PRACTICING AND LIFE
MEMBER CATEGORY
WINNER
2016 RICHARD SPEAR, MD,
MEMORIAL ESSAY CONTEST
WHEN MEDICINE BECAME MORE THAN A DIAGNOSIS
David Dageforde, MD
J
ust before 8 a.m. on a beautiful morning,
I walked over a hill in western Ethiopia
for my first clinic day as the only physician, and I saw over 500 patients sitting patiently on a hillside. I immediately experienced
“doctor shock,” my term for a complete change
in my understanding of the doctor-patient relationship. I knew well about culture shock, the
feeling of disorientation where your brain and emotions go into on
overdrive from being in a new culture, but I was determined culture
shock was not going to affect me in Ethiopia. I had mountaineered
with friends in Africa and Russia, and trekked in Nepal, camping
with locals and carrying our food (live chickens) on our backpacks.
But, I was not ready for “doctor shock” for two reasons: first, I am
not a primary care doctor, although the 20 hour combination of
flights gave me plenty of time to review my notes from a course in
Tropical Medicine taught in London, England. Next, 30 patients is
thought to be a big clinic day: what about 500!
Missionary outpost medicine on a mountainside in the middle
of nowhere is practiced a little differently. You work backwards
to the diagnosis. First, you look in your boxes of medicine so you
know what you can treat. Secondly, you review those disease state
symptoms and signs. Thirdly, if you cannot treat it, there is no
reason to alarm the patient because no individual can afford the
12 hour drive to the capital city for possible treatment. For 16 days
the clinic continued for ten hours each day. I