"clinical experience"

As the adage goes, don't judge a book by its cover. Or, as it turns out, a professor of pediatrics by his rounding style. Initially, the prof rubbed Jyoti the wrong way, as he rounded only twice a week, and seemed to know very little about each patient, making split second decisions based on a limited data set. I ate my words last Thursday, when prof proved to be quite a compassionate, not to mention extremely competent, head of Pediatrics here at PMH. After a blitzkrieg of rounding in the morning, Jyo's MO and med student disappeared, and she had the task of arranging a chest xray for a young baby who appeared clinically well. The baby had come in with a fever, was written for IV antibiotics, and was looking tons better despite not even getting the medicines yet. Jyo attributed the improvement to just some gentle encouragement of hydration and feeding, which the baby seemed to enjoy. Now he was playful and laughing, looking ready to go home. However, prof did a fairly cursory exam, pronounced "decreased breath sounds on the left," and asked Jyoti to continue antibiotics (i.e., start them) and get a chest xray to rule out pneumonia...so Jyo performed her task and by the afternoon she brought over the fairly obvious radiograph for me to review. There was a large left sided infiltrate consistent with pneumonia! We realized that maybe the prof did, in his own way, take pretty good care of his patients, and his fairly extensive clinical experience made for good clinical judgement in many cases. And on a related note regarding his compassion: he discovered that due to some technicality in the governmental rules, babies in Botswana can get free formula only if their mother is HIV positive, or if they have been abandoned. The baby in question had failed to regain birth weight after 2 months because of severe malnutrition. The mother's milk supply had dried up, and several older siblings had already perished from malnutrition. HOWEVER, because the mother was not HIV positive, the baby got no newborn formula from the government, and the mom could not afford any milk for him (she was G8P8 and destitute). The prof was rather frustrated by this pronouncement from "the management" that he walked a half hour in the rain to the nearest grocery store, bought a month's supply of formula out of pocket, and gave it to the baby's mom. I liked the prof even more after hearing this story -- there are others like him at PMH, for better or worse; those who subvert the unnecessarily complex red tape by taking matters into their own hands so that patients are better served. For example, John, a NICU doc here, was outraged that Zimbabwean babies do not get HAART, so he bought a stockpile of AZT and supplies it to mothers at his own expense. Some would argue that this approach has its drawbacks; it does nothing to change the current inequity, and may crumble quickly if the prof or if John left abruptly, after perhaps spurring reliance on such efforts to get basic health care (though John is making it more sustainable by setting up a trust fund of sorts). But as physicians who take care of individual patients every day, it's often difficult to look past the patient in front of you, whom you know you could help with a simple intervention, to worry about what downstream effects your actions may have. In that sense, I'm glad Penn has a really well developed, well thought out relationship with U of Bots. I know long after I'm gone, there will still be a healthy and productive partnership between the two entities. And it helps that my replacement come January will be none other than Mosepele Mosepele, whose return many of the nurses here are already eagerly awaiting (he is a Motswana MD who did training in Australia, returned to Bots for an MO year, and now a 2nd year resident at HUP). :)