In Doctors We Trust

An Apple a Day Keeps the Doctor Away 

The NHI Clinic Karilyn and I work at everyday

At first I thought it was the relaxed Belizean culture, but over the past 3 days I have come to appreciate the high level of trust the Belizean people place in their doctor. Let me explain further through an example between 2 experiences I had in my primary care office in America and the clinic here.

America: A patient comes in and begins to describe what has been going on for the past few days: low grade fever, chills, malaise, sore throat, and runny nose and a few swollen lymph nodes. The PA and I concluded that this patient probably has a viral illness and he needs nothing more than a few days rest, lots of water, and an over the counter decongestant. The patient was very hesitant to agree with our diagnosis. He stated this is the second place he has visited and the other doctor came to the same diagnosis that we had suggested: a cold. The patient was convinced, as a result of internet research, that he had lymphoma because of his symptoms. He instead he get an ultrasound of his neck, a full dose of antibiotics, and a complete hematologic blood workup. Talking to the patient would not soothe his fear and we eventually ended up giving him what he wanted because we knew he would continue to visit other places until he got his antibiotics, blood work, and ultrasound.

Belize: A patient comes in describing a 3 day history of runny nose, sore throat, cough, and fever. The doctor and I agree that this patient has a cold and needs rest, fluids, and could benefit from some Vitamin C supplements. The patients thanks the doctor for seeing him and says "you always know what makes me better doc."

While both of these are some of the more extreme cases I have seen, very few of the patients I have seen in Belize these past 3 days (which have been over 100, it's a busy practice!) have disagreed with the doctor's decision or considered their diagnosis to be wrong. While they may question the doctor about the diagnosis and plan of care, no one has outright disagreed with what the doctor was saying.

Back in America, it's not only distrust in a clinician's decision about the patient's care, it's also trust in who is seeing them and examining them at their time of arrival. To many, the student knows nothing and their time with the patient is just an excuse to keep the patient at the office longer. They always question what you are doing, if you know what you are doing, if you have ever done something before and if there is someone else more experienced around to help. It is hard to gain confidence in yourself and feel like you are doing something right when people constantly question you and look down on all of your time and efforts.

Since I have been in Belize, I have been amazed by the level of trust both the patients and doctors have in my abilities. The clinic serves those from birth until the time they pass away. Each time a child comes in, the doctor tells them the student will be doing the exam. The majority of the mothers freely hand the baby over to me as I take it over to the examining table around the corner. Only a few mothers hold their newborn infant to make the exam easier for me or stay nearby if the child is crying. The first time I was handed a baby and told to do the physical exam, I was shocked. I never expected the mother to trust a stranger, especially an American who is clearly not a local, with her child.

At the same time the patient is placing their trust in me, so is the doctor. For each patient, I am responsible for the full physical exam to the extent I feel necessary. The doctor never does the physical exam himself and he relies on me completely to find if there is anything abnormal of note. I am accustomed to doing a physical exam and then having someone else come right after me to do their own to make sure nothing was missed. Having this level of trust placed within my hands has forced me to become more confident in knowing what to do and knowing when to speak up when I think there is something wrong. For the first time since I have started rotations I can finally see what the responsibilities of everyday work would include.

I was talking with Karilyn about this observance and the value of trust and both we agreed that people back home seem to be much more hesitant to trust their medical providers. Patients are constantly seeking a second opinion or asking for something unnecessary because of outside sources feeding them different information. I don't know if this lack of trust patients seem to have for their doctor stems from a poor patient-clinician relationship, or from the vast amount of information on the internet that they can acquire.

This realization makes me think about the type of clinician I want to be to my patients. I want to have a trustworthy relationship with my patients where they feel comfortable asking me questions about their care, while at the same time trusting my decisions to provide them with the most appropriate medical care for their underlying condition. I want them to feel comfortable in my presence or in the presence of a student should I ever have one rotating with me. Right now I am so focused on learning all of the facts and figures I sometimes forget to take a step back and realize that the more important part of medicine is establishing a relationship with your patients and gaining their trust.

Its been a busy day, filled with patients and discussing with the doctor all the important pieces of the puzzle to being a quality clinician.

All the patients I examined today, over 35! 

Karilyn and I catching up writing SOAP notes in the clinic  

 Since everyone loves photos, here are a few more from my day:

Karilyn and I enjoying a cup of coffee before being picked up to head to the clinic

We cross this bridge everyday to get to the clinic. The river separates the heart of Belize City from the surrounding city centers 

The Publics grocery store we have visited everyday since it opened back up on January 3rd.
Their homemade fresh bread and treats are DELICIOUS and keep us coming back for more.