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.

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.

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.

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.

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.