Longitudinal Clinical Experience

As part of the third year, we have a Longitudinal Clinical Experience or outpatient continuity clinic. This spans the entire year and consists of 22 half-day sessions with an outpatient preceptor. I actually had a few logistical problems; the first two assignments I had did not work out even though they were with a cardiologist and a pediatric cardiologist, my top choices (along with emergency medicine). Finally, after 3 months into rotations, I got assigned to a hematologist-oncologist who works at California Pacific Medical Center. Today, I'm going to blog on the patient population.

California Pacific Medical Center is an interesting place; it is made up of several large private hospitals and caters to a higher socioeconomic population. I find it striking coming three miles from San Francisco General to CPMC. At the General, a substantial number of patients are poorly clothed if they are clothed at all; they may be covered in bodily fluids; they are emaciated, homeless, jobless. It's a remarkable difference compared to those who come to clinic at CPMC dressed in a suit and a tie, reading The New Yorker, talking about buying a new BMW. I've met the CEO of a big steel company, a local film director, a retired pathologist. Patients talk about sailing on a boat in the Mediterranean, carry an Apple iBook to their appointment, make recommendations on wines.

It's a good experience seeing different patient populations, but I honestly have mixed feelings. There will always be someone to take care of the rich; there's no doubt about that. But it takes considerable dedication to devote one's life to helping those who can't help themselves, the drug users, the poor, the homeless, the jobless. There is a big sacrifice in that. The middle to upper class patients show up on time, they are respectful, rational, educated, they bring gifts, they ask about your kids. They get sick too, and certainly if you're good at what you do, you can make a good living by catering to this population. The facilities are nicer, you can get the tests you want, your patients get their medications, you have technology at your disposal, they have a place to go when they leave the hospital. So I don't know. I feel strongly for serving the underserved, and I feel that it would be hypocritical to get one's training from the poor socioeconomic class and then reaping the benefits serving the rich. Yet I can see the appeal of putting yourself in a position with financial and emotional resources long term.