by Rod Hughes
To most of us, the nuts and bolts of medical administration is a mystery hidden in hospital and clinic file drawers.
But according to a story in the daily paper La Nación today, the system the Social Security Administration (Caja) uses to schedule operations has a screw loose.
The surgeons, says the story, use notebooks to remind them who needs an operation and when it is to be performed. The often life-or-death info is scrawled, usually in pencil, in the legendarily undecipherable handwriting of doctors and often lacks a few facts—like the patient’s phone number so he can be notified when and where the operation will take place.
Caja personnel call this system “manual agendas” or “under the arm” or “desk drawer,” says the article.
Doctors often defend the chaotic system by saying that the office staff of most hospitals are overworked as it is. And, in truth, La Nación has run stories in the past about how most vital medical records are passed through typewriters—a machine that many of the younger Internet generation may have seen only once, in some dusty storeroom. They abound throughout the Caja network from the most rural small clinic to the central offices on Av. 2, San Jose.
What is the result of this antiquated public medical service? How about the woman who has been patiently awaiting varicose vein surgery for 16 years? Others have had it easier; they have been waiting only since 1995 or so. (There is the answer of why recipients of medical services are called “patients.”)
Here is the data the newspaper gleaned from Caja records. Today, some 260,000 Costa Ricans are awaiting medical atttention, those who haven’t died yet. Of those, 40,000 are on the surgery list. Another 134,000 are awaiting diagnostic exams and 85,000 more are waiting to see specialists.
Sloppy record keeping also accounts for the existence of corruption–biombos, is the local word for when doctors are slipped money under the table so a patient can be pushed up to the top of the waiting list. In the past, doctors have been fired from the Caja for this practice but, as long as the list for free public medical services remains endless and the desperate and impatient are willing, greedy medics can be found.
And sloppy records make it hard for them to be found out.