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Second Guessing the Second Opinion

Second Guessing the Second Opinion “Dobre dien, sleepyhead.” Jeffrey awoke me from a Sunday afternoon nap. An American and the director of our project, Jeffrey was a fluent Russian speaker. “Nazir and his wife are upstairs with their son. They want you to examine him.” Where was I? It came back quickly—on mission with Doctors Without Borders in Chechnya. We supplied physicians in war-torn hospitals with medications and equipment and recorded the number of land-mine and gunshot victims. I’d come for an adventure, restless with my plush American life. However, I’d begun to wonder if I could make any difference. As I trudged up the outside stairs to the medical office, the afternoon air was chilly, the sun low in the cloudless sky. Nazir was one of my favorite guards. Each evening, he made a quick trip home to administer vitamin injections to his son. It made me uncomfortable; medical practice was so different here. But staff regularly brought me their “healthy” family members to get an “American” doctor’s opinion. I often felt that I had little to offer. They’d already purchased injectable antibiotics from the pharmacy that would not help the viral infection. Or the inhaler they needed was not available here. Different part of the world but the issues were the same: patients wanted something I could not give—a pill for something that demanded their time and patience or what they needed was out of their reach. Nazir stood proudly in the medical room next to his petite wife who held their 18-month-old son. The child wiggled, and she set him down. He toddled across the wooden floor to the window where he babbled—appropriate language for his age. Nazir explained his child’s health problems in Russian, and Jeffrey translated, “Their child had problems at birth. I’m not sure exactly what. They kept him in the hospital for 2 weeks.” That was not terribly long, I thought. In Russia, healthy moms and babies remained in the hospital for a week. Jeffrey handed me the child’s medical records—about a dozen stapled papers covered with blue and black Cyrillic letters. I flipped through, lots of numbers in no particular order, no graphs. Jeffrey continued, “The doctors have monitored him regularly, as these records show. Nazir gives him vitamin injections to aid his growth.” I interrupted. “Where does he give the injections?” “In the legs.” My heart sunk. In Eastern Europe, children were crippled because of frequent injections in the legs. Some component of the preservative probably atrophied the muscles. I watched the child waddle around the room; he was lucky, so far. “Now the doctors want to give him some kind of brain medicine.” Jeffrey handed me a scrap of paper with scribbled Russian. I took a deep breath and walked over to the cabinet reaching for the Russian Physicians’ Desk Reference. Because most medical terms had a Latin root, I could usually figure out enough of the meaning to understand the significance. If not, Jeffrey, despite his nonmedical background, was always interested in helping. “Looks like it’s for dilation of the blood vessels. Is that what you’re reading?” I asked. Jeffrey nodded. “Vessels in the brain to be specific.” “We have nothing like that for kids in the US. This medicine must be expensive. And they pay out of pocket.” No insurance here, I thought. How did I tell them that their child’s physician was a crock? “Will you ask Mom to hold her son while I examine him?” First, we laid him on the desk to measure his height, then his head circumference. We didn’t have a scale, but he was not malnourished. I charted the results on a growth chart that I’d brought with me and finished the examination. This was a healthy child. I handed Jeffrey the growth chart. “See how I graphed his measurements. I would expect to see something like this. Instead they’ve written down numbers almost weekly. Look at these dates. The numbers don’t seem to have any progression. I question their accuracy. A lot of hassle and worry for Nazir and his wife—lots of doctor visits. They want my advice.” I searched Jeffrey’s face. He’d worked in the area for more than 5 years, overseeing various projects in the North Caucasus. I’d been here a couple of months. How to deal with this cultural disconnect? “You’re the doctor.” Jeffrey gave me a mischievous grin. What do Nazir and his wife really want from me? This was a hard one. In this small town, this physician would be their doctor for years to come. Could I say he’s a quack? Did they have other options? Frequent injections could be crippling. It all cost money. I shook my head and looked at Jeffrey. “You’re not helping me on this one, are you?” Jeffrey shrugged. “You could suggest they talk with Dr Musa.” Dr Musa was a respected Chechen neurosurgeon now treating primary care problems. The head physician for our project, he shadowed me when I saw a patient, trying to understand our western ways of practice. “Good idea. Tell me if this is appropriate.” I took a breath. “Based on what I know, your child is normal. This brain medicine does not exist in the US. I don’t think he needs it. However, I was not trained here and doctors do things differently. You might talk with Dr Musa. He’s smart and may know someone who can help you.” Jeffrey smiled and then translated. I watched Nazir and his wife—such loving parents. Nazir held his son and gently kissed his hair. His wife stood close, looking at Nazir to read his expression. When Jeffrey was done, they thanked me graciously and walked down to their car in the courtyard. Nazir’s wife held her son on her lap in the front seat, no infant seats here. Correspondence: Dr Zink, Department of Research, Olmsted Medical Center, 210 9th St SE, Rochester, MN 55904 (tzink@olmmed.org). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Second Guessing the Second Opinion

Second Guessing the Second Opinion

Abstract

“Dobre dien, sleepyhead.” Jeffrey awoke me from a Sunday afternoon nap. An American and the director of our project, Jeffrey was a fluent Russian speaker. “Nazir and his wife are upstairs with their son. They want you to examine him.” Where was I? It came back quickly—on mission with Doctors Without Borders in Chechnya. We supplied physicians in war-torn hospitals with medications and equipment and recorded the number of land-mine and gunshot victims. I’d...
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Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.158.12.1105
Publisher site
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Abstract

“Dobre dien, sleepyhead.” Jeffrey awoke me from a Sunday afternoon nap. An American and the director of our project, Jeffrey was a fluent Russian speaker. “Nazir and his wife are upstairs with their son. They want you to examine him.” Where was I? It came back quickly—on mission with Doctors Without Borders in Chechnya. We supplied physicians in war-torn hospitals with medications and equipment and recorded the number of land-mine and gunshot victims. I’d come for an adventure, restless with my plush American life. However, I’d begun to wonder if I could make any difference. As I trudged up the outside stairs to the medical office, the afternoon air was chilly, the sun low in the cloudless sky. Nazir was one of my favorite guards. Each evening, he made a quick trip home to administer vitamin injections to his son. It made me uncomfortable; medical practice was so different here. But staff regularly brought me their “healthy” family members to get an “American” doctor’s opinion. I often felt that I had little to offer. They’d already purchased injectable antibiotics from the pharmacy that would not help the viral infection. Or the inhaler they needed was not available here. Different part of the world but the issues were the same: patients wanted something I could not give—a pill for something that demanded their time and patience or what they needed was out of their reach. Nazir stood proudly in the medical room next to his petite wife who held their 18-month-old son. The child wiggled, and she set him down. He toddled across the wooden floor to the window where he babbled—appropriate language for his age. Nazir explained his child’s health problems in Russian, and Jeffrey translated, “Their child had problems at birth. I’m not sure exactly what. They kept him in the hospital for 2 weeks.” That was not terribly long, I thought. In Russia, healthy moms and babies remained in the hospital for a week. Jeffrey handed me the child’s medical records—about a dozen stapled papers covered with blue and black Cyrillic letters. I flipped through, lots of numbers in no particular order, no graphs. Jeffrey continued, “The doctors have monitored him regularly, as these records show. Nazir gives him vitamin injections to aid his growth.” I interrupted. “Where does he give the injections?” “In the legs.” My heart sunk. In Eastern Europe, children were crippled because of frequent injections in the legs. Some component of the preservative probably atrophied the muscles. I watched the child waddle around the room; he was lucky, so far. “Now the doctors want to give him some kind of brain medicine.” Jeffrey handed me a scrap of paper with scribbled Russian. I took a deep breath and walked over to the cabinet reaching for the Russian Physicians’ Desk Reference. Because most medical terms had a Latin root, I could usually figure out enough of the meaning to understand the significance. If not, Jeffrey, despite his nonmedical background, was always interested in helping. “Looks like it’s for dilation of the blood vessels. Is that what you’re reading?” I asked. Jeffrey nodded. “Vessels in the brain to be specific.” “We have nothing like that for kids in the US. This medicine must be expensive. And they pay out of pocket.” No insurance here, I thought. How did I tell them that their child’s physician was a crock? “Will you ask Mom to hold her son while I examine him?” First, we laid him on the desk to measure his height, then his head circumference. We didn’t have a scale, but he was not malnourished. I charted the results on a growth chart that I’d brought with me and finished the examination. This was a healthy child. I handed Jeffrey the growth chart. “See how I graphed his measurements. I would expect to see something like this. Instead they’ve written down numbers almost weekly. Look at these dates. The numbers don’t seem to have any progression. I question their accuracy. A lot of hassle and worry for Nazir and his wife—lots of doctor visits. They want my advice.” I searched Jeffrey’s face. He’d worked in the area for more than 5 years, overseeing various projects in the North Caucasus. I’d been here a couple of months. How to deal with this cultural disconnect? “You’re the doctor.” Jeffrey gave me a mischievous grin. What do Nazir and his wife really want from me? This was a hard one. In this small town, this physician would be their doctor for years to come. Could I say he’s a quack? Did they have other options? Frequent injections could be crippling. It all cost money. I shook my head and looked at Jeffrey. “You’re not helping me on this one, are you?” Jeffrey shrugged. “You could suggest they talk with Dr Musa.” Dr Musa was a respected Chechen neurosurgeon now treating primary care problems. The head physician for our project, he shadowed me when I saw a patient, trying to understand our western ways of practice. “Good idea. Tell me if this is appropriate.” I took a breath. “Based on what I know, your child is normal. This brain medicine does not exist in the US. I don’t think he needs it. However, I was not trained here and doctors do things differently. You might talk with Dr Musa. He’s smart and may know someone who can help you.” Jeffrey smiled and then translated. I watched Nazir and his wife—such loving parents. Nazir held his son and gently kissed his hair. His wife stood close, looking at Nazir to read his expression. When Jeffrey was done, they thanked me graciously and walked down to their car in the courtyard. Nazir’s wife held her son on her lap in the front seat, no infant seats here. Correspondence: Dr Zink, Department of Research, Olmsted Medical Center, 210 9th St SE, Rochester, MN 55904 (tzink@olmmed.org).

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Dec 1, 2004

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