Well-meaning within our means

Short White Coat is a blog about learning to be a doctor. Posts appear here as part of White Coat Notes. Ishani Ganguli is a third-year Harvard medical student. E-mail her at shortwhitecoat@gmail.com.

I spent last Thursday and Friday mornings at a women’s shelter health clinic run by Women of Means. A six- by four-foot folding table in the center of the main room served as a communal exam table, and tupperware bins were filled with alphabeticized paper cards that constituted patients’ medical records.

Some women were first-time visitors, walking in, say, with a complaint of overgrown toenails, while others were regulars coming in for a finger stick to check their blood sugar. The scene was a refreshing contrast to the specialty clinics I had been attending throughout my outpatient medicine month.

At first, I felt a compulsion to go through each of these women’s complete histories and physical exams and to think through exhaustive plans based on the latest evidence-based medicine, a procedure drilled into me during my year at Brigham and Women’s Hospital. But I came to realize that it was far more important to think practically about how to help these women there and then, with triage-level clinical judgments and packets of ibuprofen, gauze, and nail clippers bought with private donations and stashed in metal cabinets in the back room.

This point was most compellingly demonstrated for me when I managed to elicit Trousseau’s sign in a patient -- a tingling sensation that occurs with tightening of the blood pressure cuff and signals low calcium level. I asked her in Spanglish about her history of low calcium and sent her off with a handful of Tums and a reminder to follow up with her primary care doctor.

It was a simple intervention, one that I hope tided her over until she managed to get that primary care appointment. It also reminded me of a key lesson -- as my training continues to immerse me in the often esoteric pedagogy of the Boston tertiary care teaching hospital, I must not lose sight of the healthcare-in-a-pinch brand of medicine that serves populations equally deserving of thought and care.