Xoxo, cont.

This week was a more positive version of my previous week. Last Thursday, I had a meeting with the medical director of the program Dra. Magaly and she asked if I wanted to switched to a different Centro de Salud. I decided to stay in Xoxo since I was getting used to their system. I really appreciated how much she valued my input on my experience. Although staying at Xoxo, I switched to a preceptor who worked at a slightly slower pace allowing us to have more discussions, and the third year medical students from UABJO started their shadowing as well. I was able to help out with H&Ps as well as discuss assessment and plan. Since I did not attend the program with any of my classmates, it was nice to have the UABJO students as peers.

Third year students

My current preceptor often had families come in for obligatory check-ups due to being on Seguro Popular (the universal healthcare for low-income populations). I noticed that any patient about 13-years-old and up was given a quick, minimal eye contact statement: “If/when you have sex, you could end up with a child. So use birth control.” As expected, the patient would be extremely embarrassed by the subject matter, especially since it was being brought up in front of their parent, and would not inquire any more information. And that may explain why 5 years and 3 pregnancies later, these same patients end up having the birth control conversation all over again.

That being said, something I did appreciate is that the family doctor worked very closely with the psychologist in the same building. In fact, when I brought up my concern about the lack of communication with the patient, my preceptor told me that it is part of the patient’s appointment to rotate through a psychiatrist (and dentist!) where the patient is able to express any issues on the emotional side of their medical care. On one hand, I think this is great because there is definitely a distance between family doctors (or any doctor, really) and psychiatrist in the US. This relationship allows mental illnesses to be investigated right away and it adds one more person in your care team. On the other hand, I still believe that the person in charge of your care should be the one having the first conversation to check the patient’s understanding.

Something else I noticed more this week was the HIPAA culture—or the lack of. One differing factor, that at first did not seem that important, is that here, the doctor (or nurse, medical student…) calls the patient into the room. Which is just a miniscule difference from how the US does it where the patient waits in the room for the doctor. So why is this incredibly small difference worth mentioning? Because the patients are used to walking into the room, sometimes they would do so without being asked to. Allow me to set the scene. The doctor is in the room with a patient when another patient knocks to ask about a quick clarification on their medication, their next appointment, or sometimes something else slightly more personal. The doctor answers their questions for a minute or two, and then returns to the original patient. In other words, at some point there are two unrelated patients in the same room talking about their personal medical care. Add the open paper records to the mix, and you have an American medical student cringing in the corner (me!).

Now, at no point did I feel like the staff was disrespecting the patients’ information, but there was definitely a large departure from the heavy need of patient privacy I am used to in the US. Unlike when I brought up my questions on patient-doctor interaction, I felt like it would be a bit rude to ask about privacy laws so I looked them up instead. A quick Google search informed me that in 2010, Mexico created the Federal Law for Protection ofPersonal Data in Possession of Individuals. It seems like a law that applies to the general public more than one specific to patient privacy therefore I am not positive how exactly the latter is handled and can only speak from what I observed. It's definitely something I plan on looking more into!