"So, what brings you in to the doctor today?"

I recently had to write a paper on the theories and models of the doctor-patient relationship. There is the paternalistic model, in which the doctor knows best and tells with patient what is wrong and dictates the care plan. There is the engineering model, in which the doctor gives the patient the facts and allows the patient to decide their own health plan. Then their is the collegial model, which emphasizes the need for relationship between the doctor and patient. It states that the doctors role is to listen, ask questions, advice the patient based on medical fact but the ultimate care plan is to be shaped by both the patient and the doctor, so that it takes into consideration the patient as a whole person, not just an isolated illness.

These all have different pros and cons, and (in my very limited experience) it really depends on the patient. In general, you (are supposed to) start with the collegial model, and adjust if you have to. The paper led me to think about the general role or job definition that physicians have. Although the obvious answer might seem to be, "heal people/improve their health," I'm learning how debated that answer is in the medical community, both in what it means and in its legitimacy as an answer to the question. A lot of the debate ends up centered around the doctor-patient relationship, and how the doctor is supposed to view the patient.

If the doctor views the patient primarily as a disease or illness, rather then a person, then the goal is simple: fix it. It might sound kind of harsh to say that these kinds of doctors don't see patients as real people, but as something to be cured, but they also get a lot more done. They see more patients a day (ie. they technically have more chances to heal), and the patient generally always receives the best care in the medical/scientific sense. Some patients seem to want this in their doctor, others don't.

If the doctor views the patient as a friend, or younger sibling, they might be really great at hearing the whole story behind the illness or injury, getting all the social/psych/family background, sympathizing or empathizing well, and maybe even sharing a personal fact about themselves. But after all of that, a lot of time has been spent and nothing has been done about the acutely medical need. Yet, a great relationship has been built, trust built, and whatever advice the doctor does give might be carried out more effectively by the patient because of that relationship. Again, pros and cons. Some patients think this is just a waste of time, others need it before they can trust the doctor.

I'm going through the gospels as my Advent reading, and its making me wonder: how would I classify Jesus' doctor-patient relationship. Sure, it gets more complicated because, well, He's the Son of God and knows people lots more intimately then I will ever know my patients. So maybe the question is more: what kind of doctor-patient relationship does Jesus teach others to have (noting the difference between following/imitating Jesus, and actually being Jesus)?

I'll let ya know what I think after I read a little more. After all, its only the second day of Advent :)

"So, what brings you to the doctor today?"

I recently had to write a paper on the theories and models of the doctor-patient relationship. There is the paternalistic model, in which the doctor knows best and tells with patient what is wrong and dictates the care plan. There is the engineering model, in which the doctor gives the patient the facts and allows the patient to decide their own health plan. Then their is the collegial model, which emphasizes the need for relationship between the doctor and patient. It states that the doctors role is to listen, ask questions, advice the patient based on medical fact but all the ultimate care plan to be shaped by both the patient and the doctor, so that it takes into consideration the patient as a whole person, not just an isolated illness.

These all have different pros and cons, and (in my very limited experience) it really depends on the patient. In general, you (are supposed to) start with the collegial model, and adjust if you have to. The paper led me to think the general role or job definition that physicians have. Although the obvious answer might seem to be, "heal people/improve their health," I'm learning how debated that answer is in the medical community, both in what it means in its legitimacy as an answer to the question. A lot of the debate ends up centered around the doctor-patient relationship, and how the doctor is supposed to view the patient.

If the doctor views the patient primarily as a disease or illness, rather then a person, then the goal is simple: fix it. It might sound kind of harsh to say that these kinds of doctors don't see patients as real people, but as something to be cured, but they also get a lot more done. They see more patients a day (ie. they technically have more chances to heal), and the patient generally always receives the best care in the medical/scientific sense. Some patients seem to want this in their doctor, others don't.

If the doctor views the patient as a friend, or younger sibling, they might be really great at hearing the whole story behind the illness or injury, getting all the social/psych/family background, sympathizing or empathizing well, and maybe even sharing a personal fact about themselves. But after all of that, a lot of time has been spent and nothing has been done about the acutely medical need. Yet, a great relationship has been built, trust built, and whatever advice the doctor does give might be carried out more effectively by the patient because of that relationship. Again, pros and cons. Some patients think this is just a waste of time, others need it before they can trust the doctor.

I'm going through the gospels as my Advent reading, and its making me wonder: how would I classify Jesus' doctor-patient relationship. Sure, it gets more complicated because, well, He's the Son of God and knows people lots more intimately then I will ever know my patients. So maybe the question is more: what kind of doctor-patient relationship does Jesus teach others to have (noting the difference between following/imitating Jesus, and actually being Jesus)?

I'll let ya know what I think after I read a little more. After all, its only the second day of Advent :)

Ambulence Sirens

I live a little under a mile away from Howard University Hospital. One of the things this particular hospital is known for is its excellent trauma department. I hear ambulances with blaring sirens going down the main street near my apartment all the time. At least one per hour, I would estimate, and sometimes more depending on the day and time.

I had an exam this morning, which meant that the last few days were consumed with studying. Since I have been studying mostly in my apartment, I hear these ambulances quite frequently. Hearing them while studying to become a doctor is an excellent characterization of some of my current frustration with being a student again. There I am, slaving away memorizing which enzymes cleave which parts of DNA, when, how, and what the significance is, and out there is all the action: real doctors with real patients.

Of course I am glad that those real doctors went to med school and learned their stuff, and that this is simply the stage of life I am in right now. I am generally someone who really enjoys school. I enjoy learning, and sometimes studying, and I am able to make the connection between working responsibly as a student in a subject area I love and worshipping God. God's given me a mind that can think and learn in a paticular way, and a desire to learn a particular set of material. Ignoring or not using that gift is not glorifying to Him, and I believe that God delights when we live and move and have our being in accordance with the way He made us, rather than trying to invent false selves.

But sitting there studying, even though I can feel connected to God in doing so, still leaves me longing to be out in the "real action." It isn't because the studying is boring, or because I don't understand its importance. Even Israel had to go through massive training in the "wilderness school" before being ready to live in the promised land. Yet, it is easy to disconnect time spent studying or "in training" from God's greater purpose. But the second they are disconnected, the preparation looses its purpose and despair ensues. Israel had to continually be reminded about who God is and what He promised not only because they were forgetful and it is important to not forget about God, but because their life situation wouldn't have made any sense outside of that context. They had to intepert the present through God's work in the past (creator and liberator), and through His promise for the future. Without the past there would have been no trust or sense of identity, and without the future there would have been no hope. And yet trust, identity, and hope are to be used in the present.

So in some ways, the amublance sirens are helpful in reminding me about the future (not that I want to be a trauma surgeon...). They also have the temptation of allowing me to think that for now my job is to study and that one day my job will be to heal people, when in fact we are created to preserve life, or "be salt," at all times, not just after going through the proper training.

personal statement

It seems like so long ago that I started writing this for my med school primary app. Almost exactly a year ago. So much changes in a year. In the last year I have very much come to know God as the Father who loves to give good gifts to His children. And they really are gifts...unearned and good. Receiving from God, I've come to see, is most complete when we can offer back to Him what He gives us and allow Him to continue to shape it.

In the spring of my freshman year at Penn I asked a few friends if they wanted to join me for an organized street clean-up of West Philly. This is the kind of invitation that many feel guilty turning down, but rationalize by saying: "the trash will just reappear the next day," or " you can't do everything to try to fix the world." Both statements are true. Half a day of picking up trash has no lasting effect, and I struggled that week with the feeling that serving others is an overwhelming task- that there are too many people and places in the world that need help.

The next summer I worked at Esperanza, a Spanish-speaking medical clinic in North Philadelphia that serves the poverty-level families of the neighborhood. My days were filled with accompanying doctors in examining rooms to translate, writing and administering quality of well-being surveys to patients, and compiling these responses for the purpose of future grant proposals.

The patients at Esperanza frequently struggle with diabetes, hypertension, malnutrition, skin diseases, depression, and a wide range of STDs. I sat with physicians and observed the process of developing treatment plans for patients, often diagnosed with multiple conditions. I then accompanied the doctor during his time with the patient, translating prescriptions and medical documents into Spanish, explaining, and often re-explaining, the purpose of each drug or nutritional suggestion. Many of the patients could not read or write well enough to complete the needed paperwork without my assistance.

One afternoon I spoke with a woman who had recently emigrated to Philadelphia from Puerto Rico. She had diabetes, but could not find a successful treatment plan. When her lab results came in, I listened as the doctors problem-solved for a better combination and dosage of drugs. What intrigued me about this process was that it required a personal knowledge of the woman's medical history as well as a powerful and intricate scientific knowledge of the biochemistry unique to the drugs prescribed. Even slight changes to dosages affect the patients in individual ways. This problem-solving process required patience and a clear and systematic thought process, as the medications she had previously been prescribed should have been effective. I learned that persistence and patience were key in the medical field, and I called the woman once more to double-check the medication that had previously been prescribed to her. Through our dialogue I learned that she could not read the instructions on the pill bottles and thus had not been correctly administering the medication. I asked the woman to come in so that we could give her a more formal explanation of diabetes, the treatment plan, and the remainder of her lab work, which showed that she was also infected with an STD. When she returned to the clinic the following day, I reviewed each medication and dosage she would be receiving and helped the doctor relay vital information about diabetes to her. I saw that as a physician I would need to know the biochemical consequences of these medications, how they would affect other physical ailments or drugs, what nutritional and environmental factors could be helpful or harmful to treatment plans, and most of all, how to communicate these facts to patients in a way that is clear and compassionate. It took a lot of patience and determination to ask the right questions in order to get accurate medical and personal histories; but it often took even more patience to respond, knowing that I had to put aside complicated scientific explanations and instead deliver accurate information in ways that showed each person dignity and compassion.

After explaining diabetes and the procedure for measuring blood sugar, the doctors and I told her about her STD, Chlamydia. She was clearly upset, vexed by the issue of how she had contracted it. It was difficult and heart-breaking to then explain that if she had been faithful, it was likely that her husband had not been. It was in conversations like these that I marveled at how different genres of medicine fit together. My time spent in research at the Scripps Institute and in science classes at Penn made the process of prescribing medication and explaining the intricacies of the human body to patients in a clinic extremely meaningful.

Further experiences at Esperanza and in my current job with the UCSD clinic have shown me that many patients share similar, heart-rending circumstances. No matter how hard the doctors, nurses, and I work, we find the same stories walking through our doors every day. My time in city clinics has taught me to persist in choosing action, relationship, and communication through the moments I am tempted to settle with simply feeling overwhelmed by the condition of community healthcare. In these clinics I find myself re-living that morning when I cleaned the streets of Philadelphia, and I think back to that summer day at Esperanza when I chose to give 'esperanza,' or 'hope,' to one of my first patients. It was then that I learned that hope, emerging from persistent scientific research melded with sincere human compassion, is not only something worth giving, but what I most desire to bring to patients in tangible and lasting ways.