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Advice for a Student Starting Medical School

JAMA. Published online August 6, 2018. doi:10.1001/jama.2018.11225

Isat at my desk trying to write a letter to Madeline, the daughter of two close friends. I have known her since she was born and mentored her on the path to medical school acceptance. My intention was to write a letter to Madeline as she embarked on her medical training. I imagined coming up with something to inspire her. However, all I could think to write was some combination of the pithy statements that fill the addresses at white-coat ceremonies or the conclusions of personal statements.

“Congratulations, now you have a chance to combine your love of science and desire to care for people. Go forth!”

On the verge of giving up, I realized that a drawing, a gift from a patient that hangs in my office, pretty well summarizes three pieces of advice for those embarking on a career in medicine. It is a simple, yet beautiful piece of art: charcoal on paper, a hand and arm fading out just proximal to the elbow.

So, Madeline, let me tell you about the patient who gave me this drawing.

I met E during the my second clinic of internship. It was 1993 and E’s primary concern was that he was infected with HIV. During his first visit he told me his story. After he graduated from high school in a small northeastern town he moved to New York City to work on his painting and escape a town that would never be comfortable with his sexuality. He spent much of the late 1980s in New York, worked on his art, and had some risky sexual encounters. In 1993 he left New York, moved to Boston, and got assigned to me, a young intern, as his new doctor.

After taking his history and doing his physical exam, I recommended HIV testing. “Not going to happen,” was his reply. My argument for early diagnosis and initiation of “cutting edge” HIV therapy went nowhere. Here, we first wrote the script that we would reenact for the next 3 years. I would see E every three months or so. We would sit and talk for the 30 minutes of the visit. I would take care of any pressing concerns. I would recommend HIV testing. He would say, “No.” By my final year of residency we would both smile when I made the pitch. We had become friends during these visits. I considered these visits fruitless.

I continued to care for him after my residency ended. In November of that next year, he paged me one morning. I could hear his breathlessness over the phone. He told me he had been feeling badly for a week and was now too short of breath to make it through a shower. I met him in the emergency department and presented his history to the emergency department resident. In rapid succession he was diagnosed with Pneumocystis carinii pneumonia and HIV.

This story has a happy ending. E was diagnosed with HIV at an opportune time. His pneumonia was treated and he was started on a regimen including the newly released protease inhibitors. His immune system recovered, his health improved, and he has continued to be a productive artist. Almost 25 years after we met, he still occasionally sends me photographs of his most recent work.

So back to the drawing: what are its three lessons and why should you care?

(Continue lendo no anexo:)