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.
Evelyn Figueroa, MD
Zoe,* a 35-year-old law student, often missed and rescheduled appointments for her toddler Elias.* I have supervised Elias’ visits with the residents since his first newborn visit 2 years ago. Although I have only seen them with the residents, Zoe identifies me as their primary care physician and has always scheduled Elias’ visits during my teaching clinics. I have examined this cute little guy at every visit and thought I knew this family well.
I knew that Zoe and Elias were struggling because of the issues we discussed at every visit: finishing law school 90 miles away, struggling to maintain her breast milk, and single motherhood. Zoe’s tired face showed determination despite her challenges. Little Elias, in a loose diaper, always clung to Zoe’s tiny frame, a fact that initially made me think he was simply on the small side. Despite multiple no-shows, we gathered enough data to construct a disappointing growth trajectory. Was it failure to thrive or constitutional small stature? Medical advice typically consisted of dietary counseling aimed at boosting calories and more frequent follow-up.
Recently, I recognized Elias’ name on a resident’s schedule. Anticipating their typical tardiness, I asked the front desk to register Elias regardless of arrival time. When they came a little late, they were quickly ushered into to an exam room. The resident reported that although Elias had normal development, his weight remained below the first percentile.