Tuesday, February 26, 2008

Reaching Out

This past Sunday, I volunteered at a blood pressure screening event organized by the Ethnic Health Institute (EHI), an outreach group associated with Alta Bates Summit Hospital. The first thing I came away with, after a long morning of measuring blood pressures at two large, African-American churches, was a complete love of outreach work. Some people whose pressures I took hadn't been to see a doctor in years. It's not that people aren't concerned about their health; it's just that they don't have the time, don't have the insurance coverage, or don't know the best way of navigating to HMO system to be able to see someone who can respond to their concerns in a respectful manner.

Which is where outreach comes in. In this revolutionary service, the health care providers go to the people, instead of the other way around. People who haven't been able to receive services suddenly find them stepping on their toes.

Outreach services have some added bonuses, which I discovered this weekend. One is that the sites where outreach services is delivered -- churches, in this case -- are much happier places than hospitals. I loved chatting with folks as they came out of church happy, talkative, and full of the music of their choirs. It also allows the providers a glimpse into the worlds of their clients. The biological world has intimate linkages to the psychosocial world, and any deeper understanding a physician can gain into this latter world will help her understand her patients' medical conditions.

Finally, I came away with a little excitement, and maybe some fear, at being looked at as a professional. I hadn't anticipated that, sitting on the other side of the table and wearing a name tag, I would be treated as an expert. People hung on every word I said, clutched the pamphlets I handed them, shook my hand. It made me think more about how I phrased my words and what I emphasized. It's not every day that someone listens to what I'm saying.

Wednesday, February 20, 2008

I got an A?

Yesterday, my patient gave me an A. My preceptor (the doc whom I shadow/help/learn from every few weeks) had left the room and given me the chance to interview the patient. On coming back, my preceptor asked the patient, conspiratorially, "So, how'd she do? An A-? B+?"

My patient, a lovely woman, and now one of my favorite people ever, gave me an A. Which, of course, made me really happy. It also has limited value, because I didn't actually have to produce any results -- the patient's treatment didn't depend on me, and the patient wasn't familiar enough with the history-taking process to know what questions I'd forgotten or not followed up on thoroughly enough.

But, I don't think it's meaningless. It says something (albeit small, I know, you don't have to remind me) about how I interact with patients. I actually do think I've gotten better at speaking with and listening to patients, at turning the "patient interview" into a "patient conversation."

But, a few minutes later, as my preceptor and I examined the patient's heart, I completely failed to hear what turned out to be a quite distinguishable heart murmur.

So, the point: medicine contains within it a huge set of skills, and a whole lot of information. It's so different from anything I've studied before because it has a well-defined end-point -- to be able to effectively treat patients -- and yet is so vast. A first-year who has improved in one area is likely miserable in a whole lot of others. And not only is it difficult to learn everything, but it's also hard to know how fast you should be learning. It's as if the "fire hose" that is medical school has created a puddle around you, and you're now trying to figure out if it's best to tread water or drink yourself to dry land. And how much you can drink at once without making yourself sick.

Tuesday, February 5, 2008

Our faces, ourselves

We recently had a basic clinical neurology lesson, in which we learned that the human face is among the most captivating objects with which to lure someone's eyes. When a patient is minimally responsive, moving your face from side to side and observing his or her eye movements can give you valuable information about the patient's mental state. Faces are the first objects that capture a baby's attention.

And yet, when I was told that a faculty candidate looked like me, I had no real basis for agreeing or disagreeing. I could objectively say that yes, her hair and skin colors looked like mine, so sure, there might be a chance that she looked like me. But could I really say if there was a "resemblance"? Could I "see it"?

No. Which is often the case with people who are told they look like celebrities or relatives or friends. Somehow, despite having a finely-tuned mechanism for picking out human faces, and telling one face from another, and years of experience with our own faces, it's very hard for us to compare these faces to others'. Is it precisely because of this extensive experience with our own faces that prevents us from seeing it as others do? Or is it a projection of our desired or possessed characteristics onto our physical aspects (as in, "I can't look like her because I'm more youthful-looking than she is")? Or something entirely? What does this mean in terms of our concepts of who we are, and our relationships to our physical appearance?