Bringing Medicine to Life

One part I really like about our curriculum is the frequent exposure to real, live patients.

For each module we have studied, we've had at least 1 patient who comes in and talks about their experience with a specific disease relating to what we are studying.

We started Endocrinology and Female Reproduction this week, and we've been lucky enough to have a patient every day.

Today's patient, Mr. X, came into the room, eager to tell his story. He starts to tell us how he suffered from high blood pressure for the past 4 years and how he had frequent episodes where he felt like he was in "the twilight zone" with a blood pressure measurement of 260/140 +. During these episodes, his whole body would tingle, his vision would go black, or color would be intensified. He described it as "If I was having an episode and came up on a red light, the whole room would have a red glow to it." He kept going back to his primary care physician, only to have his blood pressure medications changed or increased...without any significant impact except to "make me more irritable."

One part of his story really touched me when he was talking about being at his daughter's softball game, having an episode, and rushing to the doctor's office with his wife and daughter. "At one point, I guess I blacked out, and when I came to, the first thing I saw was my daughter crying. She is 21 and all, but she was just worried about her dad you know?" In that moment, I could completely understand being a daughter scared for your dad, and it just made the patient's story that much more touching.

Eventually, Mr. X was referred to the right doctor who picked up that he had a pheochromocytoma. He ended up having surgery and is doing very well after surgery. Going from 12 blood pressure medications a day to...TWO with a regular blood pressure of 120/80.

International Medicine

I returned from a medical trip to Haiti a little less than a week ago. I went through an organization called Project Medishare that aims to provide access to healthcare to the people of the rural, central plateau through local clinics and mobile clinics set up by international volunteers, like us.

I have been on a similar trip before to Costa Rica and Nicaragua, and both times I was struck by the EXTREME poverty around me. How much can sporadic primary care change the lives of people living under a faulty social structure? Although there may be a fairly constant stream of mobile clinics coming through somewhere close (and by close, I mean within 60 miles) to their vicinity, it's not like they have the same doctor who knows their history or even a different doctor that can look up their past medical history in a chart. Every time they see a new (most likely foreign) doctor, they have to start all over -- building a relationships, recounting their symptoms -- all through the barrier of non shared languages. Yes, translators help -- in fact, they are essential, but it's still not as good as being able to speak to and understand your patient.

It's an internal struggle doing international work -- am I really making a difference? Am I providing an essential service? Am I just doing this to make me feel better about myself? Am I doing more harm than good -- prescribing medicine without follow up, without knowing if the patients knows how or why they are taking their medication? I'm not the first person to face these struggles, there have been journal articles examining the effectiveness of international medical work, and even the different articles can't come to agreement-- are we doing something good or bad?

After my experience, I would say we aren't doing anything bad, and we are actually mostly doing good, AND occasionally, we're even doing something life changing. The medications we prescribe and give to our patients are mostly drugs most americans can get over the counter -- pain medication, antacids, multivitamins, etc... There is the occasional antibiotic, but honestly, antibiotic prescription abuse probably occurs more in the US than in Haiti. The doctors are very careful about prescribing anything that needs follow up --ex: anti hypertensives. And yes, it is hard to tell with a lot of the patients if they are actually sick or just describing the symptoms they know will get them the medication they need for when they really are sick and the american doctor isn't there. But when I think about it, so what if they are faking it? They are doing what they need to do in their circumstances. If I didn't have regular access to medicine, I'd probably do the same thing -- why not get some medications and get seen by a doctor while they are there? Also, I think having the doctor look at you and say "Your physical exam is normal" can provide a lot of psychological benefit.

The "life changing" patients -- the ones that have decompensated heart failure, glomerulonephritis, severe infection, early stage dementia, failure to thrive, or AIDS -- that maybe 1-3% we see, we can help them. We might not be able to be the hospitalist administering their care, but we can make sure they get that referral, that money, that transportation to get to a hospital and get taken care of.

And you know what? that 1-3% makes it completely worth it.