public health — international medicine What I witnessed was poverty and lack of resources compensated for by subsistence rationing and broad healthcare access and continuity. Indeed Cuban medical care warrants the nostalgia. Their system harkens back to the days of family physicians making house calls armed only with their deep personal patient knowledge and their stethoscope.
In Cuba, routine care visits are mandatory. Everybody has a primary care physician, and each doctor is responsible for a roster of about 1000 patients. Patients are seen at least once a year, often in their home. The entire population is riskstratified as well based on characteristics such as smoking or existing disease, and higher risk categories are seen more frequently. Physicians are available 24/7 and dispense with 70% or more of all medical issues. All of this is provided at no charge to the Cuban national. These physicians are paid practically nothing, may not have a nurse, an x-ray machine or access to the internet, but they know their patients intimately and respond to that knowledge. Emergencies are addressed immediately. Chronic conditions are identified and managed early. The system works well, and it’s easy to see why. An over-
weight or genetically-vulnerable 33-year-old may have early signs of hypertension and a creeping blood glucose level. In the U.S.—with lack of access to or emphasis on preventative primary care—this patient may not even begin seeing a physician regularly until he starts to feel overly fatigued at 42 or has his first heart attack at 49. At that point, the damage is well underway. He will start multiple blood pressure medications, a medication for diabetes, and may need procedures as well. But catching a pre-hypertensive blood pressure in the patient’s early 30’s, initially trying weight loss followed by a single blood pressure agent and titration over the next decade will likely prevent that first heart attack. The patient may still go on to die from heart failure, but it might be at 85 instead of 65 and he may largely avoid many of the medical complications of his disease by catching and intervening early.
This early intervention is possible because patients trust their doctors and are more likely to comply with treatment recommendations. I spoke with several primary care doctors and patients, and I was very impressed with their rapport. I found the doctors to be empathetic and compassionate. The pay for these neighborhood physicians is paltry, but they are
Great Location
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TRACY ALTEMUS, CCIM 602/443-4022 taltemus@ensemblere.com
AUTUMN STORM
602/385-2854 astorm@ensemblere.com
A monthly publication of the MCMS • March 2015 • Round-up • 21