One week in the Dominican Republic gave me a renewed perspective on practicing medicine.
I know most of us have wondered from time to time, if not daily, how our
personal vision of being a trusted healer, a physician, with a unique connection to our patients, became so different that what we’d hoped. I know I have.
Thanks to my long-time partner, Charles Rhodes, M.D., I can see clearly now where we have strayed over the past decades in our priorities in the U.S. health care system.
Rhodes has spent the last 20 years serving those who needed him in the Dominican Republic through medical missions with Solid Rock International, all while continuing to serve the citizens in the community we both have served for almost 40 years. This mission became his passion and the work they do is truly remarkable. It became a way, through his faith, to give back in a way he found difficult here. I am proud of what he has accomplished.
Rhodes has always supported me through my career and journey to make a difference in the U.S. health care system, as a partner and a friend. Because of schedule conflicts, I was never able to join him on his trips, until this year. It was time for me to support him in his mission and it was truly life-changing. It connected me back to what it truly means to be a physician.
While our surgical team supplemented the local physicians in San Juan and operated at the local clinic, our medical team, armed with as many medications as we could carry in our mobile pharmacy, traveled 1-2 hours by van pulling a trailer down gravel roads, crossing streams or into the mountains to provide care in tiny villages.
Imagine seeing patients, in a small, one-room church or school or any open building, armed with only an interpreter and your best diagnostic skills. There would be no labs, no x-ray available. The only medications available would be what you brought that day. Referral? You are committing the patient to a multi-day journey if they can even make the trip.
Our hope was to find patients in whose lives we could make a difference, ease suffering by providing medications, provide hope, and in some cases provide lifesaving or restorative medication or treatment. Some villages had access to a physician nearby, others had none. Everyone we saw was incredibly nice and appreciative, most not realizing how poor they were. It was clear that each village took care of their own elderly and children as best they could.
I have many stories of patients and experiences while in the Dominican Republic but what I want to share with you are the four lessons I learned from my experience that have rekindled my hope for medicine.
Lesson 1: Communicating with our patients is the most important thing we do. I immediately realized how much I rely on communication to connect with my patients when I was limited to communicating only through an interpreter. You must choose your questions carefully but much of the nuance is lost. It is very easy to start talking to the interpreter and not the patient. But connecting to the patient is still possible even under these circumstances if you make the effort to do so. A wise mentor of mine once told me, “The patient will tell you what is wrong with them, if you will only listen.”
Lesson 2: The power of touch. There is something unique about the power of touch when ministering to our patients. The gentle touch of the exam or just a reassuring touch while talking to your patients. That connection transcends even our ability to communicate with language. It says we care or that things will be ok or that we feel their pain. It has a healing gift of its own. In this case, it was about hope and caring. Getting to experience that connection with adults and children in the Dominican was a blessing.
Lesson 3: Your knowledge, experience and skill are still your most important assets. Imagine a day without all our labs and imaging, computers, or consultants. You can only rely on a history and physical exam to make a diagnosis or solid differential. Turns out that, more often than not, those are all you need.
How are your differential diagnosis skills these days? Mine were a little rusty, but still there. Imagine seeing patients with cataracts so dense the patient can’t see, a toxic goiter you can visibly see pulsating, undiagnosed advanced Parkinson disease, complications of undiagnosed polio or a child who can’t speak at age seven. What I realized is that knowledge and experience is not the exclusive purview of any discipline or specialty but is open to all. However, there are no shortcuts to attaining them. You can’t diagnose what you don’t know.
Lesson 4: Much of our work in today’s medicine is purely about getting paid When I realized that each patient visit was all about the care, I was amazed how much time I actually had to just interact with the patient and still see 15-20 patients in a session. My documentation was simple and handwritten on a single slip of paper. Complaint, pertinent physical findings if any worth noting (although I would always do my own vitals), my diagnosis or short differential and Rx, that was it. This was me practicing at the top of my license. Such a blessing to experience proving care over documentation again.
Looking back, in the end this mission trip was really more for me than those I served. It clearly reaffirmed for me why I became a physician and practiced in a small town. In these days of such cynicism, we all need an experience like this to reconnect us to our shared humanity. Thank you to all our physicians and health care professionals for your service to the citizens in this country and the world. There is no more noble calling.
L. Allen Dobson Jr., M.D., FAAFP, is a family physician and editor-in-chief of Medical Economics®.