Metaphors in medicine

April 7, 2011 § 1 Comment

I spent the summer that I graduated from high school in Westchester County, NY at home, and got so bored that I got up one day, took the train down to the city and enrolled in a real estate course. I’m not even kidding. It was only a week long course, offered by NYREI, and I thought that it would be cool to be able to talk urban planning and the merits of brownstones over high-rises at fancy cocktail parties. For one full week, I sat through lectures and guest speeches by various brokers who drilled one concept into our minds: the importance of location, location, location.

It’s a trite, tired expression, but as I’m realizing, true even in medicine. At Harvard, we learn regular medicine, and then we learn social medicine (led by none other than Paul Farmer). In the former, we learn that a cell’s survival rate in the face of ischemia can be on the order of four minutes if it’s a neuron, to four hours if it’s a skeletal muscle cell. In the latter, we learn that a newborn’s life expectancy can differ by more than forty years, depending on whether he is born in Japan (82 yrs) or Swaziland (39 yrs). Absurd.

In pathology, we are asked to locate a right upper lobe infiltrate on a chest x-ray. In radiology, we are asked specifically to locate an opacity suggestive of a right upper lobe infiltrate. In first year, we are asked to locate bright yellow arrows on the film. I’m pretty good at this last one.

In an elective that I’m taking where I follow a patient longitudinally over the course of the year, I’ve been learning that even clinic locations can matter. Depending on whether Mr. C goes to his primary care clinic or his HIV clinic, both of which are manned by the same physician, he can expect different services. Depending on whether he’s seen at the BIDMC or the Fenway Community Health Center, he can expect different kinds of social support services, different lengths of clinic visits, different tests and different check ups.

Things are coming to a head around Longwood, as my class decides whether to grow up and enter the real world of apartments and houses, or stay another year in our dorm across the street from the medical school quad. Finally, one conversation about location that I can tackle!

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