Past Experiences

Our last block of the semester focused on the GI system as well as some Complementary and Alternative Medicines. Both of these topics are very interesting to me for two completely different reasons. The former is interesting because I have unfortunately spent a lot of time in the clinic and hospital due to my own GI problems, and the latter because I'm very interested in medical anthropology and the culture of medicine.

Growing up I would often have these painful stomach episodes, leaving me unable to move for hours at a time. It seemed to occur randomly and at its worst, I was having an attack three to four times a week. Although I saw a few doctors when I was younger, my parents chalked up my episodes to over-exaggeration and/or my unwillingness to eat a balanced meal. However in college I found myself visiting the E.R. on multiple occasions because of the unbearable pain that was lasting ten to twelve hours at a time. Although the residents and attendings conducted many tests on me, and although I visited a GI specialist, I was never diagnosed with anything specific. Instead I was told to eat less and take Omeprazole (Proton Pump Inhibitor) before my meals. In reality it just took time and a lot of trial-and-error to be able to reduce the number of attacks.

At the time of this "diagnosis" I was incredibly frustrated with medicine. I had been having these attacks since a young age, they were causing me to lose a significant amount of weight, and they were unbearable. I didn't quite understand how having a diagnosis could be any worse than not having one. However this unit has helped me see just how horrendous GI syndromes and diseases can be. I recall being tested for Crohn's Disease and ulcerative colitis. Looking at the treatment pyramid for these irritable bowel diseases, it's obvious that there is no solution. Unlike other syndromes and symptoms that can be treated, individuals with these diseases become victims of their own bodies. Even chronic Irritable Bowel Syndrome can cause a lot of pain with little hope for a solution. To some extent the GI system is still a mystery to much of medicine; it is often about "managing" rather than "curing" the dilemma.

The other aspect of this block that is fascinating to me is the use of herbal medicines and CAMs in the treatment of different diseases. It was made pretty clear during our lectures that there are often more problems associated with alternative medicines rather than benefits, and that it can become difficult to support the use of these when there is little-to-no evidence of success.

In a medical anthropology class I took my junior year, I remember learning how we as a society look at alternative medicine as a cultural thing. Take for example Traditional Chinese Medicine or even Voodoo. While it is easy as an American to hold some skepticism in terms of the efficacy of these medical practices  we often fail to realize that Western medicine- biomedical medicine- is a culture in itself. And just like any culture, it is hard to force down everyone's throats. From what we learn as Pharmacology students, and more so as medical students, it is hard to imagine believing that bio-medical medicine is not the right answer to many diseases. There is scientific evidence to support all of it! But at the end of the day, doesn't it matter what the patient also wants? Won't that affect the outcomes too?

When I was shadowing a family practice physician a year ago, I remember meeting an elderly, Cambodian woman who had just been diagnosed as having diabetes. As we are learning in this current unit (Endocrine), diabetes is an incredible dangerous and chronic disease, but if it is handled carefully, patients can live fairly healthy lives. As the physician emphatically explained that treatment was necessary and that the patient should see a diabetes counselor  the patient listened quietly and patiently. When the physician had finished however, the patient explained as best as she could that treatment- management- was not going to be okay. In her community and culture, people had previously been diagnosed with diabetes, but they had sought out traditional Cambodian remedies. The patient was convinced that she could be cured by this alternative medicine just as her friends and family had been.

Unlike many other physicians, the one I was shadowing had had a lot of previous experience working with different cultures and addressing the use of CAMs. She was incredibly respectful of the patient's wishes, and came to an agreement: the patient should test her blood sugar everyday and let the physician know if it got above a certain threshold. She also encouraged the patient to visit a diabetes counselor in addition to trying out her traditional medicines.

In the end, it's not always easy to say what is the right treatment for a patient. From the culture of western medicine, it may be clear cut. But not every patient holds the same values or wants the same outcomes as this culture. As I aspire to go to an allopathic medical school in the United States, I obviously stand by the tenant that physicians should use evidence-based medicine. But I also aspire to work in under-served communities and to provide health-care globally. Even though these are MY goals, I strongly believe that every physician and health-care provider will encounter at least one patient who holds another medical culture above western medicine. Therefore all physicians need to be culturally competent and prepared to help their future patients as best as they can.