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Learning from My Patients

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Learning how to prepare a room for a colposcopy as a medical assistant.
Photos: Zoe Kornberg

By Zoe Kornberg, MS1

Before medical school, I worked as a medical assistant at a Planned Parenthood health center in the south Bay Area for two years. The job confirmed that I loved patient care and that medicine was the right path for me. It was such a thrill to pick up a chart in the queue, knock on the door, and meet my next patient. No two patients were the same, so I learned something new from each one.

One of the first visit-types a medical assistant learns how to do at Planned Parenthood is the pregnancy test visit. There is no trying to convince a patient of what she should or should not do. I was there to listen, tell her that what she was feeling was totally normal and report signs of trouble (violence, infection, ectopic pregnancy) to the clinician. I saw the way I approached family planning counseling as the way I wanted to approach all patient interactions: judgment-free and patient-centered. Why should the phenomenon of “choice” be confined to only one medical decision in a person’s life? Shouldn’t doctors give patients an informed and free choice in every health matter?

It all sounds good on paper, but I remember one patient who was in clinic for a surgical abortion. Her chart said she didn’t want any birth control to take home after the procedure. I asked if the chart was correct, and she said, “I want my husband to decide.” I had been warned that partners controlling or choosing a birth control method could be a sign of coercion or abuse in the relationship. Seven years at a very empowering girls school, a life-long passion for reproductive justice and advocacy and (at that point) a year of experience at Planned Parenthood couldn’t prepare me for that moment.

My patient very politely sat through the next ten minutes of counseling in which I reviewed the pros and cons of every birth control method. I pointed to the cartoon IUDs and pillboxes on the poster on the wall and asked about birth control she had used in the past. Finally, she repeated, plainly, “I want my husband to decide.”

I fetched her husband from the lobby. I had been taught to deliver patient-centered care and now I broke all the rules. I did not look my patient in the eye. I did not talk to her. I did not ask her opinion. I centered all my attention on the husband. I was trapped between my absolute belief in a woman’s right to choose and this woman’s right to let somebody else choose.

The Human Side of Care

Fast forward to the beginning of medical school. I knew that I had come to the right place when at UCSF’s student orientation, a diversity, bias and inclusivity training, we spent two days practicing communication methods similar to those I had learned at Planned Parenthood. As a student of medicine, I get so excited when I learn about surgeries, labor and delivery, drugs and devices, but it wouldn’t be complete without the human side. In my mind, reproductive care—all patient care —is built on the foundation of respect for the patient.

During my first two semesters, I have continued to learn about reproductive health and expand my interest in the field. Thanks to a small grant from the Medical Students for Choice (MSFC) chapter at UCSF, I traveled to the MSFC conference on family planning back in October. The conference reminded me of how sheltered I have been, living in a part of the country that mostly accepts abortion as a normal part of women’s health care. A third-year student from Massachusetts told me the previous year’s conference was the first time she had ever been comfortable saying to a room full of people that she is pro-choice. She has been spat on and called a murderer for simply voicing her opinion. Many other students I met had to petition their deans to open an MSFC chapter—to even let students talk about abortion on campus. The conference was an eye-opening experience for me and made me grateful for UCSF.

In UTEACH, students learn about many aspects of pregnancy, labor and delivery, including pain management.

Student-Patient Pairing

Back at UCSF, one of the first electives I signed up for is called Unique Teaching Experience About Childbirth and Health (UTEACH). Once a week in the fall quarter, a group of about twenty medical and midwifery students learn about pregnancy, labor and delivery. We covered pain management during labor, pregnancy complications, doula practice, fertility and much more. Additionally, each student is paired with an OB/GYN, midwife, or a patient for a shadowing experience outside of class.

I was lucky enough to accompany a primaparous (first pregnancy) patient to her prenatal visits at UCSF. It was so much fun to point out the different parts of the fetus’ anatomy to “my mom” and see her face light up when she got her first ultrasound print-out to take home. I saw blood flowing through the ductus arteriosus, a shunt between the pulmonary artery and the aorta in a fetus, which closes off within a few hours after birth and becomes a vestigial structure for the rest of a person’s life. It was so timely, because just that week in anatomy lab, I dissected the ligamentum arteriosum, which is the name for the atrophied structure in a child or adult. The shadowing experiences brought to life what I had been studying in my basic science courses.

Now in the winter quarter, I am enrolled in two more reproductive care electives. In the Family Planning and Reproductive Choices elective, one of the ten sessions was the famous papaya workshop. The inside of a papaya has roughly the same shape, size and texture as a uterus. It serves as a life-like teaching tool for developing basic surgical skills, like IUD insertion and manual vacuum aspiration. My second elective of this quarter, Women’s Health, the Environment, and Physician Activism, highlights the work of UCSF faculty conducting research on indoor air pollution and the chemical burdens on women and children.

Medical students sometimes complain that all the classroom work makes it too easy to forget why they wanted to go into medicine in the first place. Thankfully, in my first year at UCSF, I haven’t had trouble remembering why I am going into medicine thanks to all these enriching experiences.

This is part one of a two-part story – the second part will focus on research that UCSF faculty have conducted recently on pregnancy, abortion, and birth control.