Well, I saw my 3^rd rheumatologist a few days ago. Why? Because I gave up on the other two. As yall know I have Rheumatoid arthritis and Sjogren’s.   Both need to be followed regularly and since arriving in Spain Ive had more and more pain despite being pain-free for the last 15 years.

Little did I know before I got here, being seen by a doctor here means exactly that. Seen but not heard or examined for that matter. It’s like being treated as a kid in the old days when your father said kids should be “seen and not heard, and don’t speak until spoken to.” Every provider Ive seen since stepping off the plane just sits there, doesn’t smile and cuts you off after two sentences, and never gets vitals. And most importantly NEVER gets up from their desk to examine you. WTF ? Ive also seen almost no nurses except in the ER.

I read a lot of blogs and FB groups before arrival; I never saw one post of doctors never getting up from their desks. I read many a rosy blog on Spain having a low GDP and having one of the “best health cares in the world” blah blah. And how cheap it is compared to the US and their long lifespans. No one mentioned they never get up from their desks and don’t examine you. And taking vital signs is not normal either. So is that what “cheap” gets you?

How long are you gonna live if no one knows you have undiagnosed hypertension because no one has checked it in five years despite seeing a doctor multiple times? Is that what the low GDP comes from? If you do nothing you spend less?

I mean let’s face it; before you end up in a “world-class Spanish hospital” you’re usually gonna see a doc in his office first. If he never lays hands on you, nor ever takes vitals, how do they diagnose you accurately sitting six feet away? I almost asked at my last appointment if the doc will be a six-footer or a six-incher at the check-in desk. Get your mind out of the gutter, six inches means he’s close enough to examine you.

So I’m using my “private health care” insurance to the max unfortunately to find a doctor that acts like one.

First, one of the few good things I can say about the health plans here, seeing different doctors of the same specialty even if they order the same test seems to be covered.  No pre-authorization needed like in the states.  Ive seen two blood specialists in addition to two rheumatologists who ordered similar tests, again no problem, no copay. And last year I had covid and a kidney infection, so I’ve been to “urgencies” (ER’s) two times as well. And to top it off, Ive seen a dentist, an eye doctor, and two traumatologists for a strained back and hip and one general doctor for scripts. Phew Ive been around, and not in a good way.

Im glad there are no copays, but I do pay $99 a month for the insurance and 100% for my medications and one of them is $800 a month. Ouch. (I’m not eligible for public care where I would get a big discount).

Surely this no-touch doctoring can’t be everywhere here I presume. Or is it just this region? Although Ive heard similar stories from others; (ex-pats and native Spaniards) in different parts of Spain of poor care. I really do love Spain and the lifestyle, I hope I can be proven wrong by what Ive seen so far. I like the siestas and the zillion fiestas, I don’t want to give them up.

Before you judge me as a doctor shopper or a “Spain health hater” remember I’m no youngster, I didn’t pop out of a university and move here at the age of 23 to teach English to kiddos all happy-go-lucky with no aches and pains.   I’m near 60 and already came with built-in medical problems that must be addressed on a regular basis. And if I bend down too far down, I can’t always get up either. So, Ive had to tap the system here a lot. Which has given me an opportunity to see if they all act like this, at least in this region.

Either way, if a doctor never lays hand on you and diagnoses you from six feet away Im not going back because he’s either lazy, sloppy, or incompetent in my opinion. It’s just not right no matter what anyone says. Not to mention, a misdiagnosis from six feet away might cause someone to end up six feet under, and Im not going there.

So in a nutshell here is a quick breakdown of some of the nine providers Ive seen. And this doesn’t include my 5-minute cleaning at a dentist either. Oh, woe is me.

1^st rheumatologist:  unsmiling woman, no name badge, who had no interest in my history past 2 sentences.

• English speaking? yes
• Is any nurse nearby? Precheck vitals? No
• Get up from her desk and examine me? NO
• Mentioned Sjogren’s? No. She said she had no information on that. (Wtf? It’s part of rheumatology.)
• Adios, find your own way out. Visit time: 5 minutes.

2^nd rheumatologist in another larger city: He was a bit older, no name badge,  and had a five o’clock shadow.

• The visit was near identical, no interest, no engagement, never got up from his desk. Adios, come back in 6 months for labs, find your own way out.

So is this just a fluke?  Or just isolated behavior amongst rheumatologists here? Is it me? Is it the language?

No, please read on..

I went to a local clinic a few months ago about my back when I slipped and twisted it on a rock at the beach.  I went to a local modern multi-specialty clinic near my apartment and was given a “traumatologist” to see that day.  Waiting outside door number three I went in. There sat a gruff middle-aged-looking man with a bored expression and dull eyes. I could barely walk when I entered so he could see I was in pain yet he showed no emotion.

He too, sat at his desk unmoving; his exam table next to him. He never asked how I hurt my back or my history. I told him I had some sciatic pain and a steroid shot might help. He said ok and told a nurse who was at another desk beside him to give it to me.

• Did he get up from his desk? NO
• Did he examine me to see the extent of the back pain and if x-rays needed? NO
• Diagnosis? No, Just me telling him it was what I thought it might be; (sciatic caused by the fall.) Who’s the doctor here anyway?
• That was it, adios, time of visit 5 minutes, find your own way out.

Two blood doctors were also seen; (in large modern private hospitals BTW) for clarification on something found in my blood.

• 1st Dr: unkempt middle-aged, pudgy guy with no name badge and a wrinkled lab coat
• English speaking? Yes
• Got up from his desk? No
• Examined me? No
• Precheck vitals or a nurse nearby? No
• Diagnosis? “ a little disease” wtf is that?  Like a little dead or a little pregnant?
• Come back in 5 months, time of visit 7 minutes

2^nd blood Dr: young unsmiling woman who barely made eye contact. No name badge

• She too acted like the first one. Disengaged, non-caring, never got up from her desk, 5-minute visit, adios see yourself out.

So.. the saga continues… for my constant hip issues I decided I needed someone to order physical therapy or something or I’m going to a Physical therapist myself seeing how Im better at diagnosing myself than the so-called doctors.

I suspected I had bursitis as it felt like it or it was caused by my back issues from the previous fall. I decided ok, I’ll go backwards and see a small-town doc instead of going to the “modern larger clinics.” Maybe they were taught how to be real doctors and examine the patient.

Small town doctor:  elderly man on call as a “traumatologist” that day, slightly more engaged but in a hurry.

• Receptionist: was nice, said they never have a nurse if the doc wants vitals he does them himself.
• Did he get up from his desk? NO
• Examine me?  No
• Diagnosis: unknown, ordered MRI. Time of visit: 4 minutes, Adios. I limped out.

The experiment failed.

2 rheumatologists, 2 blood doctors, 2 traumatologists and a partridge in a pear tree.

I’m seriously thinking I should try a veterinarian.

Small town, big town, where oh where is a real doctor?

Seriously I’m wondering who these so-called doctors are in this so called “best healthcare in the world location.” Who trained them? U-tube? The old “operation” game?  Come on already.

They all have one common denominator:

They are all desk diagnosers.

Why is that? No one seems to know. And on top of it they don’t appear to care and want you out in 5 minutes or less. Is it money? is it just a numbers game? Are they paid by the head? It’s like they have no skin in the game. From one doctor I spoke with he said most of them work in both private and the public side to make more money. Probably because of that so-called low GDP everyone spouts off about. The less your paid the less you do. And if they all do it.. it’s like monkey see, monkey do….

So, if they don’t care should I? Unfortunately I do…especially for the weak, the vulnerable, and the elderly who need the time and the touch.

Anyway, seeing a doc here is a hassle as I ride buses and trains to see them. Then to have them spend 4. 5 minutes with me, not listen, nor examine me so they can make extra money in the private sector, makes me feel used and unimportant. Like my ex. Not that Im bitter.

Here’s what I think as if you didn’t already know: as a geriatric nurse for the past 25 years; most care as in the rest of the world will always be provided from an outpatient community clinic or private office FIRST. Not the hospital ER.

A hospital may be “world-class”, but what good is it all if the first-line providers don’t do the basics on a patient to prevent an admission?  No exam and no vital signs? Shouldn’t there be an obligation to prevent a health tragedy by doing the basics? Like OSHA makes construction workers wear hard hats?

A nurse here told me once” we don’t do vitals on everyone because it costs more, and the USA has better care and pays better salaries.” “But they say yall have one of the best health cares in the world” I said. She looked at me and laughed. That’s not good.

Ok so…there are no nurses as it costs to have them. The docs must do their own vital signs because it’s too expensive for a nurse to do it. Yet the docs I’ve seen don’t do them at all, so what is that about? Rebellion against having no nurses or just plain laziness at the expense of the patient? Whose f***ing idea was this?

So unless you pass out in front of them or have a heart attack or stroke, they don’t do vitals? Is that what it takes? “Woops, patient on the floor, call a nurse!” Oh wait, there are none. What happened doc? “I don’t know I couldn’t tell from my desk, six feet away.”

I only hope if and when I ever go to a gynecologist will he examine me? Or stand six feet away with camera on the end of a hose like plumbers use to see clogs in pipes?

Or if I see a skin doctor, what will he do? Ask if I have a mole on my back I can’t see?

Or God forbid a neurologist asks me to go find a mirror and flashlight and check my own pupils.

So before I end this with more sarcasm, the 3^rd rheumatologist was recommended from a friend of a friend in the USA. He was about 80, was a partially retired professor and a researcher, and only saw patients two days a week because he loves it.

Guess what? He never sat behind his desk. He talked and asked many things and read my history. He examined me and all my joints and gave a probable diagnosis based on facts observations and a real physical exam.

The difference?

He acted like a real doctor.

He said he is “old school” and believes in laying hands on the patient always. But in reality, when is examining the patient ever old school?

He was aware that many doctors across Spain no longer examine the patients. He agreed with my observations and expressed his own disappointment in such a practice.

You know the reason people live longer in Spain? It’s because of their lifestyle, not the healthcare. They socialize for every meal, get together constantly, walk everywhere and eat pretty darn healthy. And they often have one alcoholic drink when they eat, no binge drinking. Maybe this is why people here have a drink with almost every meal. A little alcohol cures everything.

Although it hasn’t cured my ailments no matter how much I drink.

You can dress up a hospital but will it give you better care?

Beware of desk diagnosers.

Buy your own blood pressure machine and practice the operation game.

Somewhere in Spain, hoping to never have a medical emergency…