clinical milestone

Today, I came into refugee clinic and was surprised when my preceptor said, "Why don't you interview this patient?  She is just having a yearly checkup."  A little nervous since I had not done patient interviews in quite some time, I blundered through her electronic medical record trying to figure out what her medical history was.

My patient apparently had fled the Democratic Republic of Congo ("not the Dominican Republic!" exclaimed my preceptor when I read the acroynm DRC incorrectly) to the United States for political asylum.  And, to my secret anxiety, she had a history of being raped and assaulted.  But I took a deep breath and walked out to summon my patient from the waiting room, trying to project a confidence that I was not sure I possessed.

As it turned out, my patient had had three children, was not only cheerful and friendly but comfortable with her body, and had no specific complaints except a playful request: "Can you help me get a job, doctor?"

We discussed birth control options - everything is better than condoms! And no, there are many options that don't cause weight gain - and due to her desire to get an education and not have more children, I suggested that she consider a more long-term and effective form of contraception such as an intrauterine device (IUD).

By the time I left to retrieve my preceptor, I was thoroughly charmed.  And because I had interviewed her, she had no difficulties at all when I prepared to do her physical exam (unlike times in which I silently observed) because in her perception, I was her physician.

And people are terribly resilient, despite the terrible-sounding nature of their histories or medical records.  She didn't even flinch at the awkwardness of the exam but laughed her appreciation that at least we weren't men doing the exam!  And to my secret amazement, I found her cervix with barely a pause- even though it was tilted to the side and I had to search - took her pap smear and gonhorrea/chalmydia swab, and suddenly found myself believing, Hey, maybe I can do this.  Maybe I am becoming a physician after all.

After she dressed, I asked her again as we are trained to do, Anything else I can help you with?

My patient laughed and smiled again, teasing me by asking, "Can you help me find a job?"

I smiled back at her.  If I hear of anything, I'll let you know.  I left clinic that day feeling a little taller, a little more confident, a little more deserving of wearing the white coat.