Today was my fifth clinical/ hospital rotation visit and today my group went to the neighborhood of Perdmontemps. In case you don't speak French, Perdmontemps means "I'm wasting my time." I have to say, it is one of the more unique town names I've come across. I only wish the translation didn't have any literal truth to it for anyone involved today.
It was a good 35 minute drive up and down and around the island to St. David's Parish. I had been prepped by my roommate and other classmates but still, first impressions were not much. We pulled up to an unassuming cement building just off the road with a sign that said Perdmontemps Health Clinic. As we entered there were at least 30 patients crammed into a small waiting room. There was small window and door on one side of the waiting room (the pharmacy) and on the other side a small divider was set up, behind it a nurse took vitals and triaged the patients. There was a make shift lab area and two examining rooms. Two other assistants helped organize the patients and there was one doctor. This was at 8:35am in the morning. When I later asked our patient if it was always this busy she said yes. She told me that she had arrived extra early this morning, much before 8am so that she could be patient #1 (and as a reward for coming early she got to see 5 medical students and hang out at the clinic for several hours instead of just a few minutes, lucky her!)
We were escorted into one of the examining rooms where our preceptor and physician, Dr. Drum came in to greet us. He gave us a brief run down on how public health care in Grenada worked and how patients were seen in their neighborhood clinics on a set day, once a week. Medical care is free but patients pay a nominal fee for prescriptions. Each neighborhood has its own clinic and the doctors rotate through different clinics much like traveling circuit pastors use to do in rural areas of the US. He then brought us a patient, instructed her to let us ask whatever we needed to ask and left us to do our interview and exam....
And so we did. Now our patient was diabetic and hypertensive and she took medications for both. But she explained that usually when she came to the clinic (she said she came every three months for check ups) her visit was only a few minutes long, and since she was coming so early this morning she didn't take her meds or eat breakfast beforehand. Dr. Drum came back to check in on the group once but he was so busy seeing other patients that it really was just 5 medical students and our patient for over an hour. As the time passed on she started complaining of being hungry and wanting to leave and I began to wonder exactly why she should continue to let her blood sugar fall at our learning expense. (Of course, me who ALWAYS has a snack in my bag of some kind, had only water today.... And no one in my group had anything either. Our white coats are not yet the hold all bags and walking storage units that they will soon become.) Finally we were finished and our patient was threatening to walk out so I went in search of Dr. Drum on behalf of her blood sugar. Dr. Drum came back. I presented the patient. (He critqued me and I didn't fell all warm and fuzzy, but he ended up giving my 5/5 for presentation skills so I guess I did okay.) We presented our clinical findings. He made us demonstate our technique and any pathology had to be examined and appreciated by all five of us. This was not a waste of my time, but I felt complicit in a relationship that I am not sure the patient wanted to be a part of, she was clearly ready to go at this point but Dr. Drum felt that he still had teaching to do. When we finally finished and she bolted from the room we had been there for over 90 minutes.
We (as 5 students) had seen one patient. There was a waiting room full of patients to be seen and we still had plenty of time left before the bus would be back to pick us up. A group member asked Dr. Drum if we might be able to see another patient and he replied that we should have taken more time with our given patient. (Now I think that 90 minutes is more time then we will ever get in the US healthcare system and more time than we needed. We could have subjected her an entire complete physical, instead of a focused, but to what end? She didn't even want to be examined by us. And she certainly didn't want to sit around and be reexamined again and again. I didn't ask if this wasn't a "Perdmontemps" for the patient, but I wanted to.)
I am grateful for the opportunity to see medicine at a community level in Grenada. I am thankful to Dr. Drum for allowing medical students to come to the clinic and see patients with him. He also comes to SGU and is a preceptor in our clinical skills course so I know that he cares about students and is a physician educator. But I also feel more than just a little bad "using" patients to learn when I don't think they they really benefit from the encounter. Maybe this is something that I will have to accept and come to terms with. But as of now I am still wrestling with how to be a medical student that has something to give. I don't want to simply take.... I know that more often than not what I will have to offer is time, a listening ear... and hopefully I can be a good conversationalist for whatever time we have together.... the patient has so much to teach me. I only hope I can give something in return.
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