Based on your experience working in Nicaragua, what should be done to improve medical practice and health care in the United States?
We must modify our financial incentives. In the United States, we are paid very well for using things of marginal benefit and underpaid for using our thinking skills. From the patient's perspective, we go for high-tech things of dubious value. The annual income differential between high-tech specialists and low-tech specialists is staggering.
What should be done to improve medical practice and health care in Nicaragua?
Several things would help the overall health of the people in Nicaragua. I believe that this may apply to other countries as well, but I have no personal knowledge of that. A reliable source of potable water is a good starting place.
We need to educate the people about simple and inexpensive methods of handling common problems. Inexpensive medications for common problems also are essential.
Good medical records would help immensely. I have developed a simple, inexpensive, user-friendly, computerized medical record system that allows me in Oklahoma to know what is being done at a clinic in Nicaragua.
If they had access to high-tech equipment, doctors in Nicaragua would love to use it. As in the United States, teaching doctors to use less technology in their day-to-day practices can be beneficial—and such an approach is needed if we want to straddle the health care chasm that exists between Nicaragua and the United States.
Think globally. Practice locally.
U.S.-trained internists who have practiced abroad will receive a $100 stipend for contributing to this column. For details, visit
Dr. Shook and his colleagues are building a new clinic in Mina El Limón, a remote village in western Nicaragua.
Dr. Shook treats about 100 patients each day while working in Nicaragua, which he started doing in 1993. Photos Courtesy Dr. Boyd Shook