September 5, 2005

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Outsider’s View Finds Flaws in American Medicine

Photo by Jeff Cleary Tarayn Grizzard

Of course, I mean that everyone forgot about it but me. I obsessed over the error for at least a couple hours until another opportunity to mess up presented itself. I saw a colleague from my core-I rotation at lunch that day and was thrilled to see her. We both hustled around various late-lunching house staff and met up midline, where despite everything I know about Boston hospitals, I greeted her with a brief hug and side kiss to the cheek, which was met with confusion all around—what was I doing?

We made it through the conversation with little or no weirdness, thankfully. For me, though, this awkwardness, the mispronunciation, the moments of horror were all becoming an unwelcome part of my daily routine. I frequently forgot English words for medical conditions or terms and often had enormous difficulty giving reports to other physicians. In a profession that prizes brevity and efficiency in such exchanges, I simply couldn’t get the words out. I couldn’t think of them in English or Spanish. I was effectively alingual. Even when I could talk, I had some trouble relating to friends since I had no idea what news was being broadcast apart from basic headlines, what movie they were quoting, or what rich society blonde was in trouble this time.

I want to keep the odd-man-out’s ability to question the point of treating a patient’s illness at a cost that may be harmful to him, his family, and the system.

I was in full-blown culture shock. After living for varying periods in China, Chile, Scotland, and for the last year, in Peru, I should have been used to making adjustments. This was the first time that upon my return, the U.S. seemed so oddly loud, crowded, expensive, and uncomfortable. Medicine seemed this way too, between the terse interactions among colleagues, the costs, the drugs I’d never heard of, and the tests that had become newly fashionable in my absence. It was all just too much. Sadly, I found myself changing in response to these new surroundings, becoming more fixated on the latest trends, ordering new tests for patients, and generally ratcheting up my on-the-job behavior and demeanor to an acceptably “macho” level.

I know that I’ll soon forget about the weirdness I encountered when I came back. But what I desperately hope and pray that I don’t forget, no matter how many years of life and residency training in the U.S. lie ahead of me, is the feeling of being a foreigner not only in my own country, but also in my own medical system.

Although I know I’ll fully adjust to life in the U.S. and re-accustom myself to old habits and interactions, I still hope to keep—at least for my patients’ sake—an outsider’s perspective on American medicine. I want to keep the odd-man-out’s ability to question the point of treating a patient’s illness at a cost that may be harmful to him, his family, and the system. I desperately want to continue to think about the costs of care to force myself to answer these critical questions with every patient: Can I make a sound decision without all of these data? What do I actually need to know to care adequately for this patient? It’s likely that years of training will begin to erode this sensibility, but I can only hope that as an attending I still find some of what we do worth questioning—even if I am often part of the problem and not the solution.

—Tarayn Grizzard is a medical student at HMS.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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Copyright 2005 by the President and Fellows of Harvard College