Lessons from Tuberculosis Clinic

The very best part of my week is the morning I spend in clinic with my tuberculosis patients. During those hours, I get to take a break from the intense demands of running the Disease Control program and just be present, alone, with one single patient in one tiny exam room. Somehow, the intimacy of these encounters fills my need–the intrinsic need most doctors have–to truly connect with and attempt to heal another human being. The trust that patients bestow on their physician sometimes terrifies me, especially when their tuberculosis is complex and advanced. What if my medicines can’t fix it? What if I arrive at the wrong diagnosis, despite my best efforts at scrutinizing their symptoms?

The contagious nature of tuberculosis lends itself to a unique set of interview questions during our clinic visits, as the infection is spread through the air in social and family settings. What country were they born in, and how often do they visit? How many people are in their family? Were their parents ever sick? What countries have they traveled to? It is a far cry from the set of interview questions for non-communicable diseases. My mentor, Dr. Hosea, used to emphatically declare to his young trainees, “In infectious disease, the most important part of the medical history isn’t the medical history! It is the social history.” The more tuberculosis patients I see, the more he continues to be right.

But these kinds of questions–the “social history”–often lead my patient and me down an unintended road. They tell me about their mother who died when they were 10 and left them to raise six younger siblings. They tell me about their secret struggle with alcoholism, and the monsters of addiction that scratch at their door. They confide about an extra-marital affair, and fear that they are being punished for their transgressions with the disease of tuberculosis. They quietly share how tough it is to make ends meet as a field-worker with young children.