It probably goes without saying that the United States leads the charge in many areas, except health care. Talk with anyone outside of the States about American health care and they’ll start with a baffled, “But why?”
Unlike many Americans, I’ve been fortunate to have health insurance pretty much my entire life. I like in an area that is expensive but also allows for access to some of the best doctors and facilities in the country. At the same time, access to so much technology has also led to a more litigious approach to patient care. New Jersey is, after all, in the top five states for malpractice payouts.
Over the past few years, I’ve really struggled to find doctors that I liked: who have appointments within this lifetime, who don’t rush through the consultation, and who don’t immediately suggest prescription medication at any hint of a cough, sniffle, or ache. I tend to approach my own health from a more holistic perspective, viewing other factors like nutrition and mental health as equally important to physical wellness.
It’s been a while since I had a real one-on-one with any of my doctors and, most of the time, I avoid going to the doctor until absolutely necessary out of frustration with the experience. So after the first time, I went to the doctor in Brazil, I was completely shocked by the difference in approach.
Differences between the US and Brazil are annoyingly imperceptible to the naked eye. To set up an appointment? Call. Arrive at the doctor’s office? Sign in with the receptionist. Wait in a nondescript and mildly pleasant waiting room until the time comes. The equipment is the same; the walls, a sterile white. It all seems very familiar.
Yet while waiting for the doctor, there are very few other people in the waiting room with you. You think, “Ah, maybe this is the slow hour because the day is just starting/it’s lunch/it’s an afternoon break/they’re about to close.” The receptionist offers you a coffee, water, or tea. When the doctor comes out to meet you, she reaches out to you to introduce herself and gives you two kisses on the cheek, as if you were old friends catching up.
As you walk into her office, she doesn’t tell you to sit on the examining table, with its sticky wax paper that shifts and crumbles no matter how gently you move. Instead, she motions for you to take a seat at her desk. For fifteen minutes, you sit and talk about yourself, your health history, how you’ve been feeling, and why you’ve come to visit. She asks questions and listens to you, rather than staring away to take notes on her computer screen.
Finally, she starts to get up and says, “Let’s take a look.” The examination is quick but thorough. As she looks, she asks questions. When she’s finished, she calls you back to her desk for another conversation about what she found, what’s problematic, and what the potential solutions are. In my most recent visit to the dermatologist, my solutions were all over the counter, including instructions to take, quite simply, an iron vitamin.
The process is calm, thorough, and expansive. There may be just one, or two or three, doctors in one office, so there are no hoards of patients trying to get an exam in on their lunch hour. The doctor has that time just for you. There are no pharmaceutical companies lobbying for usage, so any medications that are prescribed are, once again, just for you. Malpractice is less common, so there are fewer fear-based practices and more recommendations tailored just for you (and not towards preventing legal action).
I was really surprised by the difference and it took me a few visits to various doctors to understand. Caveat: as an American in Rio with a currency conversion that works heavily in my favor, I have access to better doctors than many others. Nevertheless, even when I’ve visited more general urgent clinics, the attention I got there was much longer and more personalized than I’ve received before.
I didn’t realize how much I’d internalized so many of our medical practices in the US, even after spending years studying medical anthropology and different types of medicine around the world. While I’m still ready to be home in the US 100% of the time, I joke with Gustavo that maybe we’ll do all of our medical check-ups in the weeks that we visit his family in the future.
Yet, there is one concept that is missing from Brazil: HIPPA. I know there are very few personal boundaries here, but no one has batted an eyelash at sharing all of my medical information with Gustavo – even on the phone! It’s wild.