AHEC clinical rotation gives med student invaluable experience
(Editor's Note: Last week was National Area Health Education Center (AHEC) Week. Congress developed the AHEC program in 1971 to recruit, train and retain a health professions workforce committed to underserved populations.
The program helps bring the resources of academic medicine to address local community health needs. Third-year medical student Alan Kerr spent eight weeks on an AHEC rotation in Glasgow and reflects on his experience.)
In the classroom, medical students digest a lot of information about many medical issues, diseases and conditions, but our experience in clinical settings gives us a real-life knowledge that no book or lecture can. Perhaps nowhere is this better illustrated than on our AHEC rotations.
AHEC — or Area Health Education Centers — is a national program through which rural or underserved areas are infused with medical support, resources and personnel through partnerships with academic institutions like the University of Louisville. Each UofL medical student must work for eight weeks during his or her academic career at an AHEC location in Kentucky. I did my rotation in Glasgow, at the TJ Samson Family Medicine Clinic.
In the classroom, I had heard plenty about the issue of addiction to prescription painkillers — enough to know that it could be a problem among some patients, and enough to answer a test question correctly. My experience at TJ Samson was an immersion into the issue. I watched as the senior medical residents who ran the clinic deftly differentiated between pain that is secondary to the patient’s medical condition and drug-seeking behavior. Because of the increasing prevalence of addiction to prescription narcotics, this ability is an important aspect of primary care, an area that AHEC rotations stress.
Besides our clinical work, each medical student must perform a community project as part of the AHEC rotation. I attended alcoholics and narcotics anonymous meetings.
My eyes were opened as I saw people from nearly every socioeconomic class and different walks of life interact without tension in the meetings. Everyone there was extremely goal-oriented and supportive. Some of the wealthier people actually prepared Thanksgiving meals and invited everyone from the group to come and bring their families.
And people were there for each other. Most people had contact information for several members of the group, including the leader, to use in emergencies or simply for support during a stressful day. I found that communication among members was the most effective way for them to remain abstinent from drugs or alcohol.
They openly talked to me about prescription painkiller addiction. When I asked them how easy it was to get prescriptions for painkillers and whether they felt that doctors consistently paid attention to substance abuse history, I wasn’t surprised to find out that a lot of primary care physicians will prescribe these drugs without an extensive patient history and sometimes without even knowing about a patient’s prior substance abuse. We had a very extensive discussion about the potential for cross-addiction, especially for alcoholics who receive sedatives during withdrawal. As a student, I have been told to be careful in using sedatives and to begin weaning a patient going through withdrawal from them as soon as possible. But group members’ experiences suggest that physicians in the primary care setting do not always see the whole picture and may prescribe sedatives to treat anxiety, treating the symptom without fully understanding its root cause.
Many of these recovering addicts said they knew which doctors were more liberal with prescriptions and they told me the tricks that addicts use to manipulate doctors into prescribing narcotics.
As much as I have learned in medical school, I don’t think any physician could have given me such a unique perspective on a very important medical problem. My AHEC rotation provided a real-world experience and allowed me to make observations in a setting I would not have had in Louisville.