It was no exciting to finally be able to get back to the clinic after a two weeks off for vac and exam preparation. I was even more excited when I found out that I was going to be paired with a sixth year medical student. South Africans become general practitioners after six years, so this meant that the student I was with would be a certified M.D. in two months.
There was an insane amount of international students with us tonight, which one the one hand is a great thing because it allows people to meet other students and learn about their medical programs. On the other hand though, it makes things more difficult when trying to get through a lot of patients quickly. I was able to meet a group of students from Norway and Sweden, and Leonard from Holland, who is doing research on HIV here at UCT.
The first patient that we saw at the clinic was a six year old boy with a cough. He didn’t have any fever or many other symptoms besides the cough and a runny nose, but he hadn’t been tested for HIV before. I gave my first HIV test without any help and was happy to find it negative. While working with the boy I stopped to think about how amazing it is that the clinics run with so little supplies. When I went to the supplies room to look for a bandaid for the boy’s finger, one of the professors told me I should stop expecting such fancy conditions.
The next patient that we saw was a young woman complaining of a “tight chest”. She was having serious problems breathing, and was noticeably distressed with a resting heart rate of 116 bpm. I did my first chest examination without help, and was able to hear a wheezing sound. The medical student helped me determine that her airway was blocked off, probably due to asthma, and that she needed a bronchodilator. The medical student also thought that the patient may have a susceptibility to allergic reactions which was making her breathing even worse.
We asked the doctor to assess the patient, and he immediately began talking to the medical student about how she was going to be a real doctor soon and that she needed to avoid having tunnel vision. What he meant is that it is so easy to think you’ve discovered what’s wrong so early on that you only search for history to prove or disprove that idea, instead of thinking of differential diagnoses. He explained that this is how people are misdiagnosed, and that they will end up back in the clinic. He was harsh to us, but I could tell that he was trying to get us to realize the importance of exploring all options and being critical in order to make us better clinicians.
The last patient we saw was a sixty year old woman complaining of severe leghas diabetes and hypertension, which explained the pain and numbness she had. She also said that she was having incontinence. This is when things got very confusing. She didn’t speak fluent English, Xhosa, or Afrikaans, so we couldn’t understand what she was telling us. We ended up giving her Panado for pain relief and referring her to another clinic for further studies.
Tonight I really realized how much the language barriers affect physicians in this country. I wonder how many things have gone undiagnosed and treated solely because of this. I am hoping to keep adding to the small amount of Xhosa that I’ve learned in the clinic, and have made it a goal to start studying it on my own.