Tuesday, April 8, 2008

Doctors

I've always tried to avoid going to the doctor. In America, I stayed away as much as possible because I didn't have medical insurance once I got kicked off my mom's in my early 20s, and going to the doctor was too expensive. In Turkey, the cost is less prohibitive and I even have private insurance, but I still avoid going unless it's absolutely necessary. Like, threw my back out and can't walk necessary. Having a baby necessary. That kind of thing.

At first, I avoided the doctor out of habit, and also because of the nuisance of trying to describe a health problem in my broken Turkish, or worse, to the doctor who claims he speaks English but would be lucky to be placed in a Pre-Intermediate class by my reckoning. In my early months here, I picked up a nasty urinary tract infection that not only bled, but caused some serious cramps while I was teaching which caused me to get very pale, dizzy, and break out into a clammy sweat in front of my students. They were very alarmed and I was really embarrassed. Hülya, the student in the class closest to a doctor (she was a horse vet at the nearby racetracks) and coincidentally the worst student in the class (after eight months she still didn't know how to say 'dog' or 'house' in English) very sweetly offered to take me to the doctor.

When you go to a doctor here, you go to a hospital. Of course there are clinic doctors, and private ones, but usually it's a hospital. I didn't know this when I first came here. When students told me they had been ill and had gone to the hospital, I got very worried about them. After a few months, I just decided this was a race of panicky hypochondriacs. But when the urinary tract infection that got out of hand made itself known to me in front of fourteen Elementary students, I was taken to the Acıbadem Hospital across the street from my school by sweet, probably-still-hasn't-learned-a-word-of-English horse vet Hülya.

Acıbadem is like the Ritz-Carlton of hospitals. You won't find that hospital-y smell there. Everything is gleaming and new-looking, like a shopping mall or a business park. Unlike the state hospital where I went to get some forms stamped for my maternity leave, there are no rusting 50-year-old gurneys creaking out of Nightmare on Elm Street, or cats running in and out, or hordes of villagers pushing to get into a door where they heard there was a doctor but where there in fact is none because she's out at the bazaar. At Acıbadem, the person at the Information desk is bright and cheerful and often a keeper of useful information. She won't look at you in utter bewilderment like you're the first person to have entered the hospital seeking medical treatment, then disappear down the corridor for 20 minutes while she asks someone what she should do. And at Acıbadem, smoking is confined to the cafeteria and perhaps a few other designated places.

But the trade-off is this: If you go to a posh hospital, expect posh treatment. I don't mean the good kind, like down pillows and martinis and string quartets while you wait for the doctor. I mean the scary kind, like a full blood work-up, plus some other tests, plus some other tests. I guess they figure if you're paying a lot of money, you might as well have a lot of treatment, whether you need it or not. And whether or not there's anything actually wrong with you, you can expect to be given several prescriptions. A high-paying customer can hardly be asked to leave the doctor empty-handed, after all. In most cases, you will be prescribed either antibiotics or cream. Sometimes you get both. Sometimes you get an antibiotic cream. Antibiotics are doled out like aspirin here. Sore throat? Chills? Ague? A cough? A sniffle? Went outside with wet hair? Feet got cold? Antibiotics cure what ails you. If you don't want to go to the doctor, you can just report any of these symptoms to a pharmacist and you'll get the antibiotics. If the pharmacist is closed, just go to your mother-in-law, as she will most certainly have a drawer full of half-empty boxes of antibiotics left over from previous family ailments.

I'm sure my dear readers have noticed by now I often have a tendency to exaggerate. Well, I'm not joking or stretching the truth on this antibiotics thing. This past summer, I got a strep throat-type thing with a high fever that wouldn't go down and icky white crud on my throat. The doctor gave me a shot of penicillin right there in the hospital and to my amazement, I started to feel better in a few hours. It was gone the next day. Completely gone. The doctor had told me that I should come back the next day for another shot, and when BE called him to tell him I was all better, the doctor went, 'Ah, of course! She's American! They aren't immune to penicillin like we are!'

But there's a downside to all this treatment, which is this: Going to the doctor is scary even without the language barrier. Being told you need such-and-such a test, or such-and-such a treatment is also scary. We've all been taught to trust the doctor's superior knowledge and education. Just as most of us take take our cars to the mechanic because we don't know beans about the inner workings of cars, we take ourselves to the doctor because we haven't studied medicine for 15 years to know why our innards are making that pinging sound. The difference is, when a mechanic tells us the car needs $1,200 worth of repair, we might be suspicious and take it to another mechanic, or at least our brother's friend, before having the work done. But when a doctor tells you this, you kind of panic and get the work done post-haste because you're afraid if you don't, you'll die.

Unless you're in Turkey. I've learned to kind of take pause when a doctor tells me I need some expensive tests or treatment. I learned this the hard way at American Hospital, another posh medical joint. I wanted a good, English-speaking, foreign-trained doctor for a Pap smear and pelvic exam, as I just couldn't face doing one of these in Turkish, and it was when BE and I had decided we were into being fruitful and multiplying so I wanted to make sure everything was working okay. The doctor was perfectly nice, with excellent English. I was a bit confused by the pelvic exam because instead of doing it manually as they'd always done in the US, he used a vaginal ultrasound (or, to borrow a term from Bri, a dildo-cam), but because I was terribly amused when the doctor described my ovaries as 'fibrillating,' complete with a finger motion to demonstrate this fibrillation, I kind of forgave him.


A few days later, the doctor emailed me to tell me that the Pap had come back 'abnormal.' It was abnormal in what appeared to be a scary way, as showing pre-cancerous cells related to genital warts. A visit to Dr. Google only made it all more scary and aroused my suspicions that the Universe wasn't going to let me get away with all that promiscuity of my pre-married days. The American Hospital doctor recommended that I come back for a laser biopsy, just to be sure. A mere $800 of sureness, to be exact. Dr. Google had also mentioned that a yeast infection could skew the results of a Pap, so BE and I went to Kızılay hospital, a big step down from American Hospital in the Istanbul hospital food chain, but his parents' neighbor works there and she was able to get us into the gynecologist without waiting in line for four days. For 20YTL, the Kızılay doctor confirmed that I had a yeast infection (which by that time I could have told her as much myself without the Pap), prescribed some cream, and sent us on our way. So for 20YTL, I was able to learn not only that I had dodged the Universe's bullet, but that perhaps I have a little more American Puritanical guilt than I'm comfortable with.


So by the time I went to Medi-Life Hospital (a middle-of-the-road place, a few steps up from Kızılay and many steps down from American Hospital or Acıbadem) about the ache and clicking in my ears, I was an old hand. I'd long given up on the idea of ever seeing a GP again, as they don't seem to have them here. They only have specialists. When I got food poisoning, I went to an internist and when my back went out, I went to an orthopedic surgeon. So at Medi-Life they sent me to the ENT, a very jolly old guy with a very spiffy fiber-optic camera that allowed him to look into my ears, nose, and throat and which was attached to a monitor so I could also view the moist insides of the mucous membranes in my head. I thought the inside of my nose was the grossest, and will forever think of that gadget as the Booger Cam. After pulling some pea-sized balls of wax from my ears (did you know ear canals can stretch to accommodate pea-sized balls of wax? I didn't. It sucked.) and prescribing me some antibiotic ear drops, the doctor informed me that my nasal passages were malformed which may cause me to sleep with my mouth open and make my throat dry. 'Okay,' I said, more confident of my Turkish by that time, 'But how did those balls of wax get into my ears and how can I avoid ever having that again? I do clean them, after all.' 'Yes, yes,' said the doctor, taking out a pen and paper and drawing a picture of the malformation of my nasal passages, explaining how it was either congenital or that my nose had been smashed as a baby. I started to wonder why I should bother learning Turkish when some people seem to have their own conversations anyway. The doctor told me I should make an appointment for some radioscopic laser surgery to change the shape of the inside of my nose. When I asked how much it would cost, he said 'It depends.'

So I told him I'd discuss it with my husband and left. A couple of weeks later in the mail we received a glossy brochure from Medi-Life detailing all their new equipment and departments. Right there on page four was my jolly, rosy-cheeked ENT smiling next to none other than a shiny new radioscopic laser machine.

So what are you supposed to do when the doctor tries to upsell you on treatment? How do I know for sure it's not very dangerous for my throat to get dry at night? I suspect it's not all that important, but I'm not a doctor. How much and what kind of treatment you need seems to be entirely dependent on the hospital you go to and which expensive machinery they're still paying off. It also depends on how rich they think you are, and whether or not you've told them you have private insurance. So in the end, I usually decide that the recommended treatment and most of the prescriptions are a crock and don't take them. This is fine when it's just me.

But what about LE? It's all right for me to decide what's necessary and what's not for myself, but I'm way less willing to fool around with second-guessing the upselling medical professionals for him. For his pediatrician, we've stuck with International Hospital where he was born. This is also a posh place, though I think they've gone decidedly downhill since being bought recently by the Acıbadem Group. It looks nicer, to be sure, shinier with more glass and chrome, but suddenly the need for lots of expensive tests and interventions for patients has increased greatly. LE's doctor, certainly not one to send us off without reams of prescriptions, seems really obsessed with vitamins. First it was Vitamin D, which she was absolutely convinced couldn't be gotten in sufficient amounts from the 12-15 hours of daylight here. Now the bee in her bonnet is iron, and despite my telling her all the iron-rich foods LE eats every day, she thinks he's a little anemic because he's pale. Because he shows no other signs of anemia whatsoever, I'm pretty sure he looks pale to her because he's foreign. Still, she prescribed us some iron drops which I've never bothered buying. They need to be given no less than two hours from the time the kid had or will have milk or food, and they taste bad but can't be given with anything. When I asked her what I'm supposed to do, as the boy never goes 2 hours without food or milk, she just shrugged like it was my problem.

BE is mad at me about this. He wants me to bow to the doctor's superior knowledge. And granted there are times when I can't sleep that I convince myself I'm malnourishing the child and he'll get rickets and be a bit dim-witted as a result. The doctor is exasperated with me too. Every time she looks at LE's records and sees I've declined on all the vitamins, she gets a stern look and admonishes me a little. I just start wondering about who's paying who here? Are these recommendations or orders? Does anyone genuinely think I'm doing something on purpose to make LE unwell? In any case, for LE's next visit, she wants a full battery of blood tests and urinalysis for LE. How one gets a urine sample from a baby is something I'm curious about, as I have no intention of taking off his diaper and chasing him around with a little cup. I'm not particularly keen on the blood tests either, but if it will shut her up and make BE quit glowering at me every time we leave the doctor then so be it. I'll make sure BE knows it was for him and his peace of mind that we had to get the baby's feet repeatedly pricked like that. Of course if LE needs the iron I'll find a way to give it to him, but in the meantime I'm thinking we need another pediatrician.

Sometimes you can't avoid going to the doctor, and with a kid it's even harder. For me, choosing a doctor in Turkey is nearly impossible-- if I want a well-trained doctor (meaning foreign-trained, as I just can't convince myself Turkish medical training is up to snuff. Plus, if the doctor doesn't speak a foreign language, how do they read recent medical journals? Iffy translations that come out two years later?), I have to accept going to a hospital that's going to want to use every piece of amazing machinery under the sun. I have to be strong in making myself believe LE or I don't maybe have the deadly disease they've been newly equipped to test for. But if I go to a 'regular' doctor, I can expect to be given 'medical' advice that involves keeping my feet covered at all times. So it's quite the dilemma. Doctors aren't fun anywhere, but it's something in Turkey I find especially trying, and because I never went to medical school, it's not something I'm really equipped to decide about for myself.

Not fair, I say. Not fair.

15 comments:

siobhan said...

This is not a lie- I was sitting in Acıbadem today after waiting around for over an hour yesterday and half an hour today - no explanations or apologies, composing a blogpost in my head about how rubbish the healthcare is. Eerie, hey?

I misunderstood my doc about the vitamins and iron for D and never gave him any (I'm not particularly proud of this, but the vitamin d, well we go out every day and it's usually sunny). I didn't admit it to the doc and when he was a year old she had some blood tests done to ascertain whether we should keep giving him iron supplements, the results were that his iron levels were fine. I do know how to get a urine sample from a baby. I also know how to get a fecal sample which is a bit more hassle, as soon as lo does a poo you have to rush to the hospital and get the dirty nappy to the lab with half an hour. Incidentally I discovered that noone seems to know the proper term for poo here. There's a slight embarrassment in discussing kaka with medical professionals but dh couldn't help me out. I now know the real term though, I never use it because I don't think anyone will understand

Stranger said...

Wow, usually Acıbadem is pretty snap-to-it with the service... Anyway, I'd love to hear your crap healthcare experiences. I remember a post of yours from way back when about the SSK hospital in Ökmeydanı. The one I went to in Büyükçekmece was pretty fuzzy in comparison.

I'll feel bad about the vitamins if his blood test shows low iron levels, and BE will be ever so smug and feel like he never needs to listen to me again. The doc has already gotten me once about sleep-- BE was telling me 7-7.30pm is MUCH too early for bed and it's why LE is up so much at night. Assuming the doc would back me up, I told him to ask her, to which she replied, 'Oh, no, that's much too early. He should be going to sleep around 9pm (!), especially in summer.'

I considered lying about the vitamins just to get her off my case, but decided not to in case something went wrong and she carried on assuming he was having the vitamins. When I considered lying I started thinking about 'Who's paying who?' It's one thing for the dentist to get mad at you for not flossing, but vitamins for a perfectly healthy, well-nourished child should really be up to the parent, I think. He'll get vitamins when he starts school and I don't always know what he's eating. Why should he be denied the joy that is Flinstones Chewables?

I learned the word for 'stool' once but I forgot, never having needed it since. BE didn't know the word either, when I had food poisoning and the doc told me I had to give a 'xxxx' sample. He asked 'What's that?' and the doctor said 'Bok.'

Bulent Murtezaoglu said...

The word you're looking for is 'kazurat.' They might also say 'diski' with the sh s.

siobhan said...

Never ask the doctor about sleep or slippers. I thought my ob/gyn would back me up about not wearing slippers when it was 4o degrees and my feet were swollen to the size of melons because I was more or less bed-ridden because of the unnecessary c-section. She did confirm that it wouldn't effect my breastmilk but said that I should wear slippers for my own health. Dh smugly looked on. As for sleep, how can 7.30 be too early if a baby needs 12-14 hours a day and they get up at dawn and don't properly nap. You know what time the kids' channels shut down in the UK? 7.00pm, it's when kids go to sleep.

Stranger said...

'Dişki' was the one I heard. I'll probably remember it now, yet I do hope I don't have cause to need the word anytime soon.

When BE said I should keep LE up later, I told him he should just come home and try (LE's out by the time Baba gets home) to keep him awake till 8 or 9. There would be much screaming and fussing and violence, like when his grandparents forced me to keep him awake for his birthday cake while we finished dinner because no one considered the guest of honor's age and sleep habits when planning his party (I did, but no one listened). Sometimes he falls asleep in his high chair while he's eating dinner (like he did at his birthday party, and they still woke him), or while I'm changing his diaper. Anyway,if he goes down to sleep after 8, he'll have a very bad night indeed, and still be up at 5am.

Oh, and BE was insisting to me the other day that LE should wear his socks because feet directly affect the kidneys, and cold feet cause bladder infections and kidney stones (a doctor told him this, BTW. BE wonders why I don't trust Turkey-trained doctors. He thinks I'm a snob.).

Bulent Murtezaoglu said...

Oh well, 'kazurat' is likely to be perceived as more sophisticated and would be very impressive coming from a yabanci. The downside is people might not know what it means. It comes in handy for mild swearing at TV too. 'Kazurat suratli' is more suitable for a distinguished looking and serious older political figure than 'bok suratli' for example. But I digress.

You most certainly will lose any struggle to challenge the conviction that colds and drafts cause disease and cold feet are behind all manner of ailments. So, just don't try to change it, let it be. (Bare feet on tile is especially dangerous for little kids, BTW. You're likely to find out about this when LE starts walking.)

Stranger said...

Hee! I'm trying to imagine 'kazurat suratlı' in English. 'Fecal matter face?' 'Stool face' just isn't as funny...

Bare feet on tile was supposed to make me infertile, but look what's happened. It's also the cause of my back going out, not the constant awkward bending and lifting of an often squirming and kicking 11 kilo baby and his equipment.

I can be a stubborn bastard on this drafts and bare feet thing even though I try to not let it get to me, but I refuse to believe bare feet on tile are more dangerous for a little guy who walks like a drunk than socks on tile.

But, sigh, here's me bracing myself for the onslaught. I'm still in trouble because I give him cold food and drink straight from the fridge.

Anonymous said...

The cost of doctors is also pretty prohibitive if you don't have medical insuance. My dear dear husband was convinced that because he knows his insurance guy very well and his insurance guy does the insurance for the whole family's businesses, cars and health, that me being 8 weeks pregnant would be no barrier at all to private healthcare. I harped on about 'pre-existing medical conditions' to no avail.

Surprise surprise I have had to pay for private treatent 8my SSK kicks in n a couple of months but I'll prob stick with my private doc as he speaks english and is keen on normal births). So, scans are 115 YTL, and my blood tests were 535 YTL which rather gave us both heartattacks.

I've told my doc that we don't have medical isurance in a bid to keep the unnecessary down to a minimum but you never know - I doubt that a scan ever month is strictly necessary but it's rather nice all the same.

Giving birth is 2200 YTL where you opt for C section or normal birth with epidural - they will not offer gas and air or pethidine.

I do feel rather taked down to, but then I guess doctors here are used to being completely reverred and the googling which I've done to read up on pregnancy probably doesn't win me any fans with my doctor.

Ah well. At least the hospital's really clean...
Vicky, Bursa

Stranger said...

Private insurance actually influenced our family planning, as I too was unwilling to go with what SSK had to offer-- when you start the insurance, they won't even cover pregnancy or birth until you've had the insurance for a year. The first few months of the pregnancy weren't covered, and gasp (!), it was terribly expensive!

They do love the monthly scans. It's true they're totally unnecessary (though I think most docs here are so reliant on them, they can't even check on the baby manually, the old-fashioned way) but I agree with you they're nice. We have a really cute one of LE's butt at 6 months, and another where he's sticking his tongue out.

But congratulations on finding a doc that's keen on natural birth! That's really hard to do. And of course, congrats on your pregnancy too!

Sean said...

Well I am glad we are not the only ones who find this place strange. I was searching google for English speaking Doctors/Hospitals in Istanbul and came across your blog. I couldn't have written it any better if I tried! You have certainly caught the essence of this place.

Stranger said...

Thanks, Sean. Good luck finding a doctor you can deal with!

bebek said...

Dear `Stranger`,
I have just come across your blog while looking for something. I actually happen to be a board certified padiatrician practicing in istanbul.Even though your comments might reflect the truth you can not generalize them. There are tons of physicians here who will practice with a superb quality of care without really putting the emphasis on the dollar sign.I agree that overprescribing of antibiotics is a major problem here and I am fighting with that on many fronts but , I don`t think you should generalize about this either because there are many physicians who do not use unnecessary antibiotics.
Good luck and take care

Stranger said...

Bebek--

I agree that you cannot generalize anything I said to all doctors here. I was just talking about how my own experience with doctors here has made me wary, to say the least. Finding a good doctor is, however, often down to luck. This is true anywhere but I've been a lot less lucky with doctors in Turkey.

I believe that there are a lot of excellent doctors here who are working to change the things that are wrong. I also think a lot of good doctors are under administrative pressure to do the kinds of tests and surgeries that make money (which is unfortunately due, I think, to private hospitals like Acıbadem using the American model of for-profit health care).

In fact, we just came back from an wonderful pediatrician who I don't have any reservations about at all (except the cost- yikes!). I would be lucky to find as good a doctor as she is anywhere.

secil said...

Hi,
I think you should look at www.doctorsofistanbul.com, it's a great site with really qualified and ethical doctors with at least 1or more foreign language speaking.

Stranger said...

Thanks, Secil. I had a look at the site and it's really useful. I'll bump your link to a new post (this one is several years old), and pass it along to a FB women's group I'm in too...