From two traditions of medical education, the makings of “a perfect doctor”

From the role of technology in American medicine to the tone of the doctor-patient relationship and scores of other details, life in a hospital in the United States was an eye-opener for Russian doctors Elvera Manapova, M.D., and Alla Selezneva, M.D.

The two women traveled with a group of physicians from their native Kazan in the fall of 2002 to spend four to six months at St. Mary’s Hospital in Waterbury and Yale-New Haven Hospital under Yale’s exchange program with Kazan State Medical University. Russians participating in the exchange don’t practice medicine—they only observe. But what Manapova and Selezneva saw gave them valuable ideas for how to do their jobs better when they get back to Russia, as well as a new level of appreciation for the skills they already have.

At first, there was some culture shock.

Start with the patients: American patients are far more engaged with their treatment than Russians. They’re even a little bossy.

“I think it’s because you can see something on television every five minutes having to do with doctors,” said Selezneva, sitting with her colleague in an office at St. Mary’s. “People are not so interested in medicine in Russia. They know a lot, but they are not so much concerned about every disease, because we don’t have so much information about medicine in the mass media.”

Manapova agreed: “Here patients ask so many questions. ‘Doctor, do you think if I use this will I get that?’ ‘You’re giving me this medication? I heard this could be bad for my health.’ ”

Also strange for them was the way that American doctors tell patients directly that they have fatal illnesses, instead of the Russian way of telling a patient’s relatives, and the way the patients react.

“Here doctors easily say probably you have cancer, but it’s OK,” Selezneva said.

“Yeah, it’s OK. Don’t worry; you will live. We’ll give you chemotherapy,” said Manapova, amused.

“And patients are not depressed by this!” Selezneva exclaimed. “I see so many patients who have breast cancer, lung cancer, cancer of the brain, and they are not depressed. I do not know why. Either they believe so much that medicine will help them, or they take life like it is.”

Selezneva, a neurologist, was already looking ahead to her return to Kazan, where she plans to apply her new, wider understanding of medication choices for various disorders. She also learned more efficient ways of using MR and CT scans, expensive and time-consuming back home at the No. 1 Republican Hospital, where there is only one of each machine. She learned at St. Mary’s that it isn’t necessary to run both scans for certain conditions, and can now be more selective about which to use.

But technology is not the ultimate answer for treating patients, both women realized. They were shocked by how infrequently American doctors do complete physical exams for patients, rarely having patients completely undress unless to check for skin cancer.

Testing reflexes, for example, is still such a time-honored procedure in Russia that Selezneva uses a reflex hammer she inherited from her great-grandfather. In this way, she’s able to detect problems like tiny brain lesions based on nerve reactions. “You can suspect something faster, and there are things you can find out only through physical exams,” she said. “You can feel them and see them. You just need to watch the patient.”

Manapova, an infectious disease specialist, often uses the technique of percussion: gentle pounding on the patient’s body with the hand and listening to the sound. A lung sounds different if it has fluid in it, she says, demonstrating soft, sharp raps with her hand on her own arm. “Even though we don’t have equipment, we have smart doctors who are good at clinical diagnosis,” she said.

The ideal, they agreed, is to have the best of technology but not to give up the old ways that work—perhaps the biggest lesson of their visit. “To combine all your techniques and skills, that would be perfect for patients, perfect for everyone,” Selezneva said. “You’d be the perfect doctor, a god!”