My experience in the Public health and primary care clerkship has

been a very profitable one. The clerkship has moulded me to be an all

rounded future physician, firstly by combining different concepts from
the diverse subdisciplines of both medicine and surgery and being able
to apply all of them to the treatment of a single patient in the primary
care setting. Secondly it introduced new concepts that are essential to
the good practice of medicine such as law and ethics, the duties of a
doctor and the rights of a patient.
The experience at the health centre and at the General practitioners
office was an eye opener to the differences in the practice of medicine
in a primary care setting versus in a tertiary care centre such as the
hospital. The health centre setting is focused on the continuing
treatment of patient s with chronic diseases who might come for filling
of prescriptions and routine assessment of their condition versus the
hospital where acutely unwell patients present for stabilization and
commencement of new treatment. Therefore in the health centre the
doctor is likely to know the patient for years and develop a
relationship, which presents a wonderful opportunity for the doctor to
educate the patient. This doctor has the opportunity to make a bigger
impact on the management of the disease since he/she has a longer
period of interaction with the patient. The health centre/GP doctor also
has a challenging task because patients with all kinds of illnesses from
psychiatric to surgical to medical or obstetric problems can present.
The doctor has to have a wealth of current medical information to be
able to tackle all these diverse presentations. Therefore the primary
care doctor is a specialist in everything
The participation in the family study was another great experience. It
helped us appreciate the different factors that determine the impact of
the disease on the patient. These factors can be social, economic,
spiritual or environmental. For example our patient had diabetes
mellitus and her husband who had was the breadwinner had just died.
This left her in economic trouble with an uncompleted house and little
money to survive, whereby she could no longer have enough food and
have an appropriate diabetic diet which had an impact on her
condition. The psychological stress form the loss of her husband and
its aftermath badly affected her blood sugar resulting in her being
hospitalized for hyperglycaemia for the 1st time. She also had issues
with ownership of the land where her house was situated because the
sister to her late common law husband claimed the it. All these helped
me to appreciate that there are many factors affecting the patients
medical condition and if they are not addressed medical intervention
alone might not resolve the patients condition.

The other benefit from this clerkship was being taught how to appraise
research papers. This is a valuable life long skill that every doctor
needs to have so they can be able to evaluate the results of research
papers. Medical practice is always changing and doctors keep up to
date by reading research papers. Some of these papers might have
fabricated conclusions or biased conclusions and the medical doctor
must be empowered to critique every research paper rather than
believe everything that is suggested by the authors.
The communication skills sessions were also very valuable because
they help us to be able to communicate the medical information to
patients. Without good communication skills doctors will not be able to
involve the patient in the management of their conditions hence
decreasing the effectiveness of treatment. Not only that but good
communication skills are needed to be able to elicit a good history
from a patient and to elicit the patients concerns and address them. A
doctor who has all the theoretical knowledge but poor communication
skills might fail to reach out to their patient and have dissatisfied
patients because they feel their needs have not been addressed and
they have not been heared. Hence communication skills complement
scientific knowledge in the good practice of medicine.
Various seminars were also eye opening such as the presentation on
The elderly in primary care. This presentation introduced us to the
fact that the elderly have special needs and they might not have the
classical presentation of disease and they might even present late
because they do not want to bother their caregivers or worse be
ignored because their condition is attributed to old age. Whereas the
elderly are not the only age group which has special needs other age
groups like paediatrics have a speciality dealing with them whereas
we dont have a rotation in geriatric medicine. Hence this lecture was
very important. The other seminar that stood out is The introduction
to palliative care Sometimes when all medical options have been
exhausted the only option that remains is to give the patient palliative
care and help them die with dignity. This lecture was well placed since
all of the teaching in all other rotations is focused on treating patients
and the sometimes inevitable option of helping to die with dignity is
never considered. All doctors should be taught palliative care since
sometimes it becomes the only option remaining.
The group presentations and family study also helped me improve my
teamwork skills. Whereas it might not be stated as a course objective,
by working as a team indirectly our teamwork skills were improved.
This shall profit us in the future because every doctor is a member of
the health care team irrespective of their place of work. Even the
general practitioner who has their own practice is a team together with
the specialist he/she refers patient to, the lab technicians who process

the patients specimen and the patient themselves. Good teamwork

skills are always important to improve the patients health.
In a nutshell, this clerkship complements all the other clerkships and is
essential for producing a well rounded doctor. There are no repetitions
from other course modules and it is an important course together with
others that lead to the award of the MBBS degree. It is also well
organized although there is room for improvement in the timetable
where some topics can be awarded a shorter time and more topics can
be covered in a day.