From the WONCA president: Not my usual visit


I began this column at cruising altitude en route from Frankfurt to Chicago. While I enjoy my travels, there is always something special about the return home. This time it was even more so. This time I was returning as a patient.

The frantic schedule and limited travel funds make it less common for the WONCA President to attend meetings of national colleges. Typically, it is the regional conferences, WHO meetings, and other similar commitments that consume most of the time and resources available to the President. Yet, I had resolved to use personal and WONCA funds to travel to Bilbao, Spain to attend the annual meeting of semFYC, Sociedad Española de Medicina de Familia y Comunitaria.

My reasons for attending the Spanish college meeting were several. Spain was one of the largest and most influential member organizations of WONCA, sending many delegates to meetings in Europe and Latin America. The Spanish health system had shown that a shift from generic primary care to Family Medicine produced better results with higher patient satisfaction. Most urgent was that the Spanish economy was in crisis. So, I went with a desire to learn more about how the economic crisis was affecting health services, and to show solidarity with and global support for the family doctors of Spain.

Shortly after my arrival in Bilbao on Tuesday afternoon, I was doing email in my hotel room when I had the sudden onset of several episodes of near (pre-) syncope. The episodes lasted 3-5 seconds and I never lost consciousness, nor did I have chest discomfort, breathing problems, or other difficulties. My heart rate was regular and in the low 60s. Between and after the episodes, I felt well. I attributed my symptoms to jet lag and dehydration, and pushed fluids.

The next morning, I had several more similar episodes. Later that Wednesday at a reception, I mentioned them to Dr Josep Basora, President of semFYC. Within moments, I was handed over to several local family doctors who took me to a health center where my examination and electrocardiogram were normal. Dra Carmen Aranzabol, the family doctor who attended me, was thorough and compassionate. She advised me to drink more fluids, lose weight, and exercise more.

After a busy day and night on Thursday, I had my symptoms return while touring another health center on Friday morning with Doctors Jose Miguel Bueno and Ana Rubio. Another electrocardiogram was obtained, which showed atrial fibrillation with a controlled ventricular response in the 90s. Dra Ana drove me to the Hospital de Basurto (Basurtuko Ospitalea in Basque) for further evaluation.

By way of background, I should mention that I have been fortunate to not have any significant health problems. I had never been diagnosed with high blood pressure or diabetes. My mildly elevated lipids had responded well to the statin I had been on for years. My most important risk factors were the sudden death of my father at age 51 while jogging, and the angioplasty my mother underwent at age 61. In addition, I had gained nearly 40 kg in 10 years of intense travel with too many meals at too many meetings in too many time zones. My exercise routine had downshifted steadily from regular jogging to walking to seeking sleep more than walking.

At the hospital, I converted back to normal sinus rhythm within 20 minutes of my arrival. I felt well the remainder of my time in Spain. I had a normal troponin, chemistry studies, blood count, chest x-ray, and electrocardiogram. I was monitored for several hours and then advised to have further studies on my return to the United States. From the hospital, I called my family doctor to let him know about the events of the past four days. He indicated that he would schedule the necessary tests as soon as I returned home. Those tests took me down a path that I never imagined for myself, but that is another story for another time.

Instead, I want to share some reflections on my experiences as a patient in Spain. The Spanish family doctors were wonderful. There were many who stepped forward to help. In their faces, I could see a mixture of sincere concern and a hope that I would not die on their watch on their soil. Several doctors deserve special mention and thanks: Dras Ana Rubio and Susan Martin Benavides; Drs Jose Miguel Bueno, Ixaki Martinez Numatuj, and Pascual Solano.

During my four hours in the hospital emergency department, everyone was very kind and professional. I observed a number of similarities to my own health care system. Too much time was taken to check me in – cardiac patients need to be evaluated quickly. It seems that bureaucracies must have their day, no matter where they are. I noted that the bright lights throughout the corridors and exam areas of the hospital seemed to be aimed to create maximum discomfort for someone lying on a hospital bed. Perhaps lighting engineers would do well to spend some time in the supine position in a hospital.

Somewhat to my surprise, the professionals who proved more important than the emergency doctor were the nurses. Their warm smiles, comforting touch, and frequent assessments had the dual effect of reassuring me that I was being well looked after, and reminding me that I was more anxious than I had realized.

My trip to Bilbao involved much more than my medical personal experiences. I learned that the Spanish family doctors have maintained reasonably good morale in the face of difficult economic times. The most immediate effect of the financial crisis was that doctors who provide locums services were expected to be let go. The painful cuts that I feared for the Spanish health care system had not yet occurred. I was heartened by the cautious optimism of the Spanish doctors, for I knew that they had the challenging task of providing reassurance, stability, and hope for their patients and communities. We discussed strategies to reach out to local populations to help them not only with their health care, but with their economic futures.

So, my plan to bring comfort to the family doctors of Spain did not work out quite as I expected. Rather, it was they who comforted me. For that, I will be forever grateful.

photograph gallery courtesy of Dr Jose Miguel Bueno

Professor Richard Roberts, MD JD
WONCA President
27 August 2012