I knew when we brought my father to Lima in 2011 that it would be cheaper to give him personalized care there. What I didn’t anticipate is how much easier it would be work with doctors, nurses, health aides and hospitals—in contrast with the bureaucracy and complications of the U.S.
After thinking it over, I’ve come to realize what, exactly, made these interactions easier: Peruvian culture is not very litigious. Unlike in the United States, people don’t generally sue others and institutions over civil matters. And when it comes to medical issues, people rarely take doctors or hospitals to court, even when things go very wrong. For instance, the whole seven years I lived in Lima, I didn’t hear of a single person I knew (or their friends or family) suing any medical entity for malpractice. That’s not necessarily a good thing—I believe that patients who are victims of serious malpractice should seek restitution—but it does have its benefits for everyday caregiving. Because doctors and hospitals aren’t as concerned with warding off malpractice suits, they tend to be more focused on caring for patients and communicating directly with family. And that simplified our lives greatly.
Here are some ways that Peru’s nonlitigious culture made things easier for us:
No HIPPA privacy laws. No signing forms and getting them signed by a notary. Initial visits with doctors and hospitals went much faster. When calling doctors’ offices, no having to send HIPPA documents to the office before the doctor would speak to us. Without the complications of this paperwork, doctors freely shared information with us on the phone and in person.
For instance, I could call my father’s doctors any time and get instant feedback on whether a medication dosage should be increased or changed. When my father fell and cut his head, the staff at Clinica Good Hope (a hospital in Miraflores that none of us had ever visited before) didn’t stop me and Jorge at the door and ask to see documentation proving that we were healthcare surrogates. We were my father’s immediate family, and that was enough for them to trust us to make decisions. How did they know we were immediate family? My father’s geriatrician was right there, and he could vouch for us. And even if his doctor hadn’t been there, most hospitals would have looked at our national ID cards and gone on trust.
This sort of immediacy and lack of red tape meant that we could act on matters quickly, as could my father’s doctors. His doctors weren’t worried that we would sue them; Peruvians tend to trust their doctors and not to second-guess or take them to court. This in turn engendered more of an atmosphere of trust between family, patient and doctor—something that might make some Americans nervous but which worked well for our individual situation. In short, in Peru we were able to have more “agile” care—more responsive to the needs of the patient, less centered on legal protocol.
For those of you who’ve cared for elders in Latin America, did you have similar experiences? Did you find that the lack of paperwork and deemphasis on being sued made it easier to care for an elder there? Or was my family’s situation unique to Lima in 2011-2012? I’m curious to hear.