During my medical training in the U.S., friends and family members would often ask me to share my best stories from life in the medical world.
They wanted to hear about blood, injuries, and out-of-control patients. The more unexpected and fascinating the story, the better.
Now that I practice medicine for impoverished communities in Asia, friends and family want to know what my experience of the medical world is like now. Are there big differences in the way medical care is provided? What are some things that I didn’t expect? Here are my thoughts about what I've learned as a doctor in marginalized communities:
- Patients can self-prescribe. Most facilities in marginalized communities do not need a prescription or doctor’s order. For example, an ear infection results in a walk to the pharmacy shop for amoxicillin. No prescription required. A sprained knee doesn’t require a doctor’s visit, referral to sports medicine, and then MRI (after the insurance company’s prior authorization of course). Nope, a simple visit to the imaging center for the MRI will suffice.
- Patients are required to bring a personal attendant. Every patient, whether a minor, a middle-aged man, or an elderly woman with dementia is required to bring a personal attendant to be at their side during the entire medical encounter. During hospital stays the attendant brings food, water, and changes of clothes. They are also responsible for purchasing and bringing medications, IV supplies, and other medical equipment that will be used by the medical team in the treatment plan. Finally, the attendants are very valuable in receiving and understanding instructions that will help the patient manage their condition outside the clinic or hospital.
- Doctor visits are shorter. The average doctor visit lasts less than 2 minutes! Seriously. Most locals blame the physicians’ desire to generate income from as many patients as possible as the reason for this practice. And because the area is so densely populated, there’s no shortage of patients seeking care. As a result of frustration over this practice, my landlord was overjoyed that I essentially became the in-house pediatrician for his 5-year-old son. He loved that I took time with his son, asked good questions, and conducted a thorough physical examination each time he had a concern.
- “Best” isn’t always possible. During my training I was constantly reminded to follow the most up-to-date research-supported guidelines for managing health problems. While practicing in Asia, however, I regularly feel a tension between recommending what the guidelines require and what is actually possible. Many of my patients simply aren’t able or willing to pay for certain tests, procedures, or medications (or they aren’t available). Although I may know what is best, what is best may not be possible! As a result, I’ve needed a lot of humility, guidance from my mentor, and compassion for the patients to help me navigate these dilemmas.
- Gratitude from patients is a gift. Many marginalized men in our region leave home to work in wealthy foreign countries and send their earnings home to their families. One time I saw one such patient who had severe rheumatoid arthritis. He was only in his late 30s, but he could barely get out of a chair or walk because of the incapacitating pain and swelling in his joints. Unfortunately, because he was a marginalized foreigner in the country where he worked, helpful medical care was not available. As a result, he elected to travel home specifically to visit the clinic where I work. Thankfully, my team and I were able to initiate and monitor a treatment plan that brought him relief! Over the course of several visits, this man’s demeanor transformed from hopelessness and defeat to joy and optimism! During our last visit together, a big hug and tears of gratitude were his parting gift to me as he left to resume his work overseas.
Practicing medicine in Asia is certainly different from practicing in the U.S., but despite the challenges, I’m thankful for the opportunity to serve and for the gratitude I see!
About the Author: Our author is an IDEAS Associate and physician certified in Internal Medicine and Pediatrics. He and his wife moved to Asia in 2018 with their 3 children to provide healthcare for impoverished communities. Enjoy other blogs from this physician, such as Cross-Cultural Effects of COVID-19: A Physician's Thoughts.