Different:
After only one day of shadowing Dr. Boyce in the outpatient clinic, it is quite evident that Haitian patients, culture, and medicine are different from what is found in the US. First, patient treatment is performed at a slower pace and in a more relaxed manner; I was very impressed with the amount of time that Dr. Boyce was willing and able to spend with each patient. Due to various bureaucratic pressures in the US, patients are bounced around between office staff and various allied health care professionals, and face time with a physician is minimized in order to maximize profit. Continuity of care is a low priority, which leads to a lower standard of care. In contrast, Dr. Boyce had the freedom to manage the doctor-patient relationship from beginning to end; patient history, examination, diagnosis, and treatment plan were executed in the same room and by the same health care professional ... and without pressure to see "x" many of patients in "y minutes." Each patient benefited from outstanding continuity of care.
As for the patients and culture, I have never before seen such a humble, thankful, polite, and respectful patient population. The women showed up in their "Sunday dresses" (for lack of a better phrase) and what had to be their nicest shoes. They were simultaneously brave yet modest, and exuded an uncanny gracefulness. The men--most of whom were escorting the women--were surprisingly proper and courteous; a stark juxtaposition to their demeanor while competing for business on the streets of Haiti.
Differential:
"Differential" as in "differential diagnosis." I have heard the phrase so many times, yet never fully understood what it meant. As I observed Dr. Boyce, I was awed ... no, overwhelmed ... by his ability to look at a chart, discuss the chief complaint(s) with the patient, rule in/out various afflictions, and devise a treatment plan. With so many variables and so many possibilities, I thought, "How can one come to a concrete diagnosis, and by what method is such a diagnosis reached?" The answer is "differential diagnosis." The methods are taught in medical school, however, only a lifetime of application can turn book knowledge into second-hand nature. Therein lies the secret to Dr. Boyce's talent; while his bedside manner and patient care are first-rate, his abilities to diagnose are beyond reproach. One day, I hope to emulate all three.
Difference:
Though a mountain of work looms in front of us, a trail of successful patient care follows closely behind. Let me offer some perspective: patients literally line up at the clinic in the cold, dark, wee hours of the morning and stand in line, hoping to see a health care professional before the clinic closes. Sometimes, after waiting all day, patients are turned away due to staff shortages. Patients then return the next day with the same hope, but also with a tinge of fear that they might not receive care. On this particular day, Dr. Boyce was able to see over 20 patients that would otherwise have been turned away. Therein lies the ultimate metric for our collectuve success: making a difference in patient lives, one patient at a time.
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