Louisville Medicine Volume 64, Issue 2 | Page 20

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