I’m a Student, and Even I Know That

July 29, 2010

Ever since I moved to New York City for my clerkship (part of the clinical training in medical school) at the Lincoln Health Center, I wake up every morning in a great mood. And that’s saying a lot because I have never been a morning person. After years of hitting the books, I am just so excited to finally try my hand at real medicine. So in spite of sleep deprivation, everyday I look forward to going to work, meeting patients, learning new cases, and performing minor procedures. Ok, to be fair, I shouldn’t call it “work” since I’m not actually getting paid for my training, but it just sounds better.

Real hospital life is not Grey’s Anatomy (for those who don’t know, it’s a medical drama), however. Not everyday is exciting or even interesting. As a matter of fact, some days, such as today, can be painfully mundane and frustrating. The Lincoln Medical and Mental Health Center, located in the South Bronx, caters to a rather unique subpopulation of America. Most, if not all, of our patients are on Medicaid, or have no insurance. Many don’t speak English, which I actually quite enjoy because I get to practice my Spanish with my patients, but it can sometimes make history-taking challenging, in which case we call for a translator. Unfortunately, due to the fact that many cannot afford to see a primary care physician (the equivalent of our family doctors in Canada), they show up in our Emergency Room (ER) for everything and anything because by law, we cannot turn them away.

As many of you undoubtedly already know, a major difference between practicing medicine in Canada and in the U.S. is liability. Doctors here have to constantly worry about covering their posteriors. The combination of people’s financial difficulties, lack of education, and doctor’s over-cautiousness from fear of lawsuits resulted in this patient that I saw today: A middle-aged woman who showed up in the ER because of a skin lesion on her foot. She was subsequently admitted by the ER physician to our department in Internal Medicine, meaning that she was hospitalized for further assessment and treatment. As I read her chart in the morning before going to see the patient, I perused different possible diagnoses in my mind: cellulitis (a type of skin inflammation and infection), angioedema (rapid swelling of the skin and underneath the skin), dermatitis (itchy inflammation of the skin)…

When I saw the patient and examined her, I was flabbergasted and befuddled. What exactly are we looking at here? Where is the lesion that was severe enough to warrant hospitalization? Then my attending physician pointed the culprit out to me. Ladies and gentlemen, please hold onto your seat because you will not believe this. The “emergency case” was a callus! That’s the thick, hard skin that you get when you wear shoes that are too tight! I was absolutely stunned and stayed so for the rest of the day. This woman was there, taking up bed space, billing thousands of dollars to the government, when what she really needed was a pedicure!

Why was this patient not sent home by the ER physician? Maybe he or she wanted (us) to make sure that it was not something more serious out of paranoia; you don’t want to get sued for negligence later on, or maybe the emergency doctor was just functioning on auto-pilot that day and admitting all the patients, sending them off to different departments. Who knows? But when I asked my team of physicians why this woman was here because she shouldn’t be, their answer was: You’re a student, and even you know that.

Melody Ko