Although I have seen medical systems around the world, I never got to understand the differences in decision making until I came to Guyana as resident physician. The care the residents offer is far beyond my expectations for the resource-limited environment they are provided with. New cutting techniques of airway management and disease management have all been strategically adapted to the capabilities of their A&E. Still, they continue to excel while I struggled to keep up.

Throughout the first few days I found myself thinking, "Man, all I want is a CT scanner." All the decisions that I take for granted in the States suddenly have more impact here than they do in the United States. Physical exam becomes the gold standard for diagnosis and must be mastered to be an excellent physician and healer.  This was exemplified by a patient with an acute myocardial infarction. In the States, I can pick up a phone and my responsibility is essentially done as they take him to the cardiac catheterization lab. In Guyana I have to weigh the risks and benefits of giving him the clot busting medication that can cause disastrous bleeding complications. There is an increased level of continued ownership that is actually quite nice, while being scary at the same time.

Overall, my first impressions have been good. Incredibly talented residents working hard in a high stakes environment for their patients.  They do their job for their patients, and advocate for them as if they were the closest kin. I have seen them bypass bureaucratic barriers, calm the agitated and let those that are just too sick die with dignity. If anything, I have found myself learning how to be a doctor of humanity rather than a diagnostician, a refreshing ideology for a physician in training.