snapshots of mexico, literal and figurative

Somehow I’ve managed to spend a week here without getting around to a posting, some photography, or even making it as far as el Centro (although finally made it as far as Condesa for the first time this AM).  This isn’t to say I haven’t been living the Mexican life; it’s just been inside a hospital for the most part.

While I’ve spent plenty of time down here studying public health and the medical system, until now I’ve spent relatively little time seeing the actual provision of health care in Mexico, and never in an academic setting like I am currently.  It’s been an interesting experience so far.  The hospital where I’m spending my time is a mid-sized private hospital, with essentially the same technology and capabilities as any well equipped community hospital in the US.  There is a cath lab, CT, MR, electronic charting, doctors in all major specialties, an ICU and step-down unit, a number of operating rooms, and a helipad for critical transports.  The doctors who give lectures are some of the best teachers I’ve seen anywhere.  I’ve been impressed with the knowledge base of the students I’m working with, most of whom have only just begun inpatient rotations (although it’s hard to compare directly to US students in the same situation as the medical education system is quite different).

On the other hand, while the didactic teaching is excellent, the experiential learning—at least as far as I’ve seen—seems lacking, at least compared to what I’ve come to expect in the US.  As the patients are all private, outside doctors come in, round on their patients, and make all treatment decisions.  The role of students is essentially limited to seeing 8-10 assigned patients on their own, writing basic progress notes, and instead of formulating any sort of diagnostic/treatment plan write “treatment as indicated by the patient’s doctor”.  The only feedback they seem to receive is a chiding on not working quickly enough or disapproval of their physical exam notation.  The actual process of medical decision making is left out all together, except for a pair of mornings a week when the physician in charge of education discusses an admission from the previous night’s call (which while admittedly excellent does’t seem like an adequate replacement for actual daily teaching rounds).  What’s more, the case mix seems to be more determined by the patients’ ability to pay than any real medical need—not exactly a case mix with high educational value.  Probably 75% of the patients I’ve seen in the hospital would never have been admitted to the hospital, much less kept several days.  Without exaggeration I’d say half of the patients I’ve seen have been admitted for minor bumps and bruises following car accidents of one type or another–the sort of thing patients might not even come to the hospital for in the US.

I’m looking forward to getting a change to rotate through several different services over the next 7 weeks—hopefully I’ll be spending a few weeks in both the ER and ICU in addition to the time on the general wards.  If nothing else, I’ll learn a ton of medical terminology in Spanish—who hasn’t wanted to know how to say “angiotensin-II receptor blocker”, “endoscopic retrograde cholangiopancreatography” or “amyotrophic lateral sclerosis” in Spanish?