Although I have done plenty of shadowing previously, this experience has been the most fruitful. I learned so much about the Portugues health system but I also gained a lot of insight about the American health system. Public health-wise, I am made aware of universal, nonuniversal, public, and private healthcare systems. Medically speaking, I feel enlightened about the human body and its deteriorating and healing process. I also believe that this experience has helped me clarify my skills, strengths, and interests that I have not yet had the chance to nourish. Lastly, the opportunity to engage in this MayX has taught me to take ownership of my personal and professional growth in learning.
Personally, the most fascinating part about being immersed in the Portuguese healthcare system has been comparing it to the United States healthcare system. Under the National Health System (NHS) there are two types of health systems: public and private. A public healthcare system is paid for by taxes while private is paid for by the patient’s insurance. Everyone in Portugal is covered by the universal healthcare, Serviço Nacional de Saúde (SNS), provided by the country to its citizens and residents. In addition to SNS, one may decide to purchase additional private insurance, which only approximately 10-15% of Portugal’s population does. At first glance, universal healthcare seems to be astounding, however; with a closer look, it is not very ideal. From my observations, for every benefit of the system, there was an opposing harm. For example, the idea that healthcare is free to everyone entering a public hospital is unbeatable, until tourists begin to take advantage of that concept. Speaking with Dr. Antonio in trauma orthopedics, Portugal already lacks many resources, and a typical weekly case he encounters is an elderly American tourist who isn’t accustomed to the number of hills and stairs of the country and as a result, falls and gets a femoral hip infarction. Going to a public hospital after the injury, they have no option but to not only admit the patient but to also operate the necessary surgeries. In return, the insurance companies delay the reimbursement process for cases like these which deprives the hospital of the resources spent on the patient and the many that came before them. Another downfall of a universal healthcare system is due to the limited resources, the hospital has to prioritize some patients over others. Dr. George in neurosurgery decided to leave internal medicine after completing two years of his residency for this reason. He couldn’t keep surrounding himself with physicians who had the mentality of “pediatrics are further away from death than geriatrics are.” This perception led to the loss of a few patients that Dr. George thought could have been saved if the physicians were more committed and the resources were more abundant. Ironically, the lack of resources is also the reason for these issues of abandonment. Because the resources are thinly spread out, healthcare professionals are left with a low-income but high workload.
I am super grateful to have gained this perspective of public healthcare that varies globally, however, I have also learned an abundance about the human body which is universal. During the anesthesiology rotation, I learned how to predict a difficult laryngoscopy
insertion as well as the risk of vomiting in intubated patients. During the neurosurgery rotation, I learned that the reason for adding local anesthesia is to raise the blood pressure which in turn constricts the blood vessels and prevents hemorrhages. I was captivated to see the real brain anatomy which had the skin, skull, and dura mater first before reaching the brain. During the hepato-pancreato-biliary (HPB) general surgery rotation I saw cholecystectomies, a postoperative lower abdominal liquid drainage, and jaundice and pancreatitis patients. Lastly, during the trauma orthopedics rotation, I learned about the wrinkle test for patients in pre-operation which is to check for swelling and therefore the readiness of patients for surgery. I also saw many geriatric patients with femoral hip fractions due to weakened bones and falls. To spot a patient with femoral hip fractions, their leg seems shortened and curved inward or outward. These are only a few of the many things I wrote in my notes during the observations. This information is important because there is no better way to learn than with a real visual. This is also useful because things I learn visually I don’t forget easily, so these are things that I will take with me as a future physician.
Despite all the information I have acquired about healthcare from a public health and medical perspective, I found the most value in the life lessons I have learned from this experience. It is a skill to learn how to be a physician. For example, one must be able to balance the subjective and objective aspects of a patient encounter. Dr. Antonio shared with me that it is not good to only be a “people’s doctor” or “disease doctor.” One has to be able to focus on both the concern of the patient and the actual diagnosis. This skill would have taken me many years to learn and figure out on my own if it wasn’t for Dr. Antonio. Also, throughout shadowing, I was reminded of what it was like to be in a place where I couldn’t speak the language. However, this time it was much more frustrating. I especially felt this way when I was in the clinic as a patient and not a student. Having others talk back and forth about my situation without me understanding a word was extremely challenging. It has allowed me to put myself in the shoes of non-English speaking patients that I encounter in the United States regularly and has helped me gain an abundance of empathy. Another aspect about this MayX that I value has been figuring out my interests or lack thereof. Although it was tedious being in surgery almost every day, I am grateful to know that I don’t want to specialize in surgery now than to realize that later on. The skills, strengths, and interests that I have revealed during this opportunity are extremely impactful on me now and in the future. As a physician, I will remember the things that I have learned over the past few weeks to help me be the best version of myself.
Lastly, one of my main goals coming into this MayX was to become more independent. During the first week, I mainly struggled with transportation because I was always commuting from one place to another with others. However, as the days went on, I was okay with not always following others’ plans so I began deviating more often. This forced me to learn how to use the metro on my own and allowed me to grow more confident in my abilities because I successfully reached my desired destinations. I not only took ownership of growth personally but also professionally. When in the hospital, even when shadowing with others, no one was going to force me to learn anything unless I was interested. I realized this when I went into shadowing one morning extremely tired from lack of sleep. This inhibited my learning extremely and limited my curiosity in the cases I was observing. From that point forward, I knew that I had to prioritize my sleep to set myself up for success the following morning. This is important because it re-emphasized the importance of self-accountability. As a future healthcare professional, knowing how to take ownership of my learning and holding myself accountable regularly will be a vital lesson to keep in mind.
Looking back at the past three weeks, I am moved by how amazing this MayX has been. From exploring healthcare in the global context and learning about public health in Portugal to getting accustomed to a different culture and maturing personally and professionally, every moment of this experience has been unforgettable. All of the lessons, skills, and interests that I have gained are important because they contributed to my growth. In addition, the things that I have learned will be impactful when it comes time to work in the hospital. I feel much more prepared now than ever before to continue my studies in Health Sciences and as a pre-medical student and to continue working towards my goal of becoming the best physician that I can be.
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