A day at work – life of an U.S. Embassy medical officer

As I settle into the various routines of a new career at the State Department and Embassy-Dhaka, friends and family have wondered just what it is I do at work each week. There are a wide variety of duties that keep the job challenging and interesting. While specific disclosures about internal workings of a U.S. Embassy are not able to be discussed, here is a general idea of what has been keeping me busy…

First, I serve as the primary care physician for the American employees at the Embassy, along with their families. I staff a small clinic located near the Embassy along with several nurses, a receptionist and lab technician. Available lab tests are similar to a family medicine clinic in the States. I am responsible for the health care of approximately 250 individuals, much fewer than the typical patient panel of a busy family physician in America (who cover 1600-2400 patients in a busy practice). Thus, the pace of clinical practice is comfortable, relaxing and fun. I can see patients whenever they find it convenient or necessary to come to the health unit. I can spend the time I wish with the patient to meet all of his/her needs, do good quality health screening and provide patient education. These are aspects of medical practice I’ve always enjoyed, but haven’t always had the time to do with the ongoing heavy patient demand for appointments in a busy private practice. I have no billing to worry about and no HMO’s or insurance companies to hassle with. I am pleased to be able to do office surgery and provide fairly comprehensive office care similar to practice in rural Minnesota. My patients range from two-month old babies to 65 year-olds just prior to retirement. I do prenatal care, but we arrange for transfer of pregnant women back to the States for their deliveries.

A typical day may include from 5 – 12 patients. We have a small pharmacy and often prescribe medication from the clinic for self-limited illnesses. Other meds are available on the local market as Asia-produced generics and other prescriptions are filled from U.S. mail-order pharmacies. We must be careful to help patients avoid some of the counterfeit meds that find their way into some small local pharmacies.

Patient care comprises only about one-third of the Regional Medical Officer duties. Another important duty is to meet local physicians, dentists, and hospital personnel in the Dhaka area to assess which advanced health services can be used in-country. I make regular visits to several local hospitals and interview a number of local physicians each month. Fortunately, advanced Western-trained physicians and Western model hospitals are on the increase in Dhaka. I often attend consultations with my patients to assess the patient care experience and the quality of the consultant. If special needs cannot be met here, I arrange for medical evacuation of patients to world-wide regional locations or the U.S. That comprises yet another important aspect of the job.

I am also responsible for health education of the Embassy community and this is accomplished in a variety of ways. The health unit staff produces an extensive health manual specific to our geographic area and special health challenges we face here. I meet with all new arrivals to post to review health risks and ways to stay healthy and safe. We submit regular education articles to the Embassy newsletter. We hold occasional lunch-time seminars and present at Town Hall Meetings, which are periodic open gatherings for all American living and working in Dhaka to keep in touch and informed.

Training local emergency responders, teaching CPR classes and doing disaster response training is yet another set of duties that I tend to. As in many large companies and government organizations, there are meetings, briefings, and committees to be involved with. There are manuals, provider listings and quality reports to be updated or written. All of these tasks blend together to give me a good variety of daily and weekly tasks when not working with patients.

Regional Medical Officers also oversee the health care in other embassies and consulates that are smaller and staffed by nurse practitioners, physician assistants or nurses. From Dhaka I travel to Kathmandu, Nepal each quarter to support the health unit and Embassy community. Some other Regional Medical Officers have very little direct patient care, but travel up to 70% of the time supervising many smaller health units, while others work at the world-wide medical evacuation centers coordinating the more complex care needs of patients that are transferred.

That, in a nutshell, is what I am doing while working. I have a great staff and a hard-working and enthusiastic embassy community to care for. It has been great fun to take on new challenges and to be appreciated for the service I bring to the community. So far, I have enjoyed this new career very much.