Obviously, some situations are more important than others. The ticketing system for the queue at the Foreigner's Office isn't that different from the ticketing system for the delicatessen counter in the local supermarket. One, though, is essential if you wish to stay in the country legally, and the other makes for a tasty snack. It obviously helps if, like Lizarran or Wetherspoons, the organisers put up big notices to explain the system.

After my visit to the ENT people, the unpronounceable otorrinolaringología department (easier to say otorrino), I needed more tests. They said they would phone me. Nowadays, I know that great big long phone numbers aren’t some prince from Equatorial Guinea trying to steal my money, but a call from either Corte Inglés or the Health Service. I presume it's a number based on a central "switchboard" and various extensions. As I have no current dealings with the department store, the choice was easy. I used to get flustered by these calls; nowadays, I’m much better at keeping it slow and steady. I was, of course, driving when they rang, but I remained cucumber like - I asked questions: Is that 8 in the morning or the evening? When I went through a sort of confirmatory checklist with time, place, department, etc., it was the person ringing me who wasn't quite sure. "I'll ring you back with the department," she said. And she did.

So I’m there, in the specialist outpatients clinic before the cock has crowed. The gatekeeper is quite a strangely shaped woman who speaks a language that escapes me. Pointing and the odd word of comprehensible Castellano makes me plump for an information window. I wait there, I show my health card, and I’m given some bits of paper. Most of the other people have similar bits of paper. Being among a group of people all going through the same process makes it easier. I can see that the first port of call is for a blood test. As I wait, someone wearing white scrubs, leaning out of a door further down the corridor, shouts, “Anyone for cardio? You can do it in any order.” I look at my bits of paper; one has “cardiogram” written on it. The penny drops: three bits of paper, three tests.

I do my cardio, the ECG, but the conversation between the two women, as they push my results into an envelope, “We’ll let them sort that out,” isn’t that reassuring.

I go back to blood tests. I always confound blood nurses; I appear to have no veins. I can only presume that ancient ancestors lived in Transylvania and developed the feature as an anti-vampire measure. At one point, I have three medical people giving me different instructions: “Make a fist, raise your arm, tense your arm, relax.” I make the vampire joke; they grimace, but the blood eventually flows. More than once in the past, blood has been taken from the veins on my hand or between my fingers.

Last one: X-ray. I’m waiting, I'm reading. Another person in coloured scrubs asks me what my name is. Ten minutes later, she asks me if I’m waiting for an X-ray. I say yes. She asks me why I didn’t hand in my piece of paper. I could say because nobody asked me, or because that isn't the same process I've just followed in two other departments within five metres of where I am now sitting. But I don’t, and I get my X-rays easily enough.

Only once, in a medical situation, have I ever got snotty about this. In Huntingdon, in an NHS hospital at 9 p.m., I told some doctor-type, who was only speaking to me in single words, that “right” and “trousers” did not amount to instructions, and that while he may go through the same routine thirty times a day, I didn't, and he should show more respect to his patients. He needed to be a bit more Wetherspoons, a bit more Lizarran, and a lot less Alicante tram.

P.S.: I asked Microsoft Copilot to draw the picture. AI obviously has trouble with the spelling of anestesiología.

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.

On protecting my anonymity

I went to see the doctor this morning. Like all the doctors I've ever encountered, doctors in Spain make you wait. This is obviously because a doctor's time is much more valuable than mine or, indeed, yours. In truth, nowadays, nearly everyone's time is more valuable than mine in a financial sense but, as usual, I seem to be straying up a branch line.

I've been to the doctor a few times over the years in Pinoso but not to the point that it's second nature to me. I was quite decided to be decisive today. The last time I was there there was a little printed list stuck up with sellotape outside the doctors door. The appointments were arranged in 15 minute blocks. Inside the fifteen minute block there would be three names; three people had the same appointment time. I couldn't remember whether the system was first come first served or whether the list order gave the order. My decisiveness amounted to no more than asking rather than muddling through.

I was stymied on two counts. First of all there were three Britons, a couple and a single, outside my assigned door and they were people that I knew. Conversation was to be struck. The pair were in with "my" doctor before me so, until they moved, there was no hurry. They weren't sure where they were in the running order so I asked the people waiting on the plastic chairs. It was an easy conversation. I had the same time as a young woman but the system is first come first served. "It has to be that way now," said someone. "There used to be a list but the data protection act has stopped that". "Ah", said someone else. "That's why the nurse now calls people by numbers rather than names I suppose". "No matter", I said, "Spaniards like to talk". I was relieved that they sniggered rather than stringing me up by my thumbs.

I suppose that the data protection thing is to do with consent to use personal data now being clear and certain. Just because I want to see a doctor doesn't mean that I gave anyone permission to release the fact that I am there. Maybe I want to remain anonymous. Actually as I booked my appointment using an application on my phone I suppose that the list would have contravened that rule about data on a person not being used for another purpose. Maybe I should read the data protection stuff more carefully. When we visited Jumilla Castle a few weeks ago I was asked to send an email with certain details. Nothing too Edward Snowden but name, address, email and my ID number. The woman on the phone said it was for data protection. Odd though, now my data is protected they know all sorts about me whereas before they would just have known that Chris and Maggie were on their list for castle visiting.