Definitely an interesting account of things V. and I hope there is nothing serious wrong at the end my friend.
I think it could be, and is potentially of great value. If there is a way to navigate the system to get the maximum potential from it, and that level of care seems satisfactory, then the savings are enormous when compared to the cost of private insurance. We've never had reports on this forum from those who had truly ferretted out the details, and it's easy to get turned off by any number of things and miss the chance to truly learn what IMSS might have to offer to the savy consumer. I'm putting in the time at each stage to see how the pieces fit together. I've mentioned, before, my wife's reaction to INM (she can't stand it, so I do it all for her): ditto IMSS. She would use it only if I held her hand all the way through, and would grumble anyway. Not everyone is cut out for dealing with large, bureaucratic organizations. You've probably noticed by now my annoyingly repetitious mention of "no lines, and no waiting". But, this sort of thing is critical to being satisfied with the system. Finding the days and times when it's best to access the services is very important, so I've taken the time to observe the flow of patients at each stage in the process. When I enrolled, I was asked if I preferred the morning or evening shift: I always prefer the mornings for getting things done but my work seemed to make the evening shift more attractive. Now, I find this was a fine choice, as the demands on the system are not as high in the afternoon. I've not been there after 6 PM. It could be things start to pick up again, but I just don't know. As you have seen, there are a few steps which can be accomplished only in the mornings, even if you're an evening shift patient. _____________________
I returned, today, as requested. There were nine people in the line. When it got to be my turn, the clerk said, "I see you prefer Wednesdays". I told her that was correct. She gave me next Wednesday, at 4:30 PM. I was in and out, appointment in hand to see the surgeon at Regional General Hospital No 17, in just 12 minutes. Regional General Hospital, inside... And out.... My very first job in Cancun was teaching English to the medical residents there, on contract with the State of Quintana Roo Ministry of Health, so the place holds pleasant memories for me. Hope it still does, after I go there as a patient, myself. I would be amused if I find that my surgeon is one of my students: hope he liked the classes, if that's the case.... ______________________
Reliability, speed Some of the readers will have noticed by now that everything IMSS has told me they would do they have done, and at the time promised. This is remarkable for anyone, but more so for an enormous bureaucracy like IMSS. Had I gone to a private hospital for this the surgery it would have undoubtedly already been performed: I have sacrificed speed and convenience to see, up close, what IMSS can do. With many if not most expats "going bare" in Cancun, this experiment may provide them with some realistic expectations for what they might expect to get, for less than $500 USD in premiums per couple, per year.
I arrived at at the General Surgery Clinic of Regional General Hospital No 17 at 4:25 for my 4:30 appt and presented my "carnet", which is a small booklet in which appointments are notated for the patient. Ten minutes later the clerk reappeared and explained that I was mistaken about where I was to be, and I should report to the General Surgery Clinic of General Hosptial Zone 3, near my home. (Because I had on one other occasion been sent to the Regional Hospital, I just assumed that was where I was to go this time but, when I looked more closely at my carnet, I saw that there was no notation about the Regional Hospital in it, after all.) A arrived at the correct clinic, but 45 minutes late! Unfortunately for my experiment with using IMSS, this was going to disrupt the chance to see how efficiently they deal with appointments. They appear to be rather schedule conscious, because the first thing that happened was for the nurse handling the patient flow to ask me, in a slightly testy voice, why I was so late. I explained what I'd done and she said, "You'll have to wait for those patients who were here on time to be seen first". Fair enough, I thought, and was grateful she hadn't said I'd have to reschedule. There were four people ahead of me. A few minutes later she indicated the wait would not be long. From that time, it was about another 25 minutes before I was ushered into the surgeon's office. The surgeon turned out to be an extremely pleasant and rather handsome man of about 45 YOA, who wanted to joke around about Texas, where I'm from. He spoke to me entirely in Spanish. He commented that he liked to read Businessweek Magazine and that they said Texas GDP growth was one of the highest in the world, at this time (owing in part to the high profits oil companies are enjoying, as we all know!). He wanted to order additional lab tests, prior to the surgery, and I was given another appointment to see him, this time on the 4th of October; I then went to the lab, where they scheduled the lab tests for the 2nd of October, at 7 AM, giving themselves two days to turn this routine lab work around, just as they did before. Based on what I learned, last visit to the lab, I'll show up at around 7:45: there should be little or no waiting.
Went to the lab around 7:45 AM, there were about twelve people still waiting to be seen who had 7 AM appts, as I did. I was on my way before 8 o´clock. The person who drew the blood was a very gracious, 45 YOA man, who joked that he would need a ¨gallon¨ of blood. I asked if he might get by with less, as I was in a hurry!
Went back for my follow up appointment with the surgeon, last evening. The lab tests results were in, as promised; but, the surgeon was running late with his appointments, for some reason, and I didn't see him until over an hour after my scheduled appointment time. This represented the first time the system hadn't delivered what was promised, when promised. Following that visit, I was sent to a desk which manages the surgery schedule, where I presented the doctor's findings, and his request to schedule the surgery. They asked me to come back 10 October, at 10 AM, and noted that in my carnet. It will be interesting to see how many more steps are required to get to the O.R. for this minor surgery!
I went to the surgury clinic again on Monday. I had no appointment, but the surgeon saw me anyway, without any waiting. Because of the ordinary changes in personnel that occur, I saw a different surgeon. He examined me and said he thought that surgury wasn't now indicated, the condition which had brought me to this long process seemingly improved. I had no objection to his decision, as I agreed we could take a wait and see approach. _____________________ Having had five brief consultations with the doctors at IMSS in connection with this illness, my impression overall is that the system consumes a great deal of human resources, both of patient and staff, with its administrative demands. For example, on the staff side, the exams I've had have either been perfunctory, or non existent. Much of the time spent in the doctors' offices has been consumed by the system requirement that the doctors make extensive, typed entries on their computers. It's easy to imagine that whatever quality system they have in place requires a lot of data entry to effectuate: the problem with that is that the staff ends up serving the system, rather than the patients. On the patient side, the system consumes a lot of human resources by requiring multiple visits to get through the appointments, evaluations and Referrals required. My process, to date, involved seven trips: not everyone would be able to follow through, under these conditions. Those who design administrative processes, with lots of checks and balances, seldom fully consider the drain on resources the scheme will entail, and this seems to be the case at IMSS. I'm not done with this process yet, I want to consider to whom, within the IMSS system, I'd like to make some written comments- not suggesting improvements, necessarily, just pointing out what it has been like in certain respects from the patients' point of view. I never do this, frankly, but with so much at stake for so many, it may be worth the effort. _____________________ Several people on this forum who have used IMSS have commented about the inefficient way they make appointments for the Family Medical Units: I experienced this for the first time on Monday, when I tried to make an appointment concerning an unrelated medical condition. I was told to come back the next day, at 1:30PM. Well, I recognized that for what it was, they wanted me to participate in that free for all, cattle call, that others have reported on this forum, and I'll have none of it!...But, it made me reflect on the probable reason for them trying to impose what seems to me to be completely unreasonable requirements on sick people, just to make an appointment, of a personal appearance at the start of the shift, just to get an appointment, that shift- they probably have an incredibly high number of "no shows" at the FMUs, greatly reducing the number of people they can see, per shift, and don't feel they have the resources to do what private doctors do; that is, to call each patient to confirm that they are indeed planning to appear for their appointment, when appointments have been made in advance. I'm not giving up on IMSS, but I wanted the readers to have both the benefit of my experience, and an honest look at how it works. TBC
