A Journey to the Meaning of Health

By Unamarie Clibon, Pharm.D., M.D.

I have always been curious about how things in the world work. When I was a child, my family referred to me as the little scientist. At the age of 9, I received my first chemistry set. I did all the accompanying experiments, and then made up some of my own. In fifth grade, I got a microscope. I collected samples of pond and river water and parts of plants, and I looked at them under the microscope. One day, I cut myself and was bleeding; I decided to make a slide of the blood. I was fascinated with the movement of the small cells. Afterwards, I began to look at skin and hair samples, and started to develop quite an interest in how the body worked. Several times, our small-town pharmacist let me watch him compound ointments and capsules; it was chemistry in action. I was awed by the variety of medicines that were available for patients.

Along with this budding interest in the body, I also became curious about what made people act the way they do. I often discussed these things with my mother. We shared the same curiosity and interest in people, and she seemed to have some insight. In fourth grade, I told her something a visiting teacher had said, and she responded, “Do you believe that?” I don’t remember what I answered, but I do remember I had this feeling my mind was vast and that I was in control of this freedom. Over the years, my mother, several different teachers, a few books, patients and many life experiences became my mentors as I observed people to understand what motivated choices and how certain circumstances happened.

Later in college, I continued this exploration, changing my major from math to biology, and then entering the Doctor of Pharmacy program at the University of California. There, I learned about the use of medications to treat disease based on the chemistry of the drug and the abnormal function of the body in disease. I also began to learn how my choices brought about certain results. I also had my first contact with patients. I was surprised to learn how a patient’s preset ideas could affect how a medication worked or whether the patient even took the medication.

After graduating, I practiced as a clinical pharmacist at a large city hospital and taught at the College of Pharmacy for 6 years while also teaching pharmacology in the medical school. Each year, I had this expectation that the next new drug would be the answer. I was now able to observe patients over longer periods. I saw how often their cultural backgrounds determined how they interacted with the health care system, and how the health care system was limited in its response to patients’ different ideas of illness. I felt these limitations; I decided I could be of better service to patients and expand my knowledge as a medical doctor rather than as a clinical pharmacist and professor concentrating on just medication use.

Consequently, I left my recently-tenured faculty position and went to medical school. My curiosity about how the body worked and what could be done about disease continued. In medical school, there was some discussion about prevention of disease, but most of the focus was on diagnosis and treatment. It was all very interesting, and again, each year, I had the expectation that the new DNA and biochemistry discoveries would be the answer. Since I was now a medical doctor, I did the entire history and physical exam and directed treatment. Over the years, I specifically asked patients open-ended questions and listened carefully to their answers because it taught me about their thinking, not just their symptoms.

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