OB-GYN resident Stacy M. Lenger, MD, recently spent a week of her vacation helping patients in Central America as part of a surgical mission trip. She reflected on her experience in a February observations piece in the Journal of Graduate Medical Education and said that in the short time she was there, she gained valuable insight and experience she might not otherwise have acquired.
Dr. Lenger, a third-year resident at the University of Tennessee Graduate School of Medicine, said she participated in repeated vaginal and abdominal hysterectomies and provided primary medical care at remote clinics that didn’t have the access to diagnostic testing and labs that physicians are accustomed to in the United States.
She recently shared a little more about her experience with AMA Wire.
AMA Wire: One lesson you said was constantly emphasized during the trip was “don’t forget your basic assessment skills.” How did you use these skills abroad?
Dr. Lenger: We had many gynecology patients who would show up to clinic with a chief complaint of pelvic mass. Occasionally, they would bring a paper copy of an ultrasound performed three months prior at the “city hospital” a couple of hours away. The report was written in Spanish, and the images were of such poor quality that you could not decipher characteristics of the mass. We would have to rely on our physical exam to characterize the mass size and location to determine if surgery was necessary. We had no access to ultrasound or other imaging modalities at our facility to assist in making decisions.
Also, instead of obtaining a hemoglobin or hematocrit on each patient that had a chief complaint of menorrhagia, we would use physical exam findings—such as lower palpebral conjunctiva pallor—to assist in determining if our limited access to labs should be used on a particular patient. AMA Wire: Now that you are back in the states, will you use your basic assessment skills more often or use them in a different way, thanks to your experience in Central America?
Dr. Lenger: I use the experiences gained to add to my medical decision-making in patient care. I still order imaging when I believe it will add to my decision-making, but I am reminded that you don’t have to order every lab or diagnostic test just because it is available.
AMA Wire: In the piece you mentioned cultural awareness and cost awareness—are these areas that you approach or think about differently now?
Dr. Lenger: After the trip I have found myself more frequently thinking: “Will this test change my decision-making?” Although medicine should always be practiced with mindfulness, I think it is brought to the forefront more when you have been in places with very limited resources.
In residency, I see a number of patients who are from the country I traveled to. I now feel as if I can appreciate their cultural background more. For example, had I not taken the trip, I wouldn’t understand [that] there are many people who are from where I was in Central America who believe in a negative connotation associated with Rh negative blood. AMA Wire: What advice would you have for others thinking of using their medical skills internationally?
Dr. Lenger: Keep your mind, arms and heart open at all times. Learn about your patients and their culture. They will help you even more in your education than you are able to help them. AMA Wire: Do you believe this is an experience that every physician in training should have?
Dr. Lenger: Every resident should have this opportunity if they so desire. It is not something everyone should be required to do, because not everyone may want the experience. However, I think there needs to be more centralized support of this type of experience to allow each resident access to the medical, cultural and surgical training benefits if he or she desires.
