Lisa Kojima ’15, Newton Wellesley Primary Care

Lis-KojimaDay 1:

I arrived at Newton Wellesley Primary Care around 8:20 am to meet Dr. Janine Pardo ‘01. She introduced me to a few of her colleagues and then we went to her office. We had a few minutes to talk about why I was interested in medicine and what I study at Princeton, but she had her first patient at 8:30 am, so we did not talk at length. The first patient was coming in for an annual physical. Dr. Pardo had just joined the Newton Wellesley Primary Care practice last year, and she was meeting this first patient for the first time. (It turned out that all the patients that she was seeing today were all new to her.)

Having read in the media about how primary care physicians (PCPs) are in great need and how the average amount of time that a PCP spends on one patient is 15 minutes, I was surprised to see that Dr. Pardo spent on average at least 30 to 40 minutes. Part of this may have been because she was meeting her patients for the first time, which necessitated her asking many more questions than in a short follow up. She would first ask the patient whether there were things that he/she wanted to let her know, and most patients had a few things that they wanted to mention. Then she would go on to ask about the medications that they were taking, their family history, and their lifestyle. A healthy diet was a major topic for several patients, and instead of just telling the patient that they needed to incorporate more vegetables and fruits and cut down on animal protein in their diet, she also talked about the most recent studies that showed evidence of the benefits of certain diets. She took that extra step to make sure that the patient felt really comfortable with the information and would feel compelled to adopt a healthier habit. She would often print out a handout that the patients could bring home with them.

What was really interesting for Kojima 1me was that Dr. Pardo had her patients come into her office (as opposed to the exam room) and sat face to face at a desk with the patient. She had her computer so that she could jot down some notes as she spoke with the patients. I was always used to talking to the doctor in an exam room and although Dr. Pardo was typing on her computer, it felt like she was having a conversation rather than merely answering whatever questions the patient had and supplying a long list of facts.

Between each patient visit, Dr. Pardo gave me the opportunity to ask questions about the patient interaction or medical school or anything else I was wondering about. She talked a little bit about her rotations in medical school and how practicing in NY differed from practicing in Boston suburbs. She also filled in some more details on the patients’ medical records during these short breaks between patients.

One patient came in with a complaint that she had rashes isolated to the trunk of her body and during the physical exam, Dr. Pardo allowed me to look at how the rashes looked. Based on the location and the appearance of the rash, Dr. Pardo made a diagnosis and gave me some literature that I could read regarding the rash. During a different patient’s physical, we had a happy surprise—the patient found out she was pregnant!

Dr. Pardo really focuses on preventive medicine – maintaining a healthy diet, performing regular exercises, etc. —which I found very nice because I believe modern medicine is still very much focused on fixing people’s conditions and diseases as quickly as possible with medications after the problem starts but not much about what we can do to prevent the condition entirely. Before going into the Princeternship, I was interested in surgery because it’s clearer as to what is going on in the body. When you look inside the body, there is much less speculation as to what might be happening and less guessing as to what the X-ray or MRI or CT scans might be indicating. However, after today, I realized that PCPs can really affect the patients even long before the disease or condition begins. When patients visit a specialized doctor, it is usually not for preventive measures. It is usually after some problem has already been detected and needs to be checked more thoroughly by a specialist. Dr. Pardo’s newer approach to primary care, by focusing on preventive medicine, can totally change the way primary care is run.

At the end of the day, after all the appointments were done, a physician’s assistant came into the office asking for some advice about one patient who had chronic pain, for which none of the exams helped to determine the cause. Most of the day consisted of talking to patients, but this interaction with the PA allowed me to see the collaborative nature of primary care as well.

Day 2:

I arrived again at 8:20 am before the first patient came at 8:30 am. Similar to yesterday, the morning consisted of four annual physical exams. Dr. Pardo spent close to one hour with the first patient, who had multiple conditions that were all feeding into one another. Instead of focusing on one piece of the puzzle, Dr. Pardo thoroughly explained the importance of trying to improve all of the conditions simultaneously because ignoring one condition will inhibit the patient from improving other areas of his health.

Dr. Pardo and I talked a little bit about the nature of primary care and how they can be different from specialized areas. Primary care is very much diagnostic in the sense that you put different pieces together to determine the diagnosis. However, in specialized areas, the condition is often already determined by the time the patient sees the doctor, and the doctor then focuses on that one problem. PCPs, on the other hand, are the go-to doctors—they are the first person in line to look at all the symptoms, and then the patients are referred to specialty doctors.

We had more time for lunch on the second day, so we spent that time talking a little bit about Princeton. In the afternoon, there were five appointments, two of which were physicals and the rest were shorter follow-ups. In between patients, we talked about the flexibility that is allowed as a PCP.

This Princeternship gave me the opportunity not only to see the doctor’s routine in the office/exam room, but also to ask questions and have conversations about the pros and cons of being a doctor. Thank you Dr. Pardo for opening a window into the days in the life of a doctor!