Sandeep K. Aggarwal, MD, shares his thoughts on the challenges and rewards of treating different patient groups as a locum tenens physician.
Are all geographic areas the same with respect to patient care? This is one country after all. If your answer is yes, I would beg to differ. Our medical education focused on pathophysiology and treatment with a singular focus, but as we all go further and more in-depth in our studies and practices, we soon realize that all patients are not the same even within a geographic area.
Perhaps this diversity can be attributed to the melting pot of America. But a truly homogenous society doesn’t exist anywhere — even in places like in Europe or Asia — due to immigration patterns and asylum seekers from persecuted lands. Race, gender, sexual orientation, cultural background, language, and religious beliefs all play a role in our treatment and can either make or break the provider-patient relationship.
Adapting to the nuances
We are all constantly learning and fine-tuning our skills to allow for a more holistic approach to care management. Indeed, most residency programs are located in larger cities, where there is a mixture of several demographics. This allows us to learn early on in our training how to approach and appreciate the nuances. For example, some groups are more stoic or expressive. Others are defiant or passive.
The internet and electronic medical records have changed the dynamic of the healthcare field, with more readily available means of communication. This can be a blessing or a curse given the ability to write notes via “my chart” messaging. Those who are computer savvy tend to be more prolific in their writings and diligent in following up on tests and results, which can help ensure continuity of care regardless of cultural or social differences.
Appreciate the differences
Locum tenens affords physicians the possibility of traveling to areas that have specific demographic differences, some of which are influenced by the physical environment such as climate, terrain, and immigration patterns. For example, rural areas — though mostly homogenous — have seen migration of outside populations such as the Hmong or Somalians. Native Americans are located on reservations in states with large rural areas.
The co-existence of various groups in regional areas tends to allow for some cross-cultural learning and can affect attitudes toward healthcare in general and providers more specifically. Some choose to remain isolated and stick with home remedies from the old country. At times, local populations can be somewhat reluctant to pursue medical care. This may be due in part to lack of providers or distance from hospitals. Many live on farms or ranches and devise healthcare on their own. In a way, these cultural groups have many similarities even though they may come from widely separated geographic origins.
Transcending boundaries
Fortunately, the field of medicine transcends national boundaries and regions. With locums experience, one can easily transition to various clinics and adapt to regional differences rather readily. From personal experience, I can say with confidence that I can see patients in any environment and hospital system. Have a tuning fork and reflex hammer, will travel!
Working as a locum physician allows for intellectually stimulating exercises as you gather information and interpret it in the context of cultural differences. A common challenge is how a patient will respond to being prescribed typical medications — either because of a lack of perceived benefit or mistrust of the system. Indeed, some populations simply do not have faith in conventional western medications and resort to home remedies or homeopathic drugs.
The advent of new drugs and diagnostic techniques — while a great technological advancement and addition to the armamentarium for providers — are fraught with high cost and insurance barriers. Although many do have insurance, the patient responsibility can be cost- and time-prohibitive, which plays a major role in diagnosis and treatment including compliance with instructions. As providers, we all have to jump through hoops for authorization with insurance carriers despite FDA approval. This only adds to the frustration of care management. This problem can be especially acute in rural or lower socioeconomic areas where funds are tight and personal choices are often made based on basic survival.
It all makes for a dynamic and challenging process, but the opportunity to interact with people of diverse backgrounds can be just as rewarding as it is challenging.
