The last day of our summer internship was spend in a operation room for me! Although we heard from Dr. Chen that there will be a PAD surgery this morning, it was canceled when we inquired about it. Since our morning was originally scheduled for that, we end up having some time on our own. Like mentioned before, due to the rotations I choose, I did not have a chance to see any live operation throughout this internship. With the unexpected free time, we asked Dr. Ding (the neurosurgeon from Nicole's rotation) if we can join him in the operation room and he graciously allowed. It was an eye-opening experience for me. I scrubbed myself in for the first time, changed into scrubs for the first time, and stepped into a real operation room for the first time! I was worried in the beginning since I did not know anything about the surgery procedure and the fact that we have not covered neurology in class did not help either. However, I was able to pass without any major disturbance to the surgery and even managed to learn many things through the experience. Although we can only observe, I learned many things from Dr. Ding. Not only did I get to see a surgery right in front of me, I was able to see how a slight negligence from another doctor (the patient's back pain was probably due to some loose screws from previous spondylolisthesis treatment) can have enormous effect on the patient's life. Also, I was able to observe how different departments, from surgeons, anesthesiologists, nurses, and even biomedical equipment companies work together in one operation.
As the day draw to a close, we all commented on how we could not believe that four weeks can fly by so fast. This trip was truly an eye-opening experience for all of us. We have learned in this four weeks so much that it is impossible to list all of them here. It not only taught us many clinical knowledge that can only be learned during actual practice and not from the textbooks, it also taught us what it means to be a physician: the responsibility and all the hard work behind the title, and of course, the sense of pride and fulfillment that can only come when you know that what you do each day helps improve and sometimes even save another human being's life and does really make a difference in this world. I will never forget the past four weeks I spend in Taipei Hospital and all the wonderful doctors, nurses, and staffs who mentored us, helped us, and without whom we will genuinely be lost in our exploration. I would also like to say a special thank you to the TIHTC staff (Annie, Yuyu, Jessica, and Angie) and Superintendent Lin for all the hospitality and kindness they have shown us and for making this collaboration possible. I sincerely hope that this collaboration will continue to grow and future classes can also have the chance to experience all the wonders and treasures we found this summer.
Showing posts with label Jessica. Show all posts
Showing posts with label Jessica. Show all posts
Wednesday, July 6, 2011
Saturday, July 2, 2011
6/30/2011- Culture Exploration - Jessica
Today is a special day for us, since it is the only week day that we spend outside the hospital. We will be going to YehLiu National Geographic Park in the morning and ShenKeng District Public Health Center in the afternoon today with other physicians from Russia, Salvador, and China. I was surprised when we got on the bus that the bus was actually a tour bus in the most traditional Taiwanese sense. The bus features fancy curtains, entertainment system that includes multiple TV screens, microphones(for Karaoke), and even with disco balls and neon lights that can be turned on on request as well as an extremely experienced bus driver who can almost double as a tour guide who kindly took us all over Taipei for good stores to by souvenirs.
I have heard about Yeh Liu when I was still a child living in Taiwan but never really had the chance to go. Although I have seem many photos of the famous "Queen's Head" stone before. On our way there, the bus driver played a concert DVD from the very famous late singer Teresa Teng (鄧麗君) and we were delighted to find out that we actually know many of her songs from all the years of listening to our parents and grandparents playing her songs at home. I personally think that it was great to be able to find a common ground between the Taiwanese and Chinese passengers on the car despite the many different point of views due to the political situation. After arriving on the park, we were greeted by one of the staff in the park and she took us around the park introducing us to all the scenery and the stories behind each of them. Since our group consisted of such mixed group that speak many different languages, it was extremely hard for her to accommodate everyone and I really appreciated her effort.
After a delicious lunch, we went to ShenKeng to take a tour of the public health center there. The director of the center gave us a presentation on the center and it was especially interesting for me because she does it in both Chinese and English for each slide and I was able to practice my medical Chinese vocabulary as I can instantly find out unknown Chinese words from the English version later. One interesting I noticed was the amount of foreign wives (mainly from Vietnam and China) in the area and the different screenings specific for them (ie: specific parasite screening...etc). Also, Sandy ran into one of her friends from Berkeley who's studying at the National Taiwan University medical school today in the health center. Such a small world!
I have heard about Yeh Liu when I was still a child living in Taiwan but never really had the chance to go. Although I have seem many photos of the famous "Queen's Head" stone before. On our way there, the bus driver played a concert DVD from the very famous late singer Teresa Teng (鄧麗君) and we were delighted to find out that we actually know many of her songs from all the years of listening to our parents and grandparents playing her songs at home. I personally think that it was great to be able to find a common ground between the Taiwanese and Chinese passengers on the car despite the many different point of views due to the political situation. After arriving on the park, we were greeted by one of the staff in the park and she took us around the park introducing us to all the scenery and the stories behind each of them. Since our group consisted of such mixed group that speak many different languages, it was extremely hard for her to accommodate everyone and I really appreciated her effort.
After a delicious lunch, we went to ShenKeng to take a tour of the public health center there. The director of the center gave us a presentation on the center and it was especially interesting for me because she does it in both Chinese and English for each slide and I was able to practice my medical Chinese vocabulary as I can instantly find out unknown Chinese words from the English version later. One interesting I noticed was the amount of foreign wives (mainly from Vietnam and China) in the area and the different screenings specific for them (ie: specific parasite screening...etc). Also, Sandy ran into one of her friends from Berkeley who's studying at the National Taiwan University medical school today in the health center. Such a small world!
Thursday, June 30, 2011
6/28/2011, 6/29/2011- Cardiology - Jessica
On the second day of cardiology, we followed Dr. Chen (陳桂峰醫師) in the ultrasound room. Dr. Chen is very knowledgeable in his specialty and taught Nicole and I many diagnostic techniques on the ultrasound as well as clinical features of cardiology. One interesting observation we noticed was that in many valvular diseases, although surgery was indicated and highly recommended by the doctor, the patients still remain highly reluctant to operation. Dr. Chen explained that it is a common dilemma faced by cardiologists in Taiwan. In traditional Taiwanese view, surgery is already a very invasive procedure, regardless the real clinical invasiveness of the procedure, let alone cardiac surgery, where the surgery prognosis was often poor in past decades. Although the technology has gotten a lot better at cardiac surgery and the success rate has been very high, for many Taiwanese people, the stigma still present and the parents often remain reluctant to surgery unless patient life is in immediate danger. This is in contract to the amount of compliance Dr. Chen gets in his outpatient clinic. When we observed him in the outpatient clinic on Wednesday, I noticed that his patients seem to have great compliance to both his drug regiment, life style change, and even keeping a detailed blood pressure log. When I asked him about that, he answered that although many Taiwanese people are reluctant when it come to surgery, they are very welling to comply when it comes to drug, especially many cardiac drugs have immediate effects that makes convincing the patients a lot easier than other specialties. In addition, the fact that Dr. Chen has a good reputation and many year of experience in the field makes the patients respect him and will heed his advise a lot better than other doctors.
In the afternoon, we ran into a pacemaker placement in the catheter room. It was very interesting for me because unlike the other GHP members, it was the first operation that I was able to see during this trip. During the procedure, we talked with Dr. Chen again about cardiology and many aspects of being a physician. He said something that meant a lot to me: being a physician means constant learning and self-education; one must always consider the interaction between drugs and maintain the delicate balance between therapeutic effects of the drug and its adverse effect to the patient. Furthermore, adverse effects from drugs or treatment methods are responsibility of the doctor, not the patient. If a patient show signs of adverse effect from the drug, the doctor must be able to catch it whether the patient realized it or not and change the treatment plan accordingly. He also said that if any of his patient in good compliance with his treatment plan ever developed a MI, than he must have done something wrong and have failed his job as a cardiologist. It touched me to see that even after so many years in the field, Dr. Chen still shows such passion and dedication to his work and to his patients. Dr. Chen is truly a great role model for all the physicians to come.
In the afternoon, we ran into a pacemaker placement in the catheter room. It was very interesting for me because unlike the other GHP members, it was the first operation that I was able to see during this trip. During the procedure, we talked with Dr. Chen again about cardiology and many aspects of being a physician. He said something that meant a lot to me: being a physician means constant learning and self-education; one must always consider the interaction between drugs and maintain the delicate balance between therapeutic effects of the drug and its adverse effect to the patient. Furthermore, adverse effects from drugs or treatment methods are responsibility of the doctor, not the patient. If a patient show signs of adverse effect from the drug, the doctor must be able to catch it whether the patient realized it or not and change the treatment plan accordingly. He also said that if any of his patient in good compliance with his treatment plan ever developed a MI, than he must have done something wrong and have failed his job as a cardiologist. It touched me to see that even after so many years in the field, Dr. Chen still shows such passion and dedication to his work and to his patients. Dr. Chen is truly a great role model for all the physicians to come.
6/27/2011- Cardiology - Jessica
I can't believe we are in our final rotation already! It's the first day of our 4th week of rotation and we only have less than a week left in Taiwan! We start the day with Dr. Feng (馮文楷醫師) in the ultrasound room. Like Dr. Lin, the thoracic surgeon we met last week, we met with Dr. Feng before in the public health screen two weeks ago. Coincidentally, both Nicole and I were in the same station with him too. Since we are not familiar with ultrasound, we were a little disorientated in the beginning by the images. But after Dr. Feng's explanation, we quickly managed to be able to identify the key anatomy structures. This morning we saw many valvular and other cardiac diseases that we saw only on the textbooks before. For example, we saw an example of aortic stenosis and a patient with ventricular septal defect (of which we were able to hear the murmur very clearly as predicted by the textbook). We also saw a patient with suspected previous MI that caused hypokinesis of the anterior septal wall. One interesting thing we observed was the interaction between different departments, especially thoracic and the cardiology department, since many respiratory failure symptoms are either cardiogenic itself already or can be induced by heart failure.
The highlight of the day was the afternoon case presentation of colon cancer. The presentation was originally scheduled last week, but due to schedule conflict, was postponed to today. We have prepared ourselves all week long and the anticipation has made me more nervous as the time of the presentation approaches. The fact that I am responsible for the pathology section and Dr. Hsieh from the Pathology department was the only attending physician that day too did not help at all with my anxiety! But luckily the presentation went well for everybody and I didn't make any gigantic mistakes that I somehow have convinced myself would happen by all the anxiety and anticipation accumulated throughout the week. Despite the fact that it was nerve-wracking for me, the presentation was actually a very good learning experience for me, since it gave us the chance to see how different subdisciplines work together in cases like this as well as giving us the chance to practice our presentation skills that will be extremely valuable in the future.
The highlight of the day was the afternoon case presentation of colon cancer. The presentation was originally scheduled last week, but due to schedule conflict, was postponed to today. We have prepared ourselves all week long and the anticipation has made me more nervous as the time of the presentation approaches. The fact that I am responsible for the pathology section and Dr. Hsieh from the Pathology department was the only attending physician that day too did not help at all with my anxiety! But luckily the presentation went well for everybody and I didn't make any gigantic mistakes that I somehow have convinced myself would happen by all the anxiety and anticipation accumulated throughout the week. Despite the fact that it was nerve-wracking for me, the presentation was actually a very good learning experience for me, since it gave us the chance to see how different subdisciplines work together in cases like this as well as giving us the chance to practice our presentation skills that will be extremely valuable in the future.
Friday, June 24, 2011
6/24/2011- Respiratory and Thoracic Medicine - Jessica
Today is the last day of our shift in the respiratory and thoracic medicine department. We are with Dr. Chien again in his outpatient clinic. As before, Dr. Chien discussed each case with us after each consultation and Sandy and I were able to not only learn more new medical facts and clinical practices as well as review the things we have learned before from both Dr. Chien and back in Touro. In addition to clinical facts, we also talked about the general differences between the medical environment in US and Taiwan, from the national insurance Vs. private insurance, the different working environments, and even to the different social status doctors have in the two nations. Among all of the things we discussed, the most memorable part is the different social status the doctors here have as opposed to Taiwan. Although in Taiwan, doctors are still considered one of the most respected occupations, the image is rapidly changing now. As the national insurance policy started to take effect, the extremely affordable health care that sometimes disproportionally favored the patients than the health workers made the services from doctors seemed insignificant and relatively lower in value. The negative reports from the news about some bad practices from corrupted or incompetent doctors did not help either. As a result, the image for doctors start to deteriorate lately. For example, just in the three weeks I have observed so far, I have seen at least one patient treated doctors disrespectfully in each week of rotation. The first week in TCM, I have seen a patient have a fifteen minute argument with the doctor for prescriptions that did not fit her condition and symptoms. During the pediatric week, I saw a patient yelling at the doctor since the day before in the ER department and again the next day in the outpatient clinic. I can't say these situations never happened in the US, but it will be very rare. Combined with the already low salary of the doctors in Taiwan compare to other countries and the fact that health care budget is limited and many hospitals are forced to absorb the difference by themselves when the government subsidies fell short, many incoming students are having second thoughts on entering the profession now. Although the Taiwan national health system is famous for its affordable coverage to all citizens and its extreme convenience for the patients (see my previous blog about my "trip" to the dermatologist), it is arguably based on the expanse of health workers and hospitals. I hope in the future the Taiwanese government can revise to a more balanced system that benefit both the patients and the health workers, since I really think the national health system in Taiwan is really successful in improving general public health and making it affordable and available to all citizens and I hope that it will still be around for the generations to come.
Thursday, June 23, 2011
6/23/2011- Respiratory and Thoracic Medicine - Jessica
Due to Dr. Yu's ER schedule today, Sandy and I shadowed Dr. Tseng (曾常新醫師) instead doing patient rounds. The first case this morning was already out of the ordinary for us. We ran into Dr. Tseng just as we were going to knock on the door of the internal medicine morning meeting room. Right from the beginning, we can tell from Dr. Tseng's expression that he was somewhat stressed and preoccupied by something. After explaining that we will be following him today, he explained the situation to us: he had just receive the news of the death of a patient due to sepsis in the ICU ward and was hurrying to the ICU to meet with the family and deliver the news. When I first heard him say "a patient expired this morning", my brain went blank for a second before the thought finally sank in and I finally understood that a human live has just slipped away unbeknown to me all through this morning when I was so busy struggling through the morning commute crowd to get to the hospital from home, my thoughts spent on mundane things that have absolutely no importance in comparison to someone's life. When we arrived at the ICU, the patient laid there motionless, her face and skin an indescribable shade of pale. As Dr. Tseng went over the patient chart with us, I couldn't help but notice how the son gently stroked his mother's forehead with teary eyes and his face filled with sorrow and yet still managed to show such love and tenderness. My eyes teared up at the moment, in fact, just typing about it now is making me emotional still. Even though I knew death is something that all of us will experience one time or another during one's life time, especially for us working as health workers, it was still hard to see it. No matter how much preparation we had in doctoring courses about loss and grief, I think death is something that we can never train ourselves to be truly unaffected by it. I may not even know the patient at all, the only connection between the patient and I based on the couple pages of notes and test results on the chart, her death still saddened me and affected me on a human level. Although the fact that her face was peaceful and her son was by her side to send her off her final journey comforted me and I can only assume that it was a painless transition and suffering was limited to the bare minimum on both the patient's and family's sides.
After talking to the family and documenting the time of death and other necessary paperwork, we continued our morning round with Dr. Tseng. In one of the wards, we joined with a cardiology doctor to visit two patients hospitalized for heart conditions. One of the patient's case was very interesting because a 24 hour EKG report was done on the patient and revealed a >4sec prolonged period between heart beats. Although the arrhythmia can be a side effect from the current infection, but a pacemaker may need to be installed if the arrhythmia persists.
After a quick lunch, Sandy and I returned once again to Dr. Lin's outpatient clinic, looking forward for the surgery video he promised for today. However, when we arrived Dr. Lin was no where to be seem. The nurse told us that due to personal matter, Dr. Lin will be slightly late for today's clinic. Not thinking much of it, Sandy and I just sat and chatted for about 10 minutes in the room. But when Dr. Lin arrived, he seemed flustered and distressed. Dr. Lin informed us that due to a family emergency, he is suspending his afternoon clinic for any further appointments and will see the patients who already had the appointment made as soon as possible and leave immediately after. He apologetically asked us to leave early this afternoon and said that he will show us the videos later next week on a more convenient time. Not wishing to add to his distress and seeing him pressed for time, we replied quickly that it was of course fine and wished the best for him and his family before we left. Although we were able to get a much needed rest this afternoon, Sandy and I were still quite worried for Dr. Lin and sincerely hoped that everything will work out for Dr. Lin and his family.
After talking to the family and documenting the time of death and other necessary paperwork, we continued our morning round with Dr. Tseng. In one of the wards, we joined with a cardiology doctor to visit two patients hospitalized for heart conditions. One of the patient's case was very interesting because a 24 hour EKG report was done on the patient and revealed a >4sec prolonged period between heart beats. Although the arrhythmia can be a side effect from the current infection, but a pacemaker may need to be installed if the arrhythmia persists.
After a quick lunch, Sandy and I returned once again to Dr. Lin's outpatient clinic, looking forward for the surgery video he promised for today. However, when we arrived Dr. Lin was no where to be seem. The nurse told us that due to personal matter, Dr. Lin will be slightly late for today's clinic. Not thinking much of it, Sandy and I just sat and chatted for about 10 minutes in the room. But when Dr. Lin arrived, he seemed flustered and distressed. Dr. Lin informed us that due to a family emergency, he is suspending his afternoon clinic for any further appointments and will see the patients who already had the appointment made as soon as possible and leave immediately after. He apologetically asked us to leave early this afternoon and said that he will show us the videos later next week on a more convenient time. Not wishing to add to his distress and seeing him pressed for time, we replied quickly that it was of course fine and wished the best for him and his family before we left. Although we were able to get a much needed rest this afternoon, Sandy and I were still quite worried for Dr. Lin and sincerely hoped that everything will work out for Dr. Lin and his family.
Wednesday, June 22, 2011
6/22/2011- Respiratory and Thoracic Medicine - Jessica
Today was a exciting day for Sandy and I. We had a "field trip day" today! Instead of going to outpatient clinic today in Taipei hospital, we were going to meet with Dr. Chien in a special outside clinic for in 名權西路 called "中華民國防癆協會" (Taiwan Anti-Tuberculosis Association). The clinic used to be only for TB cases only, but with the national insurance change couple years ago, now it is a general clinic; although it still has more TB cases due to its renowned expertise in treating the disease. Since we need to be there at 8:45 am today, Sandy and I woke up early and had our first encounter with the Taipei rush hour crowd this morning. Although I knew the MRT is often very busy during the rush hour and that "personal space" is a strictly American thing and often does not apply to Asians, we were attacked by surprise when all of the crowd rushed into the MRT car and squeezed us against each after we got into the car. It was so crowded that we didn't even need to hang on the handrails for balance; we were squeezed so tight against each other that it was impossible for us to move, let alone falling down. Even though we were a little intimidated by the morning commute crowd it was still a good experience, it gave us a new facet to the Taiwanese culture that we have not had the chance to see before.
We met with Dr. Chien at the clinic and begun our day with observing Dr. Chien in the outpatient clinic. Many of the patient were here for previous TB infection follow up and asthma, only 1 or 2 patients were here for general illness like upper respiratory tract infections. Dr. Chien graciously introduced us to the staffs of the clinic and asked the head nurse if she had the time to give us a brief tour and history of the place after the clinic. Dr. Chien then proceed with the clinic and taught Sandy and I more about TB (we saw a real-life case of MAC today!), asthma management, and also more practice on interpreting patients' spirometry (we also had the chance to try it ourselves too) results. After the clinic, the head nurse kindly took us around the facility and gave us a brief introduction of the place and its history. One interesting thing we learned was the selling of stamps in the past to gather funds for TB patients who could not afford the long and expensive treatment course of TB before national health insurance became available to all citizens in 1995. It was especially interesting to me because I also recalled my aunts recounting the tale of patriotic stamp buying during there school days and was able to make the connection too. We also learned about the patient distribution and patient number change in different seasons. For example, as the weather have became quite sunny and drier in Taiwan, the number of patients significantly decreased in this clinic, as most of the patient population (ex-TB, asthma, upper respiratory infection) has less symptoms or fewer chance of infection at this time. However, during the winter months, the clinic will be filled with patients. The head nurse told us as many as 200 patients will be seem in one morning during the peak time!
We met with Dr. Chien at the clinic and begun our day with observing Dr. Chien in the outpatient clinic. Many of the patient were here for previous TB infection follow up and asthma, only 1 or 2 patients were here for general illness like upper respiratory tract infections. Dr. Chien graciously introduced us to the staffs of the clinic and asked the head nurse if she had the time to give us a brief tour and history of the place after the clinic. Dr. Chien then proceed with the clinic and taught Sandy and I more about TB (we saw a real-life case of MAC today!), asthma management, and also more practice on interpreting patients' spirometry (we also had the chance to try it ourselves too) results. After the clinic, the head nurse kindly took us around the facility and gave us a brief introduction of the place and its history. One interesting thing we learned was the selling of stamps in the past to gather funds for TB patients who could not afford the long and expensive treatment course of TB before national health insurance became available to all citizens in 1995. It was especially interesting to me because I also recalled my aunts recounting the tale of patriotic stamp buying during there school days and was able to make the connection too. We also learned about the patient distribution and patient number change in different seasons. For example, as the weather have became quite sunny and drier in Taiwan, the number of patients significantly decreased in this clinic, as most of the patient population (ex-TB, asthma, upper respiratory infection) has less symptoms or fewer chance of infection at this time. However, during the winter months, the clinic will be filled with patients. The head nurse told us as many as 200 patients will be seem in one morning during the peak time!
Tuesday, June 21, 2011
6/21/2011- Respiratory and Thoracic Medicine - Jessica
Today is the 2nd day of the respiratory rotation. We will be following Dr. Yu (游承翰醫師) today in the morning and Dr. Lin (林振嵩醫師) in the afternoon. Dr. Yu's morning shift was in the ICU, although we were here yesterday with Dr. Chien, we still find the ICU quite eye-opening for us. Dr. Yu is a very friendly person, easy going and made us felt very welcomed. He went over two patients' charts with us and went through the process of developing the diagnosis and treatment for each patient. It was very helpful to hear the thought processes behind the diagnosis and treatment course, since it really drives home a lot of the medical background we learned during class as well as the differential skills we developed. We then followed Dr. Yu around in other wards for each of his patients. Again, he explained the condition of each of the patient to us and was very helpful again in reinforcing the things we have learned in school as well as teaching us new clinical information that we have not covered yet. Dr. Yu was able to taught us many things in one morning. For example, we learned about the various aspects of the endotracheal tube, including its adverse effects, limitations, and the different ways the patients family arrived in the decision of whether to replace with tracheotomy, to leave it in, or to remove it. We also learned about the various multi-drug resistant pathogens that is common in Taiwan. We were shaken when we heard about the extended-drug resistant pathogens that does not response to almost all of the antibiotic we know and were even more surprised to see 2 patients in the ward to already have the infection. Dr. Yu's teaching style worked very well for me for some reason, probably because he present each case like a puzzle that require us to take in all the information and arrive on the right diagnosis and treatment that makes me retain the information better. Thus, I was quite sad to hear that we won't be able to have our Thursday morning shift with him again as scheduled because of his ER shift that morning.
In the afternoon, we joined Dr. Lin (on a side note, I found it interesting, although somewhat inconvenient when it comes to blogging, that there are so many Dr. Lin's and Dr. Chen's that sometimes I confuse even myself while typing :P ) at his outpatient clinic. Coincidentally, I have actually met Dr. Lin last Saturday during the community clinic and shadowed him during that time in the physical examination station. From our conversation that day, I have already learned that he is one of the few MD/PhDs in the hospital, with current research in mitochondria genetic. It was a change of pace for me because Dr. Lin is the first surgeon I have encountered during this internship. However, I was surprised to find that most of the patients in the clinic today were here for certification of their previous injury/hospitalization for insurance/school/work purposes. Only few of these patients were here for thoracic problems, mostly for uncomplicated fractured ribs that can be healed spontaneously and only required supportive care (NSAID, painkiller...etc). One interesting thing we heard today was that a 6 week monitor period should be used when dealing with rib fractures, since sometimes fractures undetectable through x-ray before may show up later as the pain subsided and the patient starts to move around and caused the fractures to be visible now.
One other highlight of the day was our first-hand experience with the Taiwanese medical system as the patient. Since I started to have skin allergy on my face and arm a day after the community clinic (probably the dust...etc in the basement of the activity center), I decided to go see a dermatologist today before the itchiness eclipses all of my sanity. Even though we have been hearing a lot about the Taiwanese health system being very convenient for the patients, it was still very surprising for us when we finished the whole registration (walk-in), waiting, consultation, paying, and finally getting all of the drugs in less than 30 minutes. The grand total turned out to be about NT$320, including the appointment fee, doctor fee, drug fee, and a week's worth of 4 types of drug (2 different strengths of corticosteroid cream, oral anti-histamine, and topical anti-histamine lotion).
In the afternoon, we joined Dr. Lin (on a side note, I found it interesting, although somewhat inconvenient when it comes to blogging, that there are so many Dr. Lin's and Dr. Chen's that sometimes I confuse even myself while typing :P ) at his outpatient clinic. Coincidentally, I have actually met Dr. Lin last Saturday during the community clinic and shadowed him during that time in the physical examination station. From our conversation that day, I have already learned that he is one of the few MD/PhDs in the hospital, with current research in mitochondria genetic. It was a change of pace for me because Dr. Lin is the first surgeon I have encountered during this internship. However, I was surprised to find that most of the patients in the clinic today were here for certification of their previous injury/hospitalization for insurance/school/work purposes. Only few of these patients were here for thoracic problems, mostly for uncomplicated fractured ribs that can be healed spontaneously and only required supportive care (NSAID, painkiller...etc). One interesting thing we heard today was that a 6 week monitor period should be used when dealing with rib fractures, since sometimes fractures undetectable through x-ray before may show up later as the pain subsided and the patient starts to move around and caused the fractures to be visible now.
One other highlight of the day was our first-hand experience with the Taiwanese medical system as the patient. Since I started to have skin allergy on my face and arm a day after the community clinic (probably the dust...etc in the basement of the activity center), I decided to go see a dermatologist today before the itchiness eclipses all of my sanity. Even though we have been hearing a lot about the Taiwanese health system being very convenient for the patients, it was still very surprising for us when we finished the whole registration (walk-in), waiting, consultation, paying, and finally getting all of the drugs in less than 30 minutes. The grand total turned out to be about NT$320, including the appointment fee, doctor fee, drug fee, and a week's worth of 4 types of drug (2 different strengths of corticosteroid cream, oral anti-histamine, and topical anti-histamine lotion).
6/20/2011- Respiratory and Thoracic Medicine - Jessica
After pediatrics, we now move on with the third week of our internship. The first day in the respiratory and thoracic medicine was spend with Dr. Chien (簡林禎醫師). We begun in the morning meeting room and Dr. Chien went over a list of his patients, going over the important clinical histories for each patient and brought us to the wards (including ICU!). Since Taipei hospital is a regional hospital, they often receive many acute patients. And since dyspnea is often one of the most common symptoms, Dr. Chien has patients of many different etiologies, from cardiogenic, infection, to trauma. During the morning session with Dr. Chien, we learned many interesting features of respiratory and thoracic medicine, including common drugs used, standard asthma treatments, typical and nosocomial pneumonia...etc. The most interesting aspect of the morning was going over each case and the path Dr. Chien took to arrive at the diagnosis from the symptoms and eventually to the treatments. Each case is like a puzzle, except that this time it is no longer child's play, each puzzle has human lives at stake and a mistake is often not an option.
In the afternoon, we observed Dr. Chien in his outpatient clinic where we saw many latent TB and minor pneumonia patients here for treatments. Again, Dr. Chien taught us many things during his outpatient clinic. After each patient, Dr. Chien would turn around and explained to Sandy and I the previous encounter with the patient. It was a great learning experience because we are able to connect what we have learned in the textbook to real patients and see how the disease/treatment course affect each patient's live.
Unfortunately, due to the case study presentation, we need to leave early in order to be on time for the meeting. When we informed Dr. Chien about the meeting this afternoon, he remarked that it seems strange that we would have a meeting like that at that time, since they (the directors of each department) are meeting with Superintendent Lin at the exact same time! In that case will we be presenting in front of all of the directors of the departments? Although we were a little unnerved by that realization, fearing that we will be late for the meeting, we hurried along to Yuyu's office as instructed last week. As we were descending down the stairs to Yuyu's office, Sandy and I tried to sooth each other's nerves and cautiously reminded each other to be on our best behaviors if we are indeed presenting in front of such important audience! However, we met with the rest of the GHP group in the stairwell and was informed, to my relieve, that the meeting had been postponed due to schedule conflict. I felt both relieved and yet disappointed by the news. I am relieved because I felt like I will have more time to prepare myself for the presentation to make it better but I also feel disappointed because I think it will be a great experience for us to present in front a group of physicians on top of their field; it will be a great educational experience for our future when we are doing it for real during rotations.
In the afternoon, we observed Dr. Chien in his outpatient clinic where we saw many latent TB and minor pneumonia patients here for treatments. Again, Dr. Chien taught us many things during his outpatient clinic. After each patient, Dr. Chien would turn around and explained to Sandy and I the previous encounter with the patient. It was a great learning experience because we are able to connect what we have learned in the textbook to real patients and see how the disease/treatment course affect each patient's live.
Unfortunately, due to the case study presentation, we need to leave early in order to be on time for the meeting. When we informed Dr. Chien about the meeting this afternoon, he remarked that it seems strange that we would have a meeting like that at that time, since they (the directors of each department) are meeting with Superintendent Lin at the exact same time! In that case will we be presenting in front of all of the directors of the departments? Although we were a little unnerved by that realization, fearing that we will be late for the meeting, we hurried along to Yuyu's office as instructed last week. As we were descending down the stairs to Yuyu's office, Sandy and I tried to sooth each other's nerves and cautiously reminded each other to be on our best behaviors if we are indeed presenting in front of such important audience! However, we met with the rest of the GHP group in the stairwell and was informed, to my relieve, that the meeting had been postponed due to schedule conflict. I felt both relieved and yet disappointed by the news. I am relieved because I felt like I will have more time to prepare myself for the presentation to make it better but I also feel disappointed because I think it will be a great experience for us to present in front a group of physicians on top of their field; it will be a great educational experience for our future when we are doing it for real during rotations.
Monday, June 20, 2011
6/16/2011, 6/17/2011 - Pediatric - Jessica
The last two days at pediatric was fantastic for me! I originally thought that the last two days will be relatively less interesting than the other days because it will be mostly outpatient clinics and thus less time for hand-on patient interaction or preceptor time, I was totally surprised to find myself enjoying every single moment of it! Although I have to admit that sitting in the stools all day long does have its toll on my anatomy, it was well worth it!. Many reasons made the last two day so much fun for me. First, as mentioned before, all of the pediatric department, the doctors, PA, and nurses are all very kind to us and very easy going and fun. Second, the children are just adorable! Although it was heartbreaking to see the actually seriously ill children, it was amazing to see how much endurance and courage the children exhibit against sickness and it was most heartwarming to see how each children recovered so fast after the illness and carry on as if the past few days of pain and suffer never touched them. I especially remember one of the baby girl coming in for vaccination. She smiled like an angel the whole time, even during the needle prick! I think it was this particular trait of children that make pediatric one of the best fields to work on and the pediatricians one of the best people to hang around with. Through working with Dr. Tsai and Dr. Wu, I can really see what it means to be a good physician. I can truly feel their dedication and love toward each and every single one of their patients... even during the trying moments where the patients' family members tried to vend their fear and anxiety toward the child's sickness on the physicians and making the situation more difficult than it has to be. Just like what Karen and I said to Dr. Wu during our last day: I think we are converted life-long pediatric fans from now on!
Wednesday, June 15, 2011
6/14/2011- Pediatric - Jessica
The second day of pediatric was a totally different experience from yesterday. Yesterday was mostly lecture, with occasional opportunities to visit the patients in their hospital rooms. On the contrary, today was all outpatient clinics and with many opportunities to observe real patients. We begun the day with Dr. Wu (吳俞哖醫師), a pediatric cardiologist. Dr. Wu has actually retired recently and is only holding outpatient clinic now for the patients that she has seem over the years and had developed a close relationship with. Dr. Wu is a very easy going and gregarious person and we were able to discuss many things, from medical facts to the Taiwan medical culture. But the most memorable part of it was her enthusiasm and attitude toward pediatric and her patients. After talking to her, I was able to renew my determination of becoming a physician once again and I sincerely hope that one day I will be able to become a physician like her.
During lunch, we learned a surprising news from Yuyu, that our colon cancer presentation has been moved up to next Monday instead of next Friday. We were a little caught off guard by the new due date, since we are still in the preliminary stage of our presentation (Mickey just got the surgery materials today), but I think if we work hard the next few day, we should still be able to have fun and still do a good job on the presentation.
The afternoon was spent in the outpatient clinic with Dr. Su (蘇冠文醫師), a pediatric immunologist. Dr. Su did his research in pediatric respiratory allergies and taught Karen and I many interesting aspects of pediatric allergic diseases, such as the correlation and possible cause of allergic shiner by chronic allergic rhinitis/sinusitis and the epidemiology of asthma in Taiwan: its strong correlation with dust mite allergy for the Taiwanese people (about 80 %). During our conversation, we found out that he actually studied at the US for a short time and is quite familiar with a lot of the US's health system. In fact, Dr. Su had researched about Touro prior to our meeting and we had a short conversation about the DO profession. Dr. Su also mentioned that this coming Thursday's outpatient clinic feature a three-panel special clinic from the pediatric, developmental rehabilitist, and psychiatric department specifically designed for children with behavioral problem. Both Karen and I think Thursday's clinic will be a great learning opportunity and we are both looking forward for it with excitement.
During lunch, we learned a surprising news from Yuyu, that our colon cancer presentation has been moved up to next Monday instead of next Friday. We were a little caught off guard by the new due date, since we are still in the preliminary stage of our presentation (Mickey just got the surgery materials today), but I think if we work hard the next few day, we should still be able to have fun and still do a good job on the presentation.
The afternoon was spent in the outpatient clinic with Dr. Su (蘇冠文醫師), a pediatric immunologist. Dr. Su did his research in pediatric respiratory allergies and taught Karen and I many interesting aspects of pediatric allergic diseases, such as the correlation and possible cause of allergic shiner by chronic allergic rhinitis/sinusitis and the epidemiology of asthma in Taiwan: its strong correlation with dust mite allergy for the Taiwanese people (about 80 %). During our conversation, we found out that he actually studied at the US for a short time and is quite familiar with a lot of the US's health system. In fact, Dr. Su had researched about Touro prior to our meeting and we had a short conversation about the DO profession. Dr. Su also mentioned that this coming Thursday's outpatient clinic feature a three-panel special clinic from the pediatric, developmental rehabilitist, and psychiatric department specifically designed for children with behavioral problem. Both Karen and I think Thursday's clinic will be a great learning opportunity and we are both looking forward for it with excitement.
6/15/2011- Pediatric - Jessica
We spent today in the outpatient clinics again, but with different preceptors. We joined Dr. Wu (吳秋文醫師) in the morning and Dr. Wong (王怡人醫師) in the afternoon. Like Dr. Ho from TCM before, as the director of the pediatric department, Dr. Wu has a heavy patient load and worked past lunch to see all of his patients. Unlike yesterday, where most of the patients were here for the doctors' specific specialties, many patients are just here for general complains unrelated to Dr. Wu's specialty, which is pediatric immunology. Especially after the clouding agent problem started, many of the patient were here for testings to determine possible exposure to the clouding agents. The clouding agents were found in many different type of food/health supplement in Taiwan. Among them, the most worrisome for parents are the contamination of certain brands of probiotics and even a syrup of Augmentin, since many were consumed regularly by their children in an attempt to improve their health. The crisis this time created such scare largely because clouding agents over stimulates femalization of developing children and thus, in a culture where continuing the family bloodline is of the utmost importance, created unprecedented panic among the parents. I have been following the news for the past week on the new development and was quite curious to see the actual effect of the clouding agents on the pediatric patients. To my surprise, contrary to the news coverage, out of the 20 patients examined for the sexual organ abnormalities throughout the last two days, only one patient seemed to have underdeveloped genitals. However, that patient also suffer from hypothyroidism, so the actual effect of the clouding agents cannot really be ascertained at this point without further testings. We also notice several interesting points about clouding agent testing. For example, we were surprised to found out that the test for sex hormones in pediatric children is often inconclusive, since most of the children will be prepuberty, their testosterone levels will be inevitably lower than the normal amount for adults and thus not entirely reliable when it is lower than expected value and require obtaining separate list of standard values for each age group to accurately determine the results.
Other than the clouding agent testings, we also saw many interesting cases. We begun the day with a case of hip dislocation where the child was too old that tissue has grown between the gap that surgery is the only option now. Remembering our training in our pediatric physical exam lab, we were reminded again the importance of early diagnosis of congenital abnormalities like hip dislocation. In addition, Dr. Wu also pointed out that when asked about abdominal pain, many children tend to just point to the umbilical region for diffuse pain and it should not be taken literally as a sign of localized pain around the umbilical area. Similarly, when the child specifically point to a place far away from the umbilical area, it is usually a good indicator for localized abdominal pain.
Other than the clouding agent testings, we also saw many interesting cases. We begun the day with a case of hip dislocation where the child was too old that tissue has grown between the gap that surgery is the only option now. Remembering our training in our pediatric physical exam lab, we were reminded again the importance of early diagnosis of congenital abnormalities like hip dislocation. In addition, Dr. Wu also pointed out that when asked about abdominal pain, many children tend to just point to the umbilical region for diffuse pain and it should not be taken literally as a sign of localized pain around the umbilical area. Similarly, when the child specifically point to a place far away from the umbilical area, it is usually a good indicator for localized abdominal pain.
Monday, June 13, 2011
6/13/2011- Pediatric - Jessica
Today is the first day of our 2nd week at Taipei Hospital! Karen and I will be rotating at the pediatric department this week. I was a little worried about this rotation in the beginning because pediatric covers such broad subjects and many organ systems, such as GI, have not been covered in our curriculum yet. Although I studied with Amanda yesterday to prepare myself, I am still a little anxious about it. However, once I met with the preceptors this morning, I felt much calmer because they seemed so welcoming to Karen and I. We begin the morning with a departmental morning meeting once again. But unlike the internal medicine meeting, we had about 15 cases this morning. The presentation and consequent discussion was so fast that I felt like even I need a translator too! Since it was impossible to translate verbally for Karen while trying to listen in the same time, I tried writing the translation down on the notebook for her, hopefully it was clear enough this way that I didn't just end up confusing her even more! Although all the presentations was concise and short, we actually learned/reviewed many medical facts and treatment conventions.
After the morning meeting, we went to patient round with Dr. Wu (吳文秋醫師). After mentioning that we have a non-Chinese speaker, he graciously agreed to use all English to communicate with us. His English was very impressive and was able to gave us a lecture on pediatric allergies all in English and I hardly ever had to step in to translate. During the round, we actually saw an interesting case. It was a little boy admitted for acute bacterial gastritis. What made the case interesting was it was the first time we get to see real sample of bloody stool. And because it was caused by salmonella infection, mucus were also present in the stool sample. In addition, the boy also started developed a mild form of upper respiratory infection, possibly nosocomial in origin, which reminds me all over again about the importance of aseptic practice in hospitals to help eliminate cross infection in hospital rooms.
After lunch, while going up the elevator, we notice one interesting phenomenon that is unique to Asian countries. We noticed that there was no 4th floor! At first, I thought it is only that particular elevator that do not have a button for 4th floor or the 4th floor is of special office use only, but when I think about it more, I realized that it is probably because 4 in Chinese (pronounced "si") sounds very similar to "death" in Chinese. Since hospital is a sensitive place where death usually occur, it was probably an attempt at easing the patient's anxiety going to the hospital.
While waiting for our afternoon preceptor, many doctors and other health workers were all very kind and tried to chat with us to keep us accompanied. After that, we spent the afternoon going over an atypical case with Dr. Tsai (蔡雅慧醫師). It was a 10 y/o boy with fever x3d, severe vomiting since morning, and loose diarrhea noticed only once. Physical examination revealed no other abnormalities except decrease breathing sound, positive wheezing, and soft abdomen with localized pain in periumbilical area. We were asked to provide a list of diagnosis on the symptom, of which we replied pneumonia and appendicitis. Dr. Tsai answered that there are 3 diseases. Diagnosis one, and the potentially most severe one was appendicitis, the second one was bronchpneumonia, probably caused by mycoplasmas, and the third diagnosis was acute gastritis. Although in this case the appendicitis and gastritis were both not yet fully blown to cause all of their characteristic presentations. After the the case presentation, Mrs. Lian, a PA who assists Dr. Wu, kindly showed us around in the department and also showed us the outpatient clinic location that we will be doing our rotation the next day.
Although both of the preceptors today said that their English was not good, both Karen and I thought they were both very good in English and were very impressed by their conversational skills and the ability to explain the complicated clinical scenarios to us in ways that was very clear and easy to understand. We also were very thankful to the PA's and other doctors in the ward who were so nice to us and tried to make conversations even if they were not comfortable using English.
After the morning meeting, we went to patient round with Dr. Wu (吳文秋醫師). After mentioning that we have a non-Chinese speaker, he graciously agreed to use all English to communicate with us. His English was very impressive and was able to gave us a lecture on pediatric allergies all in English and I hardly ever had to step in to translate. During the round, we actually saw an interesting case. It was a little boy admitted for acute bacterial gastritis. What made the case interesting was it was the first time we get to see real sample of bloody stool. And because it was caused by salmonella infection, mucus were also present in the stool sample. In addition, the boy also started developed a mild form of upper respiratory infection, possibly nosocomial in origin, which reminds me all over again about the importance of aseptic practice in hospitals to help eliminate cross infection in hospital rooms.
After lunch, while going up the elevator, we notice one interesting phenomenon that is unique to Asian countries. We noticed that there was no 4th floor! At first, I thought it is only that particular elevator that do not have a button for 4th floor or the 4th floor is of special office use only, but when I think about it more, I realized that it is probably because 4 in Chinese (pronounced "si") sounds very similar to "death" in Chinese. Since hospital is a sensitive place where death usually occur, it was probably an attempt at easing the patient's anxiety going to the hospital.
While waiting for our afternoon preceptor, many doctors and other health workers were all very kind and tried to chat with us to keep us accompanied. After that, we spent the afternoon going over an atypical case with Dr. Tsai (蔡雅慧醫師). It was a 10 y/o boy with fever x3d, severe vomiting since morning, and loose diarrhea noticed only once. Physical examination revealed no other abnormalities except decrease breathing sound, positive wheezing, and soft abdomen with localized pain in periumbilical area. We were asked to provide a list of diagnosis on the symptom, of which we replied pneumonia and appendicitis. Dr. Tsai answered that there are 3 diseases. Diagnosis one, and the potentially most severe one was appendicitis, the second one was bronchpneumonia, probably caused by mycoplasmas, and the third diagnosis was acute gastritis. Although in this case the appendicitis and gastritis were both not yet fully blown to cause all of their characteristic presentations. After the the case presentation, Mrs. Lian, a PA who assists Dr. Wu, kindly showed us around in the department and also showed us the outpatient clinic location that we will be doing our rotation the next day.
Although both of the preceptors today said that their English was not good, both Karen and I thought they were both very good in English and were very impressed by their conversational skills and the ability to explain the complicated clinical scenarios to us in ways that was very clear and easy to understand. We also were very thankful to the PA's and other doctors in the ward who were so nice to us and tried to make conversations even if they were not comfortable using English.
6/6~6/10/2011 - General TCM - Jessica
I think Dr. Ho (何彥頤醫師) is one of the most memorable doctor I met during this trip not just because he it the first main preceptor I met during this trip but because of many reasons. If you ask me what I remembered the most about Dr. Ho, it would be his efficiency and his personality. Mickey and I was shocked during our very first day in Taipei hospital because of Dr. Ho. In one single afternoon outpatient clinic, Dr. Ho tended to around 80 patients, including regular office visit AND acupuncture rounds! Since I still have some recollection about the Taiwanese health system, I already knew that the patient load for Taiwanese physicians are very high compared to the US, I never expected it to be so heavy! Even though there were more patients than usual that day because Dr. Ho's Monday clinic was canceled due to a national holiday (Duan-Wu), the sheer number of patient was still unbelievable to Mickey and I. But what surprised us even more was Dr. Wu's ability to handle that amount of patient and still manage to connect with his patients in a personal level and even knows many of his patients' names and medical conditions by memory! What impressed us even more was Dr. Ho's ability to still keep his sense of humor throughout the entire shift and helped ease the stressed atmosphere with his good natured jokes. Even though he used mostly Taiwanese to communicate with his patients and I could only understand about 65% of it, I can already feel the sense of trust between the patient and the physician even during such short patient encounter. And I think that is what make Dr. Ho unique among physicians.
Of course, as a TCM doctor, Dr. Ho stood out even more for Mickey and I: since he is the only doctor we have observed throughout this trip that utilize manual diagnoses and treatment on patient. During our rotation, Mickey and I were able to observe and video tape Dr. Ho's treatment and even had the privilege of trying it ourselves. Considering how busy Dr. Ho is everyday, we were really grateful for his time and patience to all of our questions and request of video filming him. Mickey and I have learned many things from Dr. Ho, from patient interactions to tips on palpating skills and I sincerely hope that we can collaborate even more in the future to exchange knowledge between TCM and OMT.
Of course, as a TCM doctor, Dr. Ho stood out even more for Mickey and I: since he is the only doctor we have observed throughout this trip that utilize manual diagnoses and treatment on patient. During our rotation, Mickey and I were able to observe and video tape Dr. Ho's treatment and even had the privilege of trying it ourselves. Considering how busy Dr. Ho is everyday, we were really grateful for his time and patience to all of our questions and request of video filming him. Mickey and I have learned many things from Dr. Ho, from patient interactions to tips on palpating skills and I sincerely hope that we can collaborate even more in the future to exchange knowledge between TCM and OMT.
Friday, June 10, 2011
6/10/2011- General TCM, Oncology TCM - Jessica
Today is the last day of our first week of rotation. Mickey and I, along with other groups, bought some small gifts to our respective preceptors. I left the gift I brought from the US at home, so Mickey and I bought some chocolate covered strawberries yesterday while grocery shopping at Carefour supermarket (next to IKEA) for our preceptors. However, we noticed that the preceptors in general showed great resistant to receiving the gifts. We were wondering if it is a hospital policy thing or just because it is inconvenient for the doctors to eat food during office time.
We started the day with Dr. Chen (陳建安醫師) who we rotated with before on Wednesday. However, he had a busier schedule today compare to Wednesday, so when Dr. Chen (陳駿逸醫師) from oncology came visit, Dr. Chen graciously agreed to take us in. Coincidentally, Dr. Chen (from oncology) also studied TCM, in fact, he and Dr. Chen (from TCM) were upper and lower classmen (學長弟) and he is about to teach Amanda, Bor-Han, and Sandy acupuncture basic principles today. So we end up tagging along with them and was given a quick overview of acupuncture. We were introduced to the basic acupuncture principles and some basic well-known acupuncture points. We were even given the chance to practice needling (on self or each other of course)! The whole experience was just eye-opening, fun, and interactive. We learned the points and its basic therapeutic effects and how to evaluate if the needle has reached the right point through the phenomenon of De Qì (得氣, the sense of numbness, pain, or tingling during needling that indicate successful stimulation of the acupuncture point). After observing so many days of acupuncture, I was very excited to be able to finally try it myself. Although it seemed a little traumatic for some of us, but I think all of us learned a lot during the session and actually had a lot of fun too.
We went to the basement restaurant again today for lunch and YuYu met us there to inform us that the schedule remained unchanged after all. We discussed a little bit more with YuYu about possible sight-seeing places for this weekend. Since both Amanda and I won't be around this weekend, the responsibility of tour guide rest solely on Bor-Han, and I was able to relieve my sacred duty! Toward the end of lunch, YuYu came again to inform us that there was a surgery meeting that we were welcomed to join. We all hurried there and learned about an adverse effect of phenytoin (Stevens-Johnson syndrome) that is significantly more prevalent in the Han-Chinese population.
One interesting thing was Amanda helped us figure out the exact price of the lunch set there. Although it is not that related to the academic experience, for the sake of future students who are fixated at eating good food like me, I will include the information here as well: the basic set for $NT50 includes rice, soup, and 4 courses (1 main entree/meat dish + 3 vegetable/side dishes), each additional entree cost $NT20, and each additional side dishes will cost $NT10 more.
In the afternoon, we started by following Dr. Ho again, observing his outpatient clinic until around 3pm. And then with Dr. Ho's permission, continued the morning acupuncture introduction with Dr. Chen in the remaining time. During this time, Dr. Chen continued with his introduction to acupuncture and also briefly covered some scientifically proven ways acupuncture can be used to support cancer treatments. I was surprised by how much research has already been done on acupuncture by the western medical field as well as by how enthusiastic Dr. Chen is at teaching students. I sincerely feel that we are very lucky indeed to be able to have preceptors like Dr. Chen who is truly committed to teaching the students and still feel such passion toward his field of study even after these many years.
We started the day with Dr. Chen (陳建安醫師) who we rotated with before on Wednesday. However, he had a busier schedule today compare to Wednesday, so when Dr. Chen (陳駿逸醫師) from oncology came visit, Dr. Chen graciously agreed to take us in. Coincidentally, Dr. Chen (from oncology) also studied TCM, in fact, he and Dr. Chen (from TCM) were upper and lower classmen (學長弟) and he is about to teach Amanda, Bor-Han, and Sandy acupuncture basic principles today. So we end up tagging along with them and was given a quick overview of acupuncture. We were introduced to the basic acupuncture principles and some basic well-known acupuncture points. We were even given the chance to practice needling (on self or each other of course)! The whole experience was just eye-opening, fun, and interactive. We learned the points and its basic therapeutic effects and how to evaluate if the needle has reached the right point through the phenomenon of De Qì (得氣, the sense of numbness, pain, or tingling during needling that indicate successful stimulation of the acupuncture point). After observing so many days of acupuncture, I was very excited to be able to finally try it myself. Although it seemed a little traumatic for some of us, but I think all of us learned a lot during the session and actually had a lot of fun too.
We went to the basement restaurant again today for lunch and YuYu met us there to inform us that the schedule remained unchanged after all. We discussed a little bit more with YuYu about possible sight-seeing places for this weekend. Since both Amanda and I won't be around this weekend, the responsibility of tour guide rest solely on Bor-Han, and I was able to relieve my sacred duty! Toward the end of lunch, YuYu came again to inform us that there was a surgery meeting that we were welcomed to join. We all hurried there and learned about an adverse effect of phenytoin (Stevens-Johnson syndrome) that is significantly more prevalent in the Han-Chinese population.
One interesting thing was Amanda helped us figure out the exact price of the lunch set there. Although it is not that related to the academic experience, for the sake of future students who are fixated at eating good food like me, I will include the information here as well: the basic set for $NT50 includes rice, soup, and 4 courses (1 main entree/meat dish + 3 vegetable/side dishes), each additional entree cost $NT20, and each additional side dishes will cost $NT10 more.
In the afternoon, we started by following Dr. Ho again, observing his outpatient clinic until around 3pm. And then with Dr. Ho's permission, continued the morning acupuncture introduction with Dr. Chen in the remaining time. During this time, Dr. Chen continued with his introduction to acupuncture and also briefly covered some scientifically proven ways acupuncture can be used to support cancer treatments. I was surprised by how much research has already been done on acupuncture by the western medical field as well as by how enthusiastic Dr. Chen is at teaching students. I sincerely feel that we are very lucky indeed to be able to have preceptors like Dr. Chen who is truly committed to teaching the students and still feel such passion toward his field of study even after these many years.
Thursday, June 9, 2011
6/9/2011-general TCM & Pathology - Jessica
After attending the morning internal medicine meeting, we went to Dr. Ho's outpatient clinic again. As before, his clinic was very busy and we rarely had time to ask him questions. But we did manage to slip in few questions in between. We asked if there are certain precautions we need to consider when needling the patients to avoid infection. Dr. Ho replied that first, the patient's hygiene is very important. For example, although alcohol wipes are often used, most time in outpatient settings, the needles are applied through the cloths, extra precaution need to be applied if the patient's clothes are soiled or poor personal hygiene is noted. However, since he knows most of his patients well, he does not need to worry about that often. Another important point to consider is if the patient has diabetes, which will prolong healing time and increase risk of infection. We also learned that since many of his patients are elderly patients with many of the chronic metabolic and cardiovascular disease, the goal for him is often to control and lower the condition enough using Chinese medicines to at least lower the amount of western medicine needed or even replace them to control the disease.
One of the highlights of the day was meeting with Dr. Lin and Superintendent Lin. It was great to have the chance to convey personally to him how thankful we are for the wonderful opportunity. We were each given a bag of gifts along with many much needed maps for tourist information! The TIHTC treated us again today to a wonderful lunch, there were so much food that even though all 9 of us (including Dr. Lin and YuYu) entered the restaurant with empty stomach, we could not finish all of the food. And the food was so good that even though we were probably all stuffed all the way up to our epiglottis with food, we still want to bring the left-over home! Once again, their hospitality really touched me and will always be part of my fondest memory of Taiwan.
This afternoon, due to a miscommunication, Mickey and I were not able to rotate in the afternoon TCM outpatient department. So we went to the pathology department with Sandy, Bor-Han, and Amanda. I was expecting to see a bunch of stained slides and huge amount of microscopes in the beginning. But what I saw first was actually the actual preparation of the tissue samples. Even though I knew that the slides must be made into slides from sample tissue somehow, but seeing it in real life is a different story. Just looking at the biopsied knee joint, it was hard to imagine that it once belong and was functioning within all that flesh and tendon of a living human being. But after the initial shock, I felt like it allowed me to gain a new respect to the job of a physician; that no matter how little one's interaction with the patients is, a physician's job, no matter in which specialty, will cause tremendous change in the patients' lives. Although the change is for the better or worse will solely depend on how serious the physician takes his or her job and how dedicated he or her is to the patients.
One of the highlights of the day was meeting with Dr. Lin and Superintendent Lin. It was great to have the chance to convey personally to him how thankful we are for the wonderful opportunity. We were each given a bag of gifts along with many much needed maps for tourist information! The TIHTC treated us again today to a wonderful lunch, there were so much food that even though all 9 of us (including Dr. Lin and YuYu) entered the restaurant with empty stomach, we could not finish all of the food. And the food was so good that even though we were probably all stuffed all the way up to our epiglottis with food, we still want to bring the left-over home! Once again, their hospitality really touched me and will always be part of my fondest memory of Taiwan.
This afternoon, due to a miscommunication, Mickey and I were not able to rotate in the afternoon TCM outpatient department. So we went to the pathology department with Sandy, Bor-Han, and Amanda. I was expecting to see a bunch of stained slides and huge amount of microscopes in the beginning. But what I saw first was actually the actual preparation of the tissue samples. Even though I knew that the slides must be made into slides from sample tissue somehow, but seeing it in real life is a different story. Just looking at the biopsied knee joint, it was hard to imagine that it once belong and was functioning within all that flesh and tendon of a living human being. But after the initial shock, I felt like it allowed me to gain a new respect to the job of a physician; that no matter how little one's interaction with the patients is, a physician's job, no matter in which specialty, will cause tremendous change in the patients' lives. Although the change is for the better or worse will solely depend on how serious the physician takes his or her job and how dedicated he or her is to the patients.
6/18 Integrated Community Health Screen Details
Hi all,
Here is the English translation of the flier for the health screen on 6/18. YuYu said she will ask for us if we can help performing the physical exam.
-Jessica
Here is the English translation of the flier for the health screen on 6/18. YuYu said she will ask for us if we can help performing the physical exam.
-Jessica
Time: June 18th, 2011. Saturday 8:00~11:00
Place: Fú Shòu Community Activity Center (福壽活動中心)
1 Chāngmíng Street, Xīnzhuāng District, New Taipei City (新莊區昌明街1號)
Patient Eligibility:
1. above 65 years old and have not had a physical this year
2. 40~64 years old (born between Taiwanese calendar years 30~60年次) years old and have not had a physical the last 3 years
3. 30~39 years old (Taiwanese years 61~70年次), with kidney disease and metabolic syndrome (hypertension, hyperlipidemia, and diabetes) family history, and have not had physical examination within 3 years
4. 20~29 years old and with Disabled Handbook (身心障礙手冊)
Exams Performed:
1. Cancer screening: Liver cancer, Hepatitis B, Cervical cancer, oral cancer
2. Bone density test
3. Blood and metabolic syndrome tests
4. General vitals (height, weight, waist diameter, blood pressure)
5. Health questionnaire.
6. 40 years old and above: hepatitis C, urine test, chest x-ray, physical examination (by physicians)
7. 50~69 years old: colon cancer screen (every 2 years),
8. 45~69 years old: breast cancer appointment (shuttle provided) (every 2 years)
Things to Note:
1. Remember to bring your ID, insurance ID card, and stamp
2. Please do not wear shirts that have zipper or buttons. (For women, please wear skirts and no pantyhose)
3. Please do not eat or drink after midnight the night before, free breakfast will be provided after the blood draw.
Wednesday, June 8, 2011
6/8/2011-TCM General Outpatient -Jessica
Today we begun our day with yet another new preceptor: Dr. Chen (陳建安醫師). Dr. Chen's specialty was oncology and the use of acupuncture to help alleviate the adverse effects of cancer treatment and also for recovery for stroke patients. Since it is a relatively slow morning, we spent much time talking to Dr. Chen, asking many of the questions that was raised from our observation of Dr. Ho yesterday. For example, we were curious about how the TCM doctors resolve the issue of simultaneous treatment by both western and Chinese medicine. Unfortunately, Dr. Chen does not think there is a well researched consensus among TCM doctors either on this issue. Some say at least 4 hours in between and some say 1 to 1.5 hour. We also asked about why we do not see any Tui-Na or traumatology in the clinics. To our surprise, Dr. Chen answered that Tui-Na is no longer practiced by the TCM doctors, instead, they are practiced mainly by chiropractors/massage therapists due to its low pay (problem with the national health insurance in Taiwan) and its taxing nature on the practitioner's hands and physical energy. Although I was surprised that it is no longer practiced, I was not surprised that it pays little, since I think most manual medicine will probably face similar problem with the insurance agencies, nor was I surprised that it was also because it is too tiring for the practitioners, since that is also a problem with OMT for the DO doctors too.
After asking our questions, Dr. Chen also gave us a short presentation covering many more commonly know acupuncture points, such as 合谷, 陽陵泉, 足三里...etc. I was pleasantly surprised that I actually know few of them just from observing Dr. Hsieh yesterday, which makes me even more excited for the afternoon session with Dr. Chen, since he would not be as busy as yesterday and will probably have more time to teach us and answer the questions we have for TCM.
After asking our questions, Dr. Chen also gave us a short presentation covering many more commonly know acupuncture points, such as 合谷, 陽陵泉, 足三里...etc. I was pleasantly surprised that I actually know few of them just from observing Dr. Hsieh yesterday, which makes me even more excited for the afternoon session with Dr. Chen, since he would not be as busy as yesterday and will probably have more time to teach us and answer the questions we have for TCM.
Tuesday, June 7, 2011
6/7/2011-TCM Weight Loss Clinic-Jessica
Today we finally started our first rotation in Taiwan! We begun our day by attending the Internal Medicine Department's morning meeting. It was such an interesting experience and we were able to learn so much in just one hour! Not only did we get to walk through a real-life case study with the doctors, it also helped prepare us with case presentation for our future rotations in the US. I was surprised that even with only one year of medical education, although we did not know some of the specific clinical terms, we were able to understand almost all of the pathophysiology and differential reasoning behind the case and it was great to be able to utilize what we learned in classroom to real-life situation.
At 9 o'clock, Mickey and I went to the TCM department to officially start our rotation. This morning, we had the privilege of studying with Dr. 謝抒玲. Dr. Hsieh specializes in weight loss clinic and begun the rotation with a demonstration of acupuncture on a patient. It was interesting to see how fast and efficient she was at needling and finding the acupuncture points. Unlike the osteopathic points that we are familiar with, it seems like the TCM points relies little on palpation of landmarks. Dr. Hsieh taught us that the points are often measured relative to each other with the Chinese unit 寸, which is often approximated with 1/3 of the patients' finger length. She also added that although many acupuncture points, called 穴道 in Chinese, are fixed and have specific names and corresponding effect/function like 陰陵泉 and 足三里, many of them are fluid and dynamic, depend on the patient's body and do not have a specific name. These points are called 阿是穴 and are often effective acupuncture points that are not found on literature and specific only to each patient.
After the demonstration, we spend the rest of the morning observing Dr. Hsieh doing outpatient consultations. The first thing we noticed was how fast she went through each returning patient, with each patient encounter average about 5 minutes. However, for the first time patients, Dr. Hsieh will group several of them together and give a quick patient education: including explanation of food nutrition (avoiding fried food, starch, sugar...etc), possible adverse effects (palpitation, constipation, insomnia, thirst, dehydration...etc) with the Chinese medicine (made with several different Chinese herbs, has appetite reduction effect), followup in one week (to check for any adverse effect/reaction with the Chinese medicine)...etc. She also helps the patients set a healthy weight goal by BMI calculation. One striking difference we noticed between Dr. Hsieh and US physicians was her attitude toward patient. She seemed to be a firm believer of the paternal approach to patient interaction, often speaking to the patients in an authoritative way. However, even though it may seem strange and too forceful to us Americans, all the patients seemed to be responding well to her style, probably due to the traditional Chinese view toward physicians.
One other interesting thing we noticed was the general hospitality of the Taiwanese people. Just yesterday, the TIHTC staffs brought us around to attend the Dragon boat race in celebration of the holiday 端午節. Since it was a national holiday, the staffs could have stayed at home and avoid the 34C temperature outside, instead, they were there with us at noon time when the sun was the harshest just to give us the unique experience. In addition, after the race, they even treated us to a delicious meal of ShabuShabu! And today, even before meeting us, Dr. Hsieh brought us each a cup of latte, probably in anticipation to our jet-lag! It was so sweet of her! In addition, she even gave us her cell phone number in the end when she found out that we wouldn't have more rotation with her (she is only at Taipei hospital Tuesday mornings). Kind acts like these said so much about the Taiwanese people and had really touched our hearts.
At 9 o'clock, Mickey and I went to the TCM department to officially start our rotation. This morning, we had the privilege of studying with Dr. 謝抒玲. Dr. Hsieh specializes in weight loss clinic and begun the rotation with a demonstration of acupuncture on a patient. It was interesting to see how fast and efficient she was at needling and finding the acupuncture points. Unlike the osteopathic points that we are familiar with, it seems like the TCM points relies little on palpation of landmarks. Dr. Hsieh taught us that the points are often measured relative to each other with the Chinese unit 寸, which is often approximated with 1/3 of the patients' finger length. She also added that although many acupuncture points, called 穴道 in Chinese, are fixed and have specific names and corresponding effect/function like 陰陵泉 and 足三里, many of them are fluid and dynamic, depend on the patient's body and do not have a specific name. These points are called 阿是穴 and are often effective acupuncture points that are not found on literature and specific only to each patient.
After the demonstration, we spend the rest of the morning observing Dr. Hsieh doing outpatient consultations. The first thing we noticed was how fast she went through each returning patient, with each patient encounter average about 5 minutes. However, for the first time patients, Dr. Hsieh will group several of them together and give a quick patient education: including explanation of food nutrition (avoiding fried food, starch, sugar...etc), possible adverse effects (palpitation, constipation, insomnia, thirst, dehydration...etc) with the Chinese medicine (made with several different Chinese herbs, has appetite reduction effect), followup in one week (to check for any adverse effect/reaction with the Chinese medicine)...etc. She also helps the patients set a healthy weight goal by BMI calculation. One striking difference we noticed between Dr. Hsieh and US physicians was her attitude toward patient. She seemed to be a firm believer of the paternal approach to patient interaction, often speaking to the patients in an authoritative way. However, even though it may seem strange and too forceful to us Americans, all the patients seemed to be responding well to her style, probably due to the traditional Chinese view toward physicians.
One other interesting thing we noticed was the general hospitality of the Taiwanese people. Just yesterday, the TIHTC staffs brought us around to attend the Dragon boat race in celebration of the holiday 端午節. Since it was a national holiday, the staffs could have stayed at home and avoid the 34C temperature outside, instead, they were there with us at noon time when the sun was the harshest just to give us the unique experience. In addition, after the race, they even treated us to a delicious meal of ShabuShabu! And today, even before meeting us, Dr. Hsieh brought us each a cup of latte, probably in anticipation to our jet-lag! It was so sweet of her! In addition, she even gave us her cell phone number in the end when she found out that we wouldn't have more rotation with her (she is only at Taipei hospital Tuesday mornings). Kind acts like these said so much about the Taiwanese people and had really touched our hearts.
Sunday, June 5, 2011
Few things about the dorms...
Hi all, this post is for future reference for students after us as well as for the improbable situation where you are in need of certain amenities and for some reason you can't remember where you can find it and/or if it even exist ;p
The dorms are actually pretty hotel-like, they have many things ready for us already. There is a computer and wireless connection (although a little slow....), a refrigerator, TV, hot water boiler, rice cooker, lamp, hangers, blow dryer, iron, towels, tooth brush/paste, basic toiletry, utensils, bowls/dishes, and even nail clipper set! There is coin-operated laundry room and a library at the 2nd floor.
There is a convenient store inside the hospital (Hi-Life) and supermarkets around the hospital (Carefour and Welcome), so you can pretty much get anything you want easily without going far.
Oh, and it has a AC unit in each room, so no worries about the melting Chocolate!
As for public transportation, the nearest MRT station (Xinpu) is 2 bus stops away (bus lines: 99, 918, 藍18 from the station to the hospital, and almost all the bus lines except 257 from hospital back to the station). The XinZhuang station, which will be about 1 bus stop away is still under construction. It probably will be done by next year. Tip: unless you are planning to stay in the dorm the entire time, you should buy a 悠遊卡 (EasyCard). It works on both buses and MRT (w/ discount of 20% off on fares), and even some convenient stores. Although you can buy it in convenient stores and automatic machines in MRT stations also, the best way to buy it is buy it from the operators by the booth next to the MRT gates. Usually, the card cost $NT500 ($NT100 for the card deposit that you get back if you return the card later, and $NT400 for actual usable fare), but if you buy it from the live operators, you can ask to buy it in smaller amounts like $NT300 ($NT200 for actual fare), that way you don't waste money if you don't plan on travel that much. Although it is possible to return the card later to get the refund, but sometimes that may be too much trouble if you are leaving in a hurry.
That's all I can think of right now, feel free to add more or correct any mistakes you find.
Jessica
The dorms are actually pretty hotel-like, they have many things ready for us already. There is a computer and wireless connection (although a little slow....), a refrigerator, TV, hot water boiler, rice cooker, lamp, hangers, blow dryer, iron, towels, tooth brush/paste, basic toiletry, utensils, bowls/dishes, and even nail clipper set! There is coin-operated laundry room and a library at the 2nd floor.
There is a convenient store inside the hospital (Hi-Life) and supermarkets around the hospital (Carefour and Welcome), so you can pretty much get anything you want easily without going far.
Oh, and it has a AC unit in each room, so no worries about the melting Chocolate!
As for public transportation, the nearest MRT station (Xinpu) is 2 bus stops away (bus lines: 99, 918, 藍18 from the station to the hospital, and almost all the bus lines except 257 from hospital back to the station). The XinZhuang station, which will be about 1 bus stop away is still under construction. It probably will be done by next year. Tip: unless you are planning to stay in the dorm the entire time, you should buy a 悠遊卡 (EasyCard). It works on both buses and MRT (w/ discount of 20% off on fares), and even some convenient stores. Although you can buy it in convenient stores and automatic machines in MRT stations also, the best way to buy it is buy it from the operators by the booth next to the MRT gates. Usually, the card cost $NT500 ($NT100 for the card deposit that you get back if you return the card later, and $NT400 for actual usable fare), but if you buy it from the live operators, you can ask to buy it in smaller amounts like $NT300 ($NT200 for actual fare), that way you don't waste money if you don't plan on travel that much. Although it is possible to return the card later to get the refund, but sometimes that may be too much trouble if you are leaving in a hurry.
That's all I can think of right now, feel free to add more or correct any mistakes you find.
Jessica
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