Category Archives: Doctors

Checkup Time 2015

A couple months ago, I went to see Dra. Marta Sánchez for the annual prostrate exam.

All went well, however, this year I also needed to see an internist to get a letter stating I am in good health and qualify to get a driver’s license. In Panama, this is required every two years following your 70th birthday. Prior to 70 it costs $40 for a 4 year license, i.e $10/year. After 70 it cost $40 for a 2 year license, i.e. $20/year.

Dra. Marta had recommended Dr, Héctor R. Caballero, who is an internist as well as a specialist in diabetes. My dad had diabetes, and I had asked her if she had an internist with experience in diabetes.

When Lilliam called, to set up an appointment, the admin asked if I spoke Spanish. My name had raised the red flag of a potentially Spanish challenged client.

Lilliam said my Spanish should suffice and she would be there as well. Apparently, Dr. Caballero wasn’t taking any more patients that only spoke English because of past communication problems.

This is why all people planning on living in Panama need to learn Spanish. While you can find doctors that speak English, you will be limiting your options.

I was extremely impressed with Dr. Caballero. It may have been the most thorough exam I have had, He asked me to get a special blood test, since my sugar level is borderline. I did that yesterday and will have the results for the next visit in a couple weeks.

He did provide the required letter for the transit authority. I will get that taken care of before the end of the month.

The office visit was $50. $40 with the jubilado discount. I got the blood test at Hospital Mae Lewis, since we are there every day and no need for a special trip to Hospital Chiriqui to get the results.The blood test was around $16.

My appointment yesterday was for 1:30 PM. We were told to be a little early. We arrived at 1:00PM. We entered the doctor office at about 2:45 PM..

We were entertained in the waiting room by a confused woodpecker. At least I think it was a woodpecker.

I kept hearing this noise. For a while I thought someone was working outside. It continued and I finally noticed this bird pecking at the corner of the windows. He would leave and return. I am not sure what he thought he was going to accomplish by tapping on the window, but he did keep me amused. As you can see, it doesn’t take much to amused.

Doctor Reference

Always good to get a good doctor referral.

Hi Don,

FYI, MSPH Care now covers med/Dr services at Hospital Mae Lewis.

Planning my hernia surgery, I got exams from 4 Drs; 3 at Hospital Chiriqui, 1 at Mae Lewis. I choose Dr Samuel Cattan Jr, who only practices at Mae Lewis, and does not float between both private hospitals. Meaning also, I choose Mae Lewis over H. Chiriqui, even tho H. Chiriqui is a much better facility; better to pick the Dr, not the building. Dr Cattan was the only 1 of 4 who thoroughly examined me, detailed my condition, and explained the surgery.

I had exams one day, had lab tests the second day, had surgery the third day, was released from hospital the forth day. Couldn’t have had faster than that! Much of that service due to the hand-holding of Dr Cattan. He personally walked me thru the 4 lab tests; he was there to greet me when I was admitted into hospital; after his surgery he visited me in my room; the next morning he post-op examined me and issue a hospital release. After 2 days convalescing, I bussed home to Bocas. A week later, I was back to my regular self. That only happened due to the care and skill of Dr Cattan. I cannot more highly recommend a surgeon.

Post on CC if you wish.

Larry

Another HealthCare Observation

I have another healthcare case, which is providing more experience, that I feel I should share.

This individual came to Panama with no insurance, only social security income, and has developed significant healthcare issues. He was taken to one of the public healthcare facilities and was seen by the resident doctor.

The doctor was very vocal in stating that he did not understand why elder American citizens, with medical problems, are allowed in Panama and why the U.S. Embassy does not provide assistance to them. He ended the conversation saying that he would limit his service, for this patient, to just writing a report on his condition and no more.

He explained that there are no beds in the public hospitals and that a Panamanian needs to wait almost seven days for a bed.

I know this doctor, as he is the doctor that Hogar Santa Catalina took Robert (the stroke victim) for a checkup. In that meeting, he accused all U.S. Citizens of being insolvent and if he needed treatment that he would have to be taken to his private practice in Hospital Chiriqui where he would bet paid his specialist fee.

Needless to say, this doctor was removed from my list of doctors receiving a recommendation by me. His attitude is a discredit to the medical profession and he is a poor representation of Panamanian physicians. He was extremely rude to me when I was was with Robert in his office.

That being said, it should be noted that his sentiments are shared by others. Luckily, they are the minority. I will admit, that while this doctor’s deportment is deplorable, he has some valid points behind his statements.

If this individual goes to the Regional Hospital and has the proscribed CAT scans, x-rays and other tests, he may not have the ability to pay. If that happens, it will put more more burden on the already overburdened Panama system.

Most private hospitals will not admit patients without proof of payment. The public hospitals are crowed and understaffed. Walk-ins to the public hospital will most likely be placed on the same 7 day waiting list mentioned by the doctor.

I had another case where the Regional Hospital asked a U.S. citizen to leave because they said he was in good enough condition and they hospital needed the bed. I received a call from his landlady about 6 hours after his release telling me that he was not doing well. He died about 2 hours after the 911 services arrived. It was obvious that it was an error by the hospital to release the patient.

Bottom line is that if you are moving to Panama, with a problematic medical history or the probability that medical care will be needed, be prepared to pay. I took a physical prior to moving to Panama and found that I needed surgery and didn’t know it. The rumors of cheap health care in Panama is always relative.

I can visit a clinic for a cold or infection or minor office visit. The cost will be $6 for the visit and I have always been treated with respect. However, if I need to see a specialist, the office visit will be from $35 to $80 or so after the jubilado discount. In all of my specialist doctor visits, I have always been treated with resect.

I always advise any person making an exploratory trip, for viewing Panama as a retirement location, to visit the hospitals. You should also visit the Regional Hospital (public) even though you think you would only use a private hospital, because the public hospital is most likely where you will be taken, if you are in a serious accident.

If you do move here, you should immediately determine what doctors you want to use as your primary care physicians. Finding one in an emergency may put you with one doesn’t like foreigners.

Dr. Bullen’s Next Office Date – June 13

I received an email from Dr. Bullen asking me to let those in Chiriquí know that he will be in his David Office on June 13.

When Lilliam’s search for a skin cancer specialist resulted in finding Dr. Bullen in Panama City, she would tell him of the real need in David for a doctor with his capability. She was going to him every six months and on each follow up, she ask when he would open a David office.

You can than Lilliam for him being here.

The original post and the previous post have more information of his dermatology practice. I saw what the treatment by a doctor without Dr. Bullen’s experience can do and I have seen how he has taken care of Lilliam.

That is why I don’t mind helping him become known in Chiriquí.

S.O.L. In Paradise – Beating A Dead Horse

As I mentioned in the previous S.O.L. post, it will be worth following the thread in Boquete Ning.

Today, Bonnie Williams wrote a comment that I don’t want to get lost in the midst all the other comments on the ongoing thread. While she limited it to ExPats in Boquete, I would expand it to all of Chiriquí.

Here is her comment.

I think we’ve beaten this subject to death. To summarize, I see expats in Boquete having essentially four options for healthcare:

1) Have no insurance in Panama. Go to Hospital Regional for medical emergencies, but be aware that it may be difficult to receive timely attention. And you will be billed upon departure. Non-emergency surgery will be delayed, perhaps forever. Plan to return to the U.S. for any needed medical non-emergency services.

2) Enroll in the Hospital Chiriqui co-pay plan. This will pay for many routine, preventive procedures, but it will pay only part of the cost of hospitalization and/or surgery, and there is a relatively low cap on how much it will pay annually. It pays for no bodily appliances such as stents and pacemakers. This can result in the patient owing a significant amount of money.

3) Buy comprehensive national or international insurance. It is expensive. But it has a high payout limit and, after the chosen deductible, pays most or all medical expenses. There generally is no required deductible for emergency or pre-approved hospitalization or procedures.

4) Self insure and hope that you have enough put aside to cover a catastrophic medical event such as heart surgery, serious automobile accident, etc.
As routine medical care in Panama is relatively inexpensive, most expats can meet those expenses without incurring significant financial difficulty. When considering health insurance needs, it is my opinion that particular attention should be given to catastrophic medical events which, without good insurance, could subject one to no care, poor care, and/or financial ruin.

Dr. Bullen’s Office is Open

Like the butcher that backed into his blade, I have been getting a little behind in my work.

As I said I would in my previous post, I went by Dr. Bullen’s office on May 16 and took photos. Unfortunately I took them with my real camera and not my iPhone and forgot about the project and didn’t post them.

His office is easy to locate in Hospital Chiriquí. Take the hallway directly across from the Pharmacy and the first office on the right is his Office. The sign on the office follows:

P1000597
Click to enlarge

I talked to Dr. Bullen and asked if he could do everything as if he were in Panama City. He said he will be able to after he gets the pathology lab trained. He said some of the lab work is done differently than they are trained to do it, but that will change.

He said his charges are the same in Panama City as in David. $75 for the consultation. That is $60 for jubilados.

Dr. Bullen has two areas to serve patients. I am including two photos.

P1000598
Click to enlarge
P1000599
Click to enlarge

 

 

 

 

 

 

 

 

I picked up a card in his office that takes about services he provides.

bullen x

bullen4

I wish he had been in David when Lilliam first had her problem diagnosed. However, He was a god send when she was advised to see him in Panama City. See Previous post for office hours.

S.O.L. In Paradise Discussion – Continued

The original S.O.L. In Paradise post I wrote provoked Lee Zeltzer to start a discussion on Boquete Ning called “Putting A Healthcare Rumor To Rest”.

I think healthcare is a necessary item to be discussed by foreigners living in Panama and those thinking about or in the process of retiring here. The discussion going on in Boquete Ning is very lively and I think it is worth your following the thread.

I do take issue with the way Lee framed his discussion.

What I take issue with is his saying,

“Don wrote about it, perhaps prematurely and then contacted the US Embassy to obtain verification.”

(“it” referring to Regional Hospital healthcare). That implies, that as an afterthought, I wrote the Embassy, which is not true. I wrote the Embassy prior to writing the post.

I felt that the information I had been given was of significant importance to be presented. I qualified that it might only be related to the fact that heart surgery would not be available in Hospital Regional after July 1.

Lee said that I should have talked to a second doctor before making the post. I have been in Panama since 2002 and know that you can get any number of answers from doctors. I would not trust the answer to this question being told by one, two or more doctors. The only way to get the real answer would be to ask the legal council of the hospital, and the Embassy is the best source to ask the question. Continue reading S.O.L. In Paradise Discussion – Continued

S.O.L. Post Updated

Just a note to let you know I received the U.S. Embassy response from the Regional Hospital.

Here is what the Embassy found out:

Good morning, Mr. Williams,

After several attempts, we finally got contact with the Legal Office at Hospital Regional in Chiriqui few minutes ago.

We asked the attorney there to please clarify if persons without insurance (referring to PNM Social Security Insurance -CSS) could be treated there. The attorney replied that Hospital Regional provides medical services to both the CSS beneficiaries and the non-CSS individuals, in the last case, referring to all individuals in Chiriqui that require medical attention. The attorney emphasized that it is expected that the non-CSS individuals pay their medical bills (–the attorney added that even if the individual does not have funds to pay, the Hospital is willing to accept partial payments until bill is totally paid).

We also asked the lawyer about the Hospital Regional sending or referring non-CSS individuals to Hospital Santo Tomas in Panama City. The lawyer denied this possibility saying that it is not true. Per the lawyer, Hospital Regional’s principles is to provide medical assistance to any person that needs it regardless of that person’s nationality.

Please let us know if you have any other questions regarding to this issue.

Saludos,

Dr. Ricardo Bullen – New Dermatology Clinic in David – May 16

UPDATED May 6: Office information at end of post.
It is a pleasure for me to announce a new dermatology clinic that will be opening in David.

I recently received an email from Dr. Ricardo Bullen, who notified me that he will be opening a Dermatology Clinic In Hospital Chiriquí in Office #1 on the main floor.

He said they are currently in the process of getting furniture and setting up the office. His intent is to be open in March.

His main clinics are in Panama City in Paitilla and San Fernando from Monday through Friday.

The new David Office will have office hours on Saturdays from 9:00 AM until 5:00 PM.

Following are Dr. Bullen’s current websites:

www.ricardobullen.com
www.dermatologypanama.com
www.dermatologiapanama.com 

Following are Dr. Bullen’s Credentials:

Board Certified Dermatologist

Sub specialty skin cancer surgery  Mohs surgery

Dermatology training – USA and Canada – McGill University and Boston University,  clinical dermatology – University of Wisconsin and University of Texas,  skin oncology, skin cancer surgery Mohs surgery and reconstruction.

George Washington University – Director of the department of dermatologic , surgery ,Mohs surgery and reconstruction 2008-2011

Medical Lic. Panama, California, Massachusetts, and District of Columbia.

Now on a personal note, I have been wanting to write up Dr. Bullen’s practice for some time. Continue reading Dr. Ricardo Bullen – New Dermatology Clinic in David – May 16