Development

Nhi Dong I (literally children's hospital 1 in Vietnamese) seethed with humidity, crying children, and stoic families. The corridors colonized with cots and tents, clothes hang drying in the absent wind. The ICU, as it were, stood behind a curtain, with individual beds and incongruously modern monitoring equipment marking it as the domain of the truly worrisome. I stood head and shoulders above it all, unable to follow the oscillations of foreign speech, physically removed by my alien shape, size, and coloration. I was there, theoretically, to learn and to teach, to bring my foreign viewpoint and education to work with the local pediatrics residents for four days out of a month otherwise spent in a cool office space, researching newer and better ways to promote helmet use. I sat down with my partner to hold clinic, his rapid fire interrogation in Vietnamese and 30 second physical exam directly in contrast with my slow translated questions and protracted study. His throughput was nearly quadruple of mine, and given the remarkable size of the line waiting as we broke for lunch, the reasons why were obvious. One side of my brain wondered at the brevity of his exam, the fact that there is no way he truly hears anything through his stethoscope in the amount of time he listened. The other half marveled the fact that all his poor form, the discrepancies in what I believed to be a truly good exam and what he performed, and he still arrived at all the same conclusions, all the same diagnoses and treatments. The diseases ranged from the familiar to the bizarre, and I left the day tired, sweaty, convinced that I was definitely going to get Dengue Fever while in Vietnam, and intrigued by the skill and savvy with which my Vietnamese colleagues had overcome their disadvantages in education time, resources, equipment, and ancillary support to provide care well beyond an american provider in a similar position. It left me to wonder, what was the merit of our protracted education? Why did we need 8 years of higher education, of which the majority of the final year was spent doing educationally questionable things like going to Vietnam and eating copious amounts of noodle soup. What had all my training and experience provided me that he didn't have? The answer, in the end,comes down to systems. A system like Nhi Dong, built on throughput and insane numbers of patients, leaves no room for higher level thought, for making that "great catch," or the "tough diagnosis." The numbers just don't pan out, and the system lacks the money, the doctors, and the space to truly investigate a difficult case. American Physicians are trained the way we are because we are expected to operate at a higher level, to be perfect in a way no human being truly can be. We are meant to think critically, to assess the whole of each patient, to move beyond complaints and systems to a practice model in which each patient can receive the whole of your attention, to where you can make that critical early catch, and start treatment before there is even a problem. This training is inherent in the entire model of our education, and is probably why so many of us have so much trouble facing real-world practice models. We hate the fact that you can't have our whole attention, the benefit of 20 odd years of education. We hate that even in the resource-rich United States we are still stuck with issues of access, throughput, and time.