The Primary Problem
Drs. Jennifer McLean and Amy Brown—who live in Denver and Glenwood Springs, respectively—practice in medically underserved areas of our state. It's not what most doctors would call a choice position. They do it because they love it. But their jobs come with a fringe benefit that might make other would-be docs reconsider the waning career of general practitioner.
The blood pressure numbers glow on Dr. Jennifer McLean’s laptop screen. At 168 over 110, they’re high—too high, especially for a pregnant woman in her third trimester. McLean, who is pregnant herself, quickly scans the rest of the chart and toddles to the patient’s room. A lovely woman of Hispanic descent sits on the exam table; she’s obviously uncomfortable. McLean smiles warmly at her, but it’s the kind of smile that means there’s something wrong.
Although McLean, 39, knows her patient has high blood pressure even when she’s not pregnant, the doctor is concerned about preeclampsia, a condition characterized by a rapid rise in blood pressure that can lead to seizure, stroke, organ failure, and death of the mother and baby. “I can’t let you go home with your blood pressure this high,” McLean says in a gentle voice. “I’m going to give you a pill here to see if we can get it to go down. If not, I have to send you to the hospital, OK?” It isn’t really a question.
As McLean closes the door behind her, leaving her patient to rest in the dark, she says, “Good, that one was quick. We only have 20 minutes to see each patient. If the first one of the day runs long, it can become a difficult day really fast.”
In the subsequent four hours, McLean sees 12 more patients at Clinica Family Health Services at Pecos, a community health-care provider for low-income and other underserved populations in north Denver. McLean’s second patient of the day has migraines, numb hands, and a dependency on painkillers. Patient number three has insulin-dependent diabetes, hypertension, and emphysema. Patient four is 34 weeks pregnant and has pica disorder, which makes her want to eat things like dirt, chalk, and metal. (McLean tells her to suck on white Life Savers, which have a metallic taste.) Patient seven has depression. Patient nine is a young boy with eye irritation. Patient number 10 has severe asthma. Patient 12 has kidney disease. Patient 13 is a teenage mom with a toddler who isn’t eating.
In between these patients, the doctor takes a call from a radiologist at St. Anthony North who has MRI results for her and tries to keep up with the electronic “paperwork” she’s required to complete for each patient. When she finally sits down, her feet no doubt killing her, McLean pulls a Tupperware of sliced strawberries from her bag. She runs her hands through her prematurely graying but still mostly brown wavy hair, takes a deep breath, and looks at the time. It’s 1:15 p.m. She takes three bites of strawberry before a physician assistant asks her to help with the diagnosis of an anal abscess.