Rachel Parks ’15, Capital Digestive Care

Rachel-ParksFor my Princeternship, I spent two days shadowing Dr. Julia Korenman ’78 at Digestive Disease Consultants in Rockville, Maryland. I was interested in shadowing a gastroenterologists because I am interested both in digestive diseases and in the importance of cancer screening, which are the two biggest reasons that someone would see a digestive specialist. I spent my first day observing patient appointments in the office, and then on the second day we went to a nearby endoscopy center to do procedures.

On Monday, Dr. Korenman had a meeting, so I arrived at her office a few minutes before she did. She rushed in, showed me around, and then settled down in her office to make some calls. She explained that first thing in the morning was usually the time she took to talk to patients: making personal calls to patients and writing explanatory notes on their test results. In those few minutes, she called both a Korean-speaking patient and a Spanish-speaking patient. I’ll get to this later, but I was really impressed with the way Dr. Korenman dealt with language barriers.

Dr. Korenman said that what she liked about being in a specialty like gastroenterology is that you get to perform procedures regularly, but you still have patients who you see frequently – and that was true. Most of her patients were either patients with something chronic, like Krohn’s disease, and therefore came frequently, or were just getting a one-time procedure, like biopsies or a colonoscopy. But even for this second group, they still had several interactions in a row – for example, a consultation, a pre-op visit, and one or two follow-up visits. Dr. Korenman worked really hard to write herself good notes, so that she could remember details from a visit later. On this particular day, there were a lot of computer issues, but I could see that the electronic chart system was also a big help – Dr. Korenman could see x-rays and other tests with a few click, and it was easy to forward or receive information from patients’ primary care doctors.

Even though GE seems like a specialized field, there was a lot of interaction with other areas. For instance, if patients were on a long list of medicines from their primary care doctor, it influenced the medications that they could take for GE problems. There was one patient who claimed that the procedure he had just had on his esophagus had cured his migraines! There was another woman who seemed to be bouncing back and forth between an ENT doctor and Dr. Korenman – the tight feeling in her throat wasn’t easily explained by either discipline.

Those patients were very interesting, but my favorite patient was a Salvadoran woman who came into the office for a follow-up. Dr. Korenman said that she had studied Spanish in college, and that it was extremely rusty, but I was really impressed by her ability – not necessarily by her vocabulary, which was very good, but more by the fact that she approached her patient from equal footing and worked hard to be understood. She didn’t talk down to the patient, and she patiently tried new ways of explaining when her point didn’t get across. I have worked with Latino patients before, and Dr. Korenman proved what I already believed, which is that the confianza, or trust, that patients feel toward their doctor is much more valuable than perfect conjugation of every verb.

On the second day, we were in a different building, performing procedures. This was a lot more like surgery than I expected – Parks 1Dr. Korenman was wearing scrubs, and all of the patients on this day had chosen to be fully sedated. There was a whole team doing the procedure – Dr. Korenman, an anesthesiologist and a technician. I was so impressed with how well Dr. Korenman worked with her team. She managed to be a strong, focused leader while still being friendly and considerate. The day before, when she took time out of her schedule to resolve an office conflict, I thought she was being nice, but then I realized that having a good relationship with your staff directly affects both your own and the patients’ well-being.

It was a long day of procedures – some were easy and straightforward, and others were more difficult. As I observed, I was excited when I started recognizing things like the appendix, or the difference between the way the stomach and the esophagus looked. She removed a few polyps, but many of the procedures were due to specific complaints, so she took a lot of biopsies to look for things like Celiac disease or gastritis. Afterward, she would talk to the patients (who were still a bit groggy) and explain how the procedure went. I barely remember anything from when I got my wisdom teeth out, so I was not surprised that she directed most of her comments toward the family members who had come to pick the patient up.

I enjoyed this Princeternship for one of the same reasons Dr. Korenman said she enjoys her job – I got to see so many different patients, all in just two days. I was expecting a specialist’s job to be fairly impersonal, but I saw that her relationships were extremely important – with patients, their primary care doctors, her staff, and the other doctors in the practice. I’m still not sure what kind of doctor I want to be, but this Princeternship broadened my horizons and let me see so much in just two days.