A Military Doctor Mentors Young Iraqi Physicians

How was the program structured?

They rotated through different clinics. They spent time at the front desk and saw how we emphasize privacy. They also spent time with the medics and pharmacists to see how we organize our prescriptions and order lab tests. Capt. Steve Showalter, officer in charge of the medical clinic with the 547th Medical Co., and an army nurse did an outstanding job organizing the students’ schedules so that they had plenty of interaction with other physicians. He was also responsible for making sure they got out safely.

What were your impressions about how the Iraqi physicians practiced medicine?

It was an interesting experience watching how these Iraqi students gathered information from patients – history taking and doing physical exams. They generally spent a lot more time on physical exams than did their U.S. counterparts. I asked them about it and they said that was the amount of time that felt necessary to do the exam. We had a patient with abdominal pain and, with the patient’s permission, they formally inspected the abdominal area, listening to all quadrants systematically. And when they did their palpation, they were careful and thorough and took their time.

You could argue that U.S. physicians fresh out of medical school would do the same thing. The difference is that, ultimately, in the back of our minds when we do that kind of exam, we know we’re going to get a CT scan; for them, those kinds of resources are not immediately available. Since their infrastructure has been devastated by war, they have to rely on their bedside skills.

Do you think they will grow accustomed to wanting a CT?

It’s interesting. When we would order a CT, they would ask "Why are you getting it?" and I would explain to that this is how we practice. In the U.S., we have immediate access to imaging technology, so patients expect us to use it, but it’s not necessarily the best use of resources. Perhaps we could learn from our Iraqi counterparts about how to use resources more frugally.

Interview by Kathryn DeMott