There is a sad difference, while training to be a nurse-midwife, or any health care provider, I suppose, between what is practiced and what is preached - or taught - in the classroom.
In our primary care class, we are taught to always look at the whole person - a theory to which I subscribe fully - if a woman comes in for a specific complaint: an itch, an earache, a pregnancy test, some pain - we should deal with the complaint... and then pay attention to her picture as a whole. Is she obese? Is she depressed? or does she have a history of mental illness? which co-morbidities does she have? can we manage them today as well? How are her relationships? Is she at risk for abuse? We have learned tricks and tools and resources for dealing with all of those things - wonderful, great, I'm ready to go...
But then, in my clinical site, I have barely enough time to diagnose and manage the one complaint- let alone target anything else about her history. When I launched into weight management discussions with a 342lb woman who came in to use for an STD check because the was 'trying' three men currently... I was told to hurry - we had 3 folks waiting. But how can I feel comfortable sending her out with an antibiotic prescription (indeed, she did have some critters) and not addressing this 28 year old woman's diabetes, high blood pressure, and obesity. The STD check, while important, seemed almost to be the least of her problems. My preceptor, when I pushed it, told her to make another appointment with the medical clinic and another one to go get labs drawn. With a full time job, and 2 kids with no father figure, I don't hedge my bets that she will keep them. She was in our clinic, here, now, with an acute complaint, and I just wanted to start her process...
I gave her my 30 second schtick, a pack of condoms and a rx for flagyl 2g POx 1 - and sent her on her way. Lamenting the gross difference between practice and ideal, and the way in which to pressures of low income health care surely does necessitate less than optimal care.
1 comment:
theres a study from your school looking at idealism vs time spent in residency in various sub-specialties. your sentiments are not novel. i definitely feel that way on a daily basis on the wards. the system sure makes it tough to strike the balance. i think more funds thus more providers is the only solution. hmmm... do you like any candidates health care plan? not sure i do.
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