Learning to meet patients where they are
Christa Slaught, MD, has a life-changing experience through the Resident International Grant Program
Dr. Slaught’s story
The month I spent in Botswana was absolutely incredible! Participating in the Resident International Grant Program to care for and learn from the patients with a new perspective as a resident was so special. I was impressed by how well the clinic runs, and, in particular, the work that has been done to expand support for patients with albinism. I noticed a significant increase in the number of patients with albinism that were being seen compared to five years ago, and several individuals expressed being highly satisfied with their care. One patient showed memorably emphatic gratitude when he returned to the dermatology clinic after 10 years of avoiding care due to a bad experience and frustrations with frequent sunscreen shortages. He was excited and relieved to have a place he could trust to return to regularly.
One patient encounter that particularly impacted me was an interaction I had with an elderly woman regarding her goals of care. She was Setswana-speaking only and had been diagnosed with Paget’s disease of the breast. It had taken two biopsies to prove the diagnosis, which had resulted in many months of delays. She presented with her daughter who provided most of the translation. They seemed somewhat angry and frustrated from the start of the visit, having just come from a general surgery appointment where a mastectomy had been recommended despite a mammogram not showing any definitive evidence of underlying breast cancer. Although it was not even part of the plan that day, the daughter was very focused on repeating that we could not take any more of her skin and that she would “rather die than lose her breast.”
I felt saddened by how forcefully she had to advocate for her goals, and frankly embarrassed that I had not thought of approaching the discussions of management from that perspective because of assumptions I had made about patient care and goals in a culture that I honestly can barely pretend to fully understand even after months of living there. I had to back up and start over with this patient. It was a great reminder of how important it is in medicine to meet patients where they are. We are there to help inform patients, but we must always remember to pause and provide space for patient autonomy. This can be difficult with language and cultural barriers, but we must slow down and take the time to make sure we are involving the patient in their care and decisions. I’ll never forget it.
I am so incredibly grateful to have had this opportunity to return to Botswana as a resident. When I am there, I genuinely love practicing dermatology. The focus is on caring for patients who really need the help and there is nothing more fulfilling than that. I cannot thank you enough for this experience!
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