Andrea K. Westby, MD
The practice of medicine—the traditions, diagnoses, treatments, and guidelines—is ever-changing, with new research and information flowing into clinical care at a pace that rivals the turbulence and abundance of a mountain stream in the spring. We now acknowledge human papillomavirus infection as the primary driver of cervical and now oropharyngeal cancer. Hormone replacement therapy is no longer routinely recommended for postmenopausal women. Rate control is preferred over rhythm control in atrial fibrillation. Prostate cancer screening is no longer reflexively ordered for adult men.
However, as we look back at the past hundred years, our profession has been glacially slow to release the vice grip that the concept of biological race has had on our science and our medical practice.
By Natalia V. Galarza, MD and Kristina Diaz, MD
Global health has been identified as an increasing field of interest in medicine. As Koplan et al, mention, it can be thought as a notion, depending on current events. A definition for global health has never really been reached by consensus, and so it seems that global health can be adapted to the necessities of the location and time.
Many definitions touch on the fact that global health should improve health and achieve equity for all people and protect against global threats that disregard national borders.(1,2) It has deep connections with public health, blurring the boundaries between public health and global health. Within these connections, we have “border health” as a unique part of public health, with many characteristics being shared with the broader “global health.” For family medicine residency programs that are geographically located near the United States-Mexico border, the teaching of border health is embedded seamlessly in the medical resident education, so much that we tend to diminish its importance and gravitate toward other subjects of public and global health. It is easy to overlook the unique populations that we have in our own communities and focus on those that are more conventional and shared with other residency program or educational goals.
Laura Bujold, DO, MEd
The office is about to open when my office manager—I’ll call her Sally—walks up to me and says, “Did you see the pumping space I made for you?”
“No,” I respond. Sally and I walk in the door to an office that holds two nurse triage personnel. There is a rod with a shower curtain hanging that exposes a 3 x 21/2-foot area at best. One of the “walls” is the bookshelf and the other two walls are the corner of the office. The fourth “wall” is the shower curtain. Sally says she bought the supplies herself, smiles, and then leaves.
I run to grab my pump and pumping bag while panic consumes my confusion. There is no room for my pump. Even in a true office space, I could barely manage enough room for the pump, tubing, flanges, bottles, paper towels, water, and nursing bra, let alone the cooler for the milk.
I move quickly—my first patient will be here soon. I search the office for a small table and I find one in the bathroom; I put it immediately outside the homemade cubicle. I put my pump on the table. The electrical cord to my breast pump doesn’t reach any of the outlets. My heart skips a beat. My patient will be here any minute. I move the table toward the closest outlet. With the breast pump’s electrical cord completely extended and the tubing stretched, my pump is plugged in but it is sitting about 1 foot outside of the cubicle.
In order to breastfeed and meet patient access demands, I am dividing my lunchtime throughout the office day to pump. However, this dedicated pumping time frequently gets booked with patients. When I ask for the patients booked in my pumping times to be rescheduled, I am told “Oh, you can’t see them?” or “Are you sure?” or “But there isn’t another time available in your schedule.”