Many diseases, especially common disorders like anemia and polycystic ovarian syndrome (PCOS), are easily manageable in Belize. Finding help might be confusing, especially if you don’t know who to go to. However, did you know that your general doctor is more capable than you think? The role of the humble family physician needs some revitalization. During these exceptional times, I have had to manage patients during the pandemic suffering from diseases normally controlled by specialists across the border. To the surprise of many patients, their conditions have been adequately managed by a general practitioner.
There is a sociocultural factor that we general practitioners need to face every day. Acne needs to be seen by a dermatologist. Blood sugar too high? Go to the internist. Is this menstrual cycle particularly painful? You need your OBGYN. Your 10-year-old child is having an asthma attack? You must consult the pediatrician. What does this leave to the generalist? The reality is, general practitioners are more than capable of treating these conditions and many others– usually at a fraction of the cost.
Here is a personal experience of mine as a young doctor first moving to Belize. My first job was out on the island of Ambergris Caye. I took a job working in a clinic with a colleague I had met not so long ago. It was quite the change for a “city man” like me but waking up every day to the sights and sounds of the largest barrier reef in the hemisphere was something hard to get used to (in a good way, obviously). My wife said that the view of the waves crashing over the corals on her morning runs soothed her soul. It truly is something to behold.
Work would involve treating a myriad of diseases from high blood pressure to decompression sickness, also known as “the bends.” On the island there is access to specialists at BMA up north, but this was not economically feasible for a large population of patients. The government clinic would accommodate specialists on certain days, but the largest bulk of the patient load fell into the hands of the general doctors in both the private and public clinics. Not to say a world without specialists is ideal, (it clearly isn’t) but there is a higher degree of confidence in the general practitioner in that setting. Afterall, we treated acne, high blood sugar, painful menstrual cramps and asthma in both adults and children. A great deal of our training involved learning how to diagnose and treat these very common conditions.
I left the island and settled into a new place in Belize City in early March and now I see patients from my cozy office in West Landivar. It is a neurology clinic called the Belize Institute of Neurology where I am the only general practitioner. Again, I have had to apply knowledge from a vast mental library that I’ve accumulated throughout medical school. My neurology is not up to par with a specialist, but I teach neuroanatomy remotely to medical students which has helped me settle in quickly at the clinic. There is a lot of reading that comes with the job too but that’s the beauty of the field. We are students forever.
As the solo general practitioner at the Belize Institute of Neurology, I still see the occasional runny nose, sore throat and stomachache which keeps me connected to my medical roots, but I’m also involved with the decision-making for managing patients with strokes or dementia. Having a seat at the table alongside the specialists bring me great satisfaction. I am not seen as lesser or unimportant but rather the opposite. You see, patients with strokes get just as many colds and UTI’s as everyone else. The respect I get from my colleagues in my current work environment is the inspiration for this article.
We need to stop overlooking the generalist. Even I find myself telling others, “I’m just a general doctor” when introducing myself. More pride should come with this position and we can change this.
It does not need to be me, but next time you feel sick, consider the generalist. A cough does not always need a pneumologist, aching joints does not always need a rheumatologist and a stomachache does not always need a surgeon. Next time consider us, consider your humble family physician.