Today we followed Dr. Wang during his outpatient time in the afternoon. Similar to TCM and Nephrology, the volume of patients was large and the pace was fast. Dr. Wang saw patients for a variety of reasons. Some just needed refills on their medications. Some were new patients who needed a complete history done usually due to dyspnea and chest pain. Others came for anxiety reasons, hearing about a friend or a family member who had some certain heart condition that prompted them to get themselves checked out.
Outpatient clinic is the most unique aspect of the Taiwanese health care system compared to the U.S'. Dr. Wang was overloaded with patients: he saw around 30 patients in a mere 2.5 hours. Anyone could see him - there was no requirement of going through a primary care physician. One could walk through the door and just ask the doctor questions if needed. I got the feeling that the physicians felt like they were being taken advantage of. In a universal healthcare system where healthcare is cheap and you can 'shop' for your healthcare, you treat end up treating it like an item to be bought. And you don't really respect the people selling products you buy, do you?
Of course this is a cynical take on the system. But I've seen this type of haggling and hassling in the ED when the openness of patient care allows for patients to walk in from the lobby and demand the doctor why they have not been seen yet while the doctor is performing a procedure on another patient. The audacity is beyond me at this point. It's hard to find the balance of the underserved and underinsured patients of the U.S. and the abuse of the healthcare system in Taiwan. As someone who has been a staunch supporter of single payer healthcare in CA, I am now unsure about how it will play out and what is better for the patient and the doctor. At the end of the day, the doctor might get pushed around a little bit, but at least the patient is getting care, right?
Still it was cool to see Dr. Wang in action. One older lady came in with chest pain that radiated to her arms. She had X-rays and other diagnostic pictures from the hospital in China from where she came from to visit Taiwan. Even as a visitor here in Taiwan, she can be treated well. Dr. Wang sensed an impending MI from the EKG and the stenosis found in her angiography, so he quickly set up tests to be done at a bigger hospital that he trained at. In the end, it was a friend who also saw Dr. Wang who brought in this patient. She beamed at the patient at the end, exclaiming, "Didn't I tell you? Dr. Wang is a great doctor. So dedicated and kind, rushing an appointment like that for you." In the end, I think a lot of the Chinese culture relies on social relations. Doctors reaching out to their mentors to accept patients quickly, patients referring their friends. Once healthcare became cheap in Taiwan, I'm sure doctors were advertised like products by word of mouth of their patients. I guess the ultimate question is if the benefits of universal healthcare outweigh the costs.
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