Hubris

Senior Citizen from Mexico is brought in by a relative, accompanied by CT scans, ultrasound reports and the announcement “(loved one) needs a surgery”.

Well, this was worked up in Mexico, didn’t they want to do the surgery there?

“Yes, but they said there were only two doctors in Mexico who do this surgery, and, they wanted money. (Loved one) has Medicare, so here it is free.”

At this point, I’m thinking “we’re suckers”. And then, as I had to do a history through an interpreter, came this from the family member:

“You should learn to speak Spanish”.

So, they came for the free medical care, and I got some free advice.

I want to scream. The bile is back. Vacation is history.


Comments

  1. Oh Good Lord….I’m sorry you had to go through that! I do speak Spanish although my medical Spanish sucks. They never taught me how to say things like, “micropreemie, retinopathy, ventilator, diaper changing” and a whole host of other useful terms when I was growing up! Gee, I wonder why not… LOL

    I recently admitted a micropreemie to a family where one parent speaks English and Spanish (Spanish is primary) and the other parent speaks only Spanish. They love me because I will talk to the Spanish speaking only parent in Spanish when I can…but I talk to them in English when they are together because I can say more.

    I had to roll my eyes at the request that I only speak to the baby in Spanish because that’s all he knows right now………….

    This too, shall pass. Take care!
    Carrie :)

  2. Upsurge of bile understandable. At the same time, would you not make a similar decision based on family economics? That’s just rational behavior — honestly acknowledged, with rather admirable candor as you describe it — never mind who may be the suckers and why. And as to speaking Spanish, it would be pretty useful in a part of the country that is proudly and historically bilingual, never mind the wars, treaties and laws that have established borders and “national” languages. But, no, no one likes to be instructed on what they SHOULD do… especially doctors. Especially by patients. Especially by “charity” patients. (Nor, for that matter, by cheeky commentators whose opinion nobody asked for, eh?)

  3. Kim du Toit says:

    “And as to speaking Spanish, it would be pretty useful in a part of the country that is proudly and historically bilingual, never mind the wars, treaties and laws that have established borders and “national” languages.”

    DOW,

    It’s attitudes like that which cause unrest — and demands that English be made the Oficial Language of the United States, history, wars and treaties notwithstanding.

  4. Oficial language. (Freudian spelling error or sly comment?) I don’t got to spick no oficial language, no me importa what laws you pass. You gonna send me to the hoosegow [venerable Western English slang from juzgado] if I feel equally at home in the Spanish my New Mexico forebears have used since before Daniel Boone crossed the Cumberlands? Or deny services to my 80-year-old father-in-law from Guangdong who’s now a permanent resident of San Francisco but understands only Mandarin? (OK, both examples are hypothetical.) Point: America is a big country, and we’re enriched by every kind of diversity, even linguistic. Obviously, no doctor can learn every one of the nine languages California now requires medical information to be available in– Farsi, Hmong, Russian…. But where one is a strong local idiom, it doesn’t hurt to try for at least a minimal grasp. And as I recall, GruntDoc has no argument with that proposition.

  5. Just a point of clarification: when a doctor in Mexico wants money, it’s almost always the ENTIRE fee up front. While a Mexican surgeon may only charge 1/2 of what a U.S. surgeon would charge for a similar operation, the amount would still be nothing to sneeze at for doctors bills, hospital, etc. It’s just the way the economics works here because of customarily low wages, even for docs.

    The comment about Spanish was, I agree, uncalled for, given their situation and need. It’s not like the hospital wasn’t providing the translation service. It would have been at least understandable if there was nobody around to help.

    And just to be sure “nobody goes there” with respect to a person from Mexico getting medical care for “free” in the U.S., to get Medicare coverage you need to be a U.S. citizen or a legal, documented alien meeting further eligibility requirements.

  6. Even illegals not eligible for medicare/medicaid from south of the border often display this sense of entitlement. The border can’t be that well protected if Mexicans with femur fractures, completed strokes, and advanced cancer can make it to my hospital 100 miles Inland. Yes, it’s true.

  7. Aerospace Genius says:

    But what of the Mexican doctor and hospital? They just lost some business they should rightfully get. How can the Mexican hospital survive if Medicaid policy constantly undercuts them to the tune of 100%? Additionally, this policy has cost a Mexican medical insurance company the premiums the person involved should have been paying.

    This is worse than subsidizing another country’s economy. It is actively harming Mexico’s economy.

    I’m still waiting for some congressman to introduce legislation changing American policy regarding illegal aliens to match Mexico’s policies regarding illegals in their country.

  8. NoAcuteDistress says:

    Imagine an Italian immigrant in New York City, turn of the 19th century demanding of the local doctor that he “should learn to speak Italian,” or a German immigrant demanding that the doctor “should learn to speak German.” or an eastern European Jew demanding he be spoken to in Yiddish. The latter has a word for that behavior- it’s called chutzpah.

  9. The first time I went to France, I remember overhearing an American getting upset with a waiter because he couldn’t understand English.

    We want the world to speak to us in our language wherever we go. Nobody else gets that privilege, I guess?

  10. Just a historical note: In Cincinnati (and Milwaukee, and some other big cities) at the turn of the 20th century, German was taught with English in the public schools. My father learned it there until WWI patriotic fervor ended the bilingual practice; sauerkraut became “liberty cabbage” just as French fries have latterly been redubbed “freedom fries.” There were more German-language daily newspapers than English in the city and no German-speaking Cincinnatian (like some of my distant aged cousins into the 1950s) would have had the least difficulty finding a storekeeper, tradesman or doctor who could communicate in that language fluently. Don’t know about Italian, but I bet the same could have been said about Yiddish in NYC and Norwegian in Minnesota. Sure, people learned English — just as the kids of Hispanic immigrants eagerly speak English. My five-year-old grandson, for example, understands his father’s Mexican Spanish perfectly but only deigns to respond in the English that otherwise surrounds him. If he grows up like his mother, he’ll speak Spanish and Portuguese and French as well… and maybe Arabic and Mandarin. And more. It’s a wide world. Communication is v. cool.

  11. I wish I could say I was shocked at such behavior, but this is sadly typical for illegals. Often times, even if they have lived here (ilegally) for years, they cannot or *will not* speak english.
    Those Mexican doctors are not going broke. Frankly, our hospitals would not be in such a financial crunch if we could demand fees for service up front.
    It would also be cheaper here since those who pay would not also be footing the bill for those who do not.

  12. Grunt Doc, I’m not prejudiced against anyone, of any nationality, for any reason …

    … that said, if I were to visit (or move to) a Latin country, I would not suggest that the locals adapt to me, my needs, and my language.

    The very idea is so arrogant that it makes me catch my breath!

    Here in New England, we have a large Franco-American population. Many of the older people speak English very poorly. There are a lot of last names like Beaulieu, and Thibeault … and yet, the large businesses coming into the area only make accommodations for Spanish … still a comparatively very small population outside of the largest cities. What about the Francophones who make up such a huge segment of the population up here?

    Meanwhile, my son in law, who is from Sweden, is having to struggle to stay in this country, and if he tries to get help from the government to support his family, he risks being deported. As far as I know, he wouldn’t even be able to get Medicaid for himself until he’s naturalized!

    When we finally wake up and smell the coffee, we’ll be singing the National Anthem in Spanish.

    Our roots are not Hispanic, they’re Anglo … and our strength is not in becoming yet another Hispanic nation, it’s in being a melting pot from many nations. Our strength lays in our homogeneity.

    This isn’t just an immigration issue … why can’t people see that what we’re losing is our very identity?

    … and that, to a people who seem to expect that we owe it to them?

    Thanks for the room to rant. Your post smacked me right between the eyes. I hear what you’re saying about needing yet another vacation now … *comfort*

  13. “The first time I went to France, I remember overhearing an American getting upset with a waiter because he couldn’t understand English.

    We want the world to speak to us in our language wherever we go. Nobody else gets that privilege, I guess?”

    When I’m at a tourist attraction, for tourists, DURING TOURIST SEASON, and the guy at the INFORMATION desk PRETENDS not to speak English for 5-10 minutes (then answers our questions in excllent English when he finally wants to be rid of us), yeah, that’s a problem.

    When I go to the hospital needing treatment, I hope there’s a translator (been there, actually).

    The difference is length of stay and who is paying.

    When I go to another country, even for a visit, I learn some of the language (at least “bathroom”, “please”, “thank you”, “hello”, “excuse me”, and “Does anyone speak English?”), and I expect to need to ask around if I need something more than that while separated from any translators.

    When I go to another country to LIVE (even for a quarter year), I take pains to be able to speak the language sufficiently to get directions (albeit simple ones) from the locals.

    That is not only polite, it is the INTELLIGENT thing to do, so that you aren’t dependant on finding someone to speak your language so that you don’t DIE.

  14. You paid good money to go to Medical School on the border. I guess all that time speaking spanish on rounds was just wasted:) Really, I get the same thing in Ark.,and I have had illegals, without medicare, expecting free care. I am all for taking care of people but let’s not bankrupt the system any more than we have to. I agree, we should enforce the same immigration laws that Mexico does. We have to get a handle on this ASAP. Just 2 years ago I would see a patient that spoke spanish maybe once every six months. Now it is daily that I have to wait on an interpreter. Tal es vida!

  15. So Gunnar, do you think we ought to kick Tyson’s out of Arkansas so we can reduce the number of Hispanics?

  16. TXERdoc says:

    I don’t like it when the bile rises up, so I try not to worry about stuff like that. Nobody has ever given me a pat on the back or a kind word for rationing care, so I try to give every single patient the very best care that I can. No administrator or boss of mine has ever criticized me for ordering too many tests or admitting too many indigent patients. It’s not my job to care for the hospital or the government….my job is to care for the patient.

    It only takes a few words of Spanish to make your patient feel like you are trying to connect with them…I’ve found that most of them appreciate the effort even if you still need a bit of help with the details.

  17. don Meaker says:

    Don’t worry about the Mexican Doctors. Some of them move here, others set up in the border area and sell Latrile to dumb and desparate US cits.

  18. When we continue to cater to foreigners who refuse to learn English and abuse our system, we all lose. Getting something for nothing thrives. No wonder health care premiums are escalating at a 20 percent rate every year. Someome is paying. The soon to be gone middle class.

  19. I have trouble getting angry at people for taking advantage of a situation we have imposed on ourselves, and I am no more disgusted by non tax paying illegal aliens taking advantage of our health care system as I am of non tax paying “citizens” who do the same. If you want to stop the problem fight this http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act
    in its entirety. People do not have a right to health care. “Rights” do not incur obligations on other people’s part. Any attempt people make differentiate between citizens and non citizens who take advantage of the health care system I dismiss as xenophobia and nothing less.

  20. You don’t speak Spanish and you work in Texas? I mean, I could understand if you were in Wisconsin, but Texas? And since when do you need to be worked up about who pays the bill? As long as HCA takes care of you, it matters how? This is an ED you work in, not a plastic surgery clinic, right?

    DOW – how crazy are you? Let’s see – imagine the you ran across some people on the side of the road and they needed help, but because you only speak the “oficial” language of English, you can’t help them. What kind of samaritan does that make you? One who can do nothing except rant about what should and shouldn’t be done and how we need to go back to the bad old days? That would be very convenient to say that humans who don’t speak English don’t have to be helped.

  21. “And since when do you need to be worked up about who pays the bill? As long as HCA takes care of you, it matters how?”

    Dave,

    Mose ER docs are self-employed, paid by some type of fee for service arrangement. Reletively few are employed and recieve a salary. I have nothing against being a good Samaritan. I have been to India, Mexico just for that purpose. But I can’t make a living for my family in my day-to-day job being a good Samaritan taking care of an increasing percentage of illegal aliens. There is no magical good Samaritan in the sky that pays for them. Federal EMTALA law says they must be seen in the ED but it is an unfundated mandate.

  22. 1. Don’t run Tyson out of Arkansas. They can hire legal workers and it still would not cut into the millions that Don Tyson gets paid each year.
    2. I said I am all for taking care of the patient, and that is what I do. You are either very niave or are a democrat if you think we can take care of our citizens and those from other countries without it putting a financial burden on us (US citizens). There is a finite amount of funds available. It is very short sighted not to control our spending on healthcare now. If we don’t handle this now socialized medicine is not far off. I sure hope you don’t handle your personal finances the way you control healthcare costs.
    3. English is the official language of this country. Everyone should expect that we all converse in english, not to expect us to speak their language. If you want to stay here at least make an effort to learn the language. Would you expect Germany, Italy or any other country to accomodate you if you lived there (illeagally?)? I have had patients who have lived in this country for years and cant speak a word of English. Give me a break! Anyone can pick up enough english/spanish to get by, if they want to.
    4. Bottom line. I happily take care of anyone who presents for care and do everything I can to help them. We as a group need to be responsible for the future of medicine, or some lawyer/legislator will.

  23. Jerry, well-said. And to every other ER Doc out there who doesn’t work for an HCA or another corporation like that, I apologize for over-generalizing.

    In GruntDoc’s anecdote, this might have been an unnecessary surgery, maybe the person wanted pain medicine – whatever. You can’t really blame people in this situation. You need the government to actually do something about immigration reform, and penalize folks who employ undocumented immigrants (like HCA probably) if you expect anything to happen. Treating people like second class HUMANS is not going to help, especially if you’re the one who’s supposed to be caring for them.

    Can you see internment camps for undoc. immigrants in New Mexico or Arizona? They’ve already started putting them in jail there.

  24. Dave:
    They are *illegal* immigrants, not “undocumented” ones. Drug dealers selling narcotics on the street are criminals, not “undocumented anaesthesiologists.” Documentation is not the core issue.
    The simplest solution is to just revoke EMTALA, and then tell hospitals that medicare will not reimburse for patients that cannot prove they are here legally. I know, the idea that deregulation, and cutting spending can actually address a problem is not the way the government (or citizens) are used to thinking, but there is something there.

  25. “They are *illegal* immigrants, not “undocumented” ones.”

    Being in this country without the proper documentation is not a criminal offense.

    “Don’t run Tyson out of Arkansas. They can hire legal workers and it still would not cut into the millions that Don Tyson gets paid each year.”

    We have a shortage of unskilled workers in this country, in large part because our high school dropout rate has shrunk so far. These people are filling a niche that would not otherwise be filled. And Tyson’s lost money last quarter.

    “English is the official language of this country.”

    No, it is not, and never has been.

    “Anyone can pick up enough english/spanish to get by, if they want to.”

    Would medical terms be included in “enought to get by”? How much Spanish have you picked up?

  26. One night I spent my entire shift speaking Spanish. Every single patient. I’m not good at comprehending it (unless the patient speaks slowly and very basically), but I can speak enough to get through a triage and do basic discharge instructions with help from the Spanish-translated papers.

    Why do I speak Spanish? At least the little that I do?

    Because I studied it for four years in high school and I love the language. Lord knows I’ve had numerous opportunities to use it every day!

    I believe that everyone in this country should speak at least a bit of English to get by in day-to-day life. But in my experience, once a patient knows you are willing to try Spanish for them (and where I live, they do appreciate it, they are willing to let you hear some of their English. They just don’t want to appear stupid or to make mistakes.

    So when I show them I’m willing to sound silly and make mistakes in Spanish, we help each other and manage to get through the visit, and in very serious situations with no translator, we use a cordless phone translator system that is easy and covers every imaginable language.

    Now, coming here because you don’t have to pay up front? That just sucks. A bit of my paycheck went for that operation! And I didn’t even get a thank-you note…..

  27. “The other day, I had to go to the emergency room. So, not wanting to sit there for 4 hours, I went to the Army-Navy store, and bought some OD pants and a shirt. Ran back home & sewed a couple of patches on them which I had ordered from the Internet.
    I went back to the emergency room and was amazing how most all the people started leaving. I figured they suddenly decided they weren’t that sick after all. My patches said: “U.S. Border Patrol.”

    This is a mass email that idiots like to forward.

    In any case, I know the system is at the breaking point. I’m also sure in the border states undocumented immigrants are packing the ER’s, and might seem like most of the problem in those areas, and maybe they are. But the fact is they’re here for now. What’s going to be done to prevent them from coming? Sending around stupid emails? Building a fence? Doubling the Border Patrol? Or, we can do like Reagan (and what Dubya wants to do) and grant amnesty every 20 years or so. That’s easy, because HCA gets to keep their workers, the construction industry won’t collapse, and lawns will stay freshly manicured in Los Angeles.

    The fact is, denying health care to non-citizens or deporting them will not immigration because there is too much incentive to come here. THIS WILL ONLY END WHEN THE GOV’T DEMANDS THAT EVERY EMPLOYER VERIFY SOCIAL SECURITY NUMBERS, and penalize those who don’t.

    You can’t have the cake, stomp on it, piss on it, deport it and then eat it as well.

  28. Bad Shift says:

    Matt, the shortage of unskilled workers is a myth mostly promulgated by large corporations, who use it as an excuse to pay immigrants illegal wages. This is a similar statement to “they do the jobs white people won’t do,” which I find demeaning to both groups. If there were no undocumented workers, then wages would increase, and I promise the jobs would be filled. We would then pay more for landscaping and produce, and our health care system would be significantly less burdened.

    Really, I think it’s the entitlement that is frustrating. But when you give something for free for long enough, people will expect it, and then use it inappropriately.

  29. Bad Shift,

    There are, let’s say, 12 million undocumented workers in this country, of which about 8 million are working. There are about 100 million people of working age in this country. We have 4% unemployment, and of course not all of those people are physically able or would do (by virtue of having the ability to earn more) agri labor, poultry plant work, etc. The numbers simply don’t add up.

    And, wages will not increase, the work will go to where the wages are cheaper. So not only have you lost those jobs, you hurt the place they buy groceries, gas, have their cars repaired, etc.

    The majority of these people aren’t here for the “free stuff”, they’re here because there is work here.

  30. Illegal immigration hurts exactly the most disadvantaged Americans. It lowers there wages. Amnesty will just make it worse. Now the new Americans will demand more from their employers so the employers will then bypass them in favor of the newest illegal immigrants.

    Agri Labor, poulry plants, etc. can innovate and learn to get by without the slave aparthied type labor like other places like Australia. Also when I travel outside of southern california to the red states I see Americans and teenagers doing the jobs that supposedly Americans won’t do.

    I see them coming all the time to my hospital for the “free stuff”

  31. The numbers don’t add up, and since they don’t the jobs will go overseas. How will that help America? To reduce our manufacturing capacity even more?

    We produce fewer and fewer unskilled laborers every year, as evidenced by the falling dropout rates. Unless your goal is to produce more unskilled labor, we simply do not have enough workers to fill the jobs.

  32. Pete–That was funny!!

    Matt–According to CNN there are 7000 high school dropouts each DAY in the US. Tyson could use these guys/girls. BTW, Tyson does employ a lot of legal workers. I see them all the time in our ED, with what we affectionately call “Tysonitis”.

  33. Everyone of us needs to make sure we contact our senators and house members on this topic. This problem will only get worse if we do not get our representatives to understand our desires or replace them with those that do understand.

  34. rosignol says:

    Being in this country without the proper documentation is not a criminal offense.
    —-

    It may not be a criminal offence, but it certainly is a civil offense. Just because you don’t get thrown in prison for doing something doesn’t make it legal.