The Doctor-Patient Relationship: A Puerto Rican Example
Notes
1.Currently there are three institutions in Puerto Rico accredited by the Association of American Medical Colleges: 1.Universidad del Caribe School of Medicine, 2. Ponce School of Medicine and 3. the University of Puerto Rico School of Medicine. 

2. Emili Duke is a Phi Beta Kappa graduate of North Carolina State University: B.S. Chemistry, Zoology, Genetics; B.A. Spanish, Anthropology, and an Honors student at University of North Carolina medical school.
Note update:  Emili Mack, MD is a licensed pediatrician currently at Oberlin Road Pediatrics in Raleigh,  North Carolina.  December 2008.

 3. Researcher and subject had never met, but shared a distant familiar bond: Julia Cardona Mack, the coauthor of this article, is the mother of Emili's fiancé and a niece of Dr. Ortiz.  In the context of Puerto Rican society this connection constituted a strong personal link between researcher and subject.
 
4. The same Census reports 55.3% of the families in Puerto Rico with incomes below poverty level.  In North Carolina Hispanic families with incomes below poverty level at this time were 13.3% of the total Hispanic population.  In the total population of the state of North Carolina 9.9% of the families had incomes below the poverty level in 1989.

 5. Emili did not observe women asking for more privacy during the physical examination.  This may have been a reflection on the gender of the observer.  We do not know if men would have been comfortable with a man observing their physical exam, and this subject did not come up during conversations with Dr. Ortiz. 

 6. For example, the cost of debridement was $40.00.  This was a one-time-only fee.  When the patient returned for repeated treatments the visits were free.  A TB skin test was $11.00, which was the cost of the test and supplies.  Twenty dollars was the fee for a physical exam for driver's license or job applications. For sick visits, Dr. Ortiz only asked for the percentage of the standard charge that Medicare wouldn't pay.  It was always variable between $1.74 - $8.00.
 
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