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 fifth-year Harvard medical student. E-mail her at firstname.lastname@example.org.
The women start lining up outside the puestos de salud around 6 a.m., children strapped to their backs with knotted swaths of handwoven fabric. As we pull up to one of the two-room health centers that we visit each weekday morning, I see the by-now-familiar mix of pregnant bellies and snotty noses.
Each young patient comes in with his mother, her face taut with concern, supplanting the voice of her muted child. "Mi nene tosea y tosea" (in colloquial Spanish: my baby keeps coughing). Since when? Yesterday. When a few more questions and a physical exam reveal a viral infection, as they most often do, I reassure them, maybe prescribe something for the cough or fever.
Hours in line for the common cold?
Besides the setting (Iím doing a two-month rotation in rural Guatemala) and the attire, this scenario is not so different from one you might see in Boston.
At the same time, being far from home forces me to re-evaluate how I, and my patients, think about risks to our health.
I tend to play the martyr when it comes to my own colds, refusing even to treat my symptoms as if this were a sign of weakness. But when Iím hurtling down steep mountain roads in a van, door agape (still in Guatemala), I grip whatever I can find and periodically calculate my chances of surviving the journey. Meanwhile, thereís a 3-year-old boy lounging on the rear-facing bench seat. Heís blithely licking a lollipop and mimicking the driver's shouts to potential passengers ("Antiiiiigua, 10 Quetzaaaaales") while his parents snooze next to me. Hmm.
As Lisa Belkin pointed out recently in the New York Times -- we make irrational, affectively driven decisions about safety, especially when it comes to our children. We tend to underestimate the risks of riding in a car, for example, and overestimate those of rare, high impact dangers like terrorist attacks.
These perceptions are shaped, of course, by individual quirks, cultural norms, and the inescapable factor of financial limitations. Just outside the town of San Juan Sacatepequez, car seats and private transportation are out of reach for most people. But cough is the sort of risk (or perception of risk) that we can do more to mitigate as doctors, with some counseling and expectorant provided for free by the national government.
No matter the setting, I realize, itís helpful to understand how my patients think about risks. I can better explain the implications of those risks and how to address them, in a way that resonates with their lives. Thatís how a cultural experience translates into better clinical care.
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