Island Medicine

Summering in Martha’s Vineyard connotes a vacation of presidential proportions. For me, it was another fourth year rotation. While my initial draw to the month-long elective in rural medicine was the va-tation (or, alternatively ro-cation) two-in-one package, I soon discovered that this setting had much more to offer than butter-drenched seafood in the hospital cafeteria and a beach across the street.

Equipped with an MRI machine, Martha’s Vineyard Hospital in the town of Oak Bluffs is not your typical rural hospital. But after my month of internal medicine at Massachusetts General Hospital, the change in scale was immediately apparent - and welcome.

It was the perfect opportunity to fill in a few of the gaps in our training. I had wondered what happened to patients en route to the ER, so I rode with the paramedic team for an afternoon. I’d had little exposure to broken bones and muscle injuries, so I flagged down the hospital orthopedist and spent the day in clinic with him. I drew blood with the nursing staff and even received a sample acupuncture treatment at the island’s center for complementary medicine (After all, we will get questions from patients about it.).

This ease of access allowed me to see the (not always) integrated healthcare system in a manner that hadn't been possible on my previous rotations. I met one woman when she came to the emergency department for a stroke, then again a week later in pediatrics clinic when she brought her daughter in for a check-up. By the time I saw her a third time, during a follow up visit with her primary care doctor, I had gained new insight into a patient’s experience of the healthcare system. It’s a concept that Harvard Med now emphasizes during our third year spent at a single Boston hospital, but it was only on the island that this point was driven home.

Atul Gawande and others have written about the importance of getting the big picture in making medical decisions. Understanding how different parts of the healthcare system come together, and the consequences of each decision, is critical to avoiding the costs of so-called fragmented care. This perspective can be difficult to maintain between month-long immersions into cardiology or palliative care, and must be even more so once doctors-to-be commit to a specialty. After a rotation like this one, I hope I’ll hold onto this perspective in a meaningful way. That, and the memories of seafood lunch trays and evenings on the beach.