Learning medicine on the front lines

With pens and note pads in hand, eight first-year medical students walk briskly into the Athens Nurses Clinic, eager to interview patients for the first time.

The clinic is a non-profit clinic, located in an old building near downtown Athens, that provides free health care to poor and uninsured residents of Athens Clarke-County (ACC). The students are 5 weeks into their training at the Georgia Health Sciences University-University of Georgia Medical Partnership.

Like first-year med students elsewhere, these young people endure grueling days filled with classes and largely sleepless nights. Medical school is not an easy course of study.
In addition, unlike students at many schools, these students begin interacting early with patients at one of five community partner sites in ACC.

“Because it happens in their first year, it kind of sets the tone for one’s future medical career,” said Dr. Clive Slaughter, associate professor of biochemistry at the GSHU/UGA partnership.
What they find may surprise them.

“I didn’t know this before moving here, but apparently Athens is one of the most impoverished parts of the United States,” said Boris Kovanlenko, one of the new students. .

Soon after arriving at the Athens Nurses Clinic, Kovanlenko interviews his first patient, Diane, a 50-year-old woman, with high blood pressure. She is uninsured and has been coming to the clinic for less than a year.

“It was pretty eye opening,” said Kovanlenko. ”It’s very different to actually sit down with one of them [ a clinic patient] and have a 20- minute conversation as opposed to just reading one little line in a textbook describing the region of Athens,” he said.

And seeing the patients in context is the point. “We think it’s very important that our students have a chance to talk with real people as they explore these larger community problems,” said Dr.Laurel Murrow, an internist who leads the community health component director for Essentials of Clinical Medicine, a course that covers everything about medicine except the basic sciences.

With 36 percent of county residents living below the poverty line, ACC has no shortage of community problems.

For years, medicine in industrialized nations has been dominated by a biological model, which understands disease based on what happens inside the human body. It has paid less attention to environmental and socioeconomic factors that act on the body from outside.

Over the past decade, however, medical schools have been talking more about the social determinants of health.

The World Health Organization defines the social determinants of health as the conditions in which people are born, grow, live, work and age, including the healthcare system.

“We put a great deal of emphasis on the social determinants of health,” said Murrow. “We know poverty in particular influences whether we’re healthy or not.”

Educators at GHSU/UGA Medical Partnership believe that students must be immersed in the community to fully understand how powerful these forces.

“Talking to patients in a clinic of that kind is something many students won’t have the chance to do before,” said Slaughter.

“To get to know people who are low-income people and have problems accessing healthcare that we would have oftentimes never of expected is enormously beneficial and instructive.”


Marcie McClellan

Marcie McClellan

Marcie McClellan is a second-year HMJ student who is also completing a global health certificate. She worked for three years developing prevention programs for youth in Fulton County, and as a journalist she covers mainly child health and health disparities. She is a 2007 graduate of Spelman College, where she earned a B.A. in English.

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