Note: Certain details in this entry have been omitted or changed to protect the identity of the patient.
I was seeing patients in a primary care clinic a few weeks ago while on my ambulatory medicine rotation. The first two patients of the day were fairly straightforward: One was there for hypertension (high blood pressure), and another came in for an evaluation of his medication regimen.
The third patient was another story. I’ll call her Shreya. She was in her late 60s and presented complaining of headaches, nausea, weakness, and a host of other issues. She had been to more than 10 doctors in the past few months, including three recent emergency department visits. She brought with her a handful of encounter notes and lab results from various hospitals that listed differential diagnoses and treatment plans, none of which hd helped.
Complicating matters was that she was new to the United States and didn’t speak English. She was in clinic to establish primary care along with addressing her various concerns.
Shreya wasn’t going to be straightforward. I braced myself and went in to see her.
The first thing I registered as I walked in was that she was Indian (I am also Indian by ethnicity). This alone is not remarkable – there are more than half a million Indians in California with a high concentration in the Bay Area.
Shreya’s daughter was present to help interpret. But when I asked her how she was doing, she responded in Telugu, a South Indian language that my family speaks (and the third most widely spoken language in India). No interpretation would be necessary. I probed further and learned that not only were we from the same state in India, she had just migrated from my ancestral village!
Shreya’s entire affect changed. She was previously slumped in her chair and looked extremely tired, but as we talked about the village, she sat up, smiled, and seemed to find a new reservoir of energy. She told me that she felt like her problems subsided while talking to me and that she thought I looked like her son. (She showed me a picture and I have to admit there was some resemblance.)
After spending some more time chatting, we turned to her medical problems. It turned out that she had untreated hypertension with her systolic pressures running in the 150s. She was also having trouble sleeping, which she associated with her recent move to the U.S.
Despite her complicated presentation, I began to suspect that her concerns stemmed from these two issues. A high BP and lack of sleep would explain headaches, weakness, and most of her other complaints. She had gone through full diagnostic work-ups in the ED, which ruled out several other etiologies. But no one had sat down with her to go over these common root causes of her problems and what to do about it.
After I talked about her with the attending physician, we sent Shreya home with a new plan for both treatment and robust follow-up. She expressed a great deal of confidence that this approach would work for her.
I took two major takeaways from this encounter. First, it showed me how a good doctor-patient relationship and cultural understanding can dramatically improve communication and the patient’s attitude towards illness. Shreya was visibly stronger simply because she had met a “doctor” who she felt understood her and helped her feel comfortable in a new country. And even though I would not be there for her follow up visit, she was now happy to return to this clinic.
Second, Shreya’s visit highlighted the importance of strong primary care. Her problems were ultimately treatable. But she had gone through several weeks of suffering, many appointments, and extensive testing because she had sought care through emergency rooms and an assortment of specialists. The providers who saw her did not communicate with each other and as a result, no one put together her story until she came to us. Coordinating a patient’s care is in many ways more difficult than the care itself.
There are many ways in which health-care providers treat patients. Sometimes it involves complicated diagnostics or challenging procedures. But in other cases, it is as simple as finding a point of common interest halfway across the world.
Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the Stanford Medicine Unplugged category.
Akhilesh Pathipati is a third-year medical student at Stanford. He is interested in issues in health-care delivery.
Photo of Kumararama temple by Aditya Gopal
