Christine Le, Week 2: Cardiology, Day 4

This morning I had the morning off from Cardiology, so I decided to join Anny in Nephrology. We accompanied Dr. Chen on his morning rounds and Anny informed me about each patient, most of whom she had seen earlier in the week. Many of these patients had urinary tract infections (UTIs), and other cases included cellulitis with a leg fracture, renal hemorrhage, and upper and lower extremity edema. Something to note is that elderly patients (a large proportion of patients in this hospital) more often present with atypical UTI symptoms or non-specific symptoms. While they still present with the classic symptoms of fever, frequency, and dysuria, they may also present with altered mental state (like confusion), newly developed urinary incontinence, or urinary retention. It is very important to treat UTIs as soon as possible because sepsis can result as a complication. Those most at risk for developing sepsis are the young, elderly, and immunocompromised patients.

During one patient visit, Dr. Chen asked the patient if she used any herbal remedies and the patient denied any use. After we exited the room and began heading down the hallway, the patient's daughter ran after Dr. Chen and informed him that her mother did, in fact, use herbal remedies. After Anny explained the conversation to me, I cringed internally. We have learned that herbal remedies are not always safe, as they can interact with prescribed medications. Furthermore, since herbal remedies are not always purified or highly regulated, the patient may unknowingly be using substances other than what the packaging implies. By not reporting the use of herbal remedies, patients are preventing their physicians from providing the most appropriate care, as physicians can use this opportunity to educate patients about the use of these alternative therapies as well as figure out which drug interactions may occur. I wonder why patients choose not to disclose use of these herbal remedies... embarrassment? fear of the doctor scolding them? distrust of the medical system? The pervasive use herbal therapies is not unique to Taiwan, many countries around the world have a tradition of using herbal remedies, so as future physicians we must keep in mind how patient background and culture may play into their perspective on medicine. We should acknowledge that a patient may seek alternative therapies and build a relationship in which the patient will feel that they can disclose the use of these therapies, so that we can educate the patient and provide the best care possible.

In the afternoon, we observed Dr. Wang perform echocardiography again. Some interesting cases were 1) atrial septal defect and 2) ventricular septal defect.  We tried to listen for the systolic heart murmur on the atrial septal defect patient, but it was difficult for us to discern. A few patients had minor mitral valve prolapse, as well. Even though I still have trouble figuring out what exactly I am seeing in echocardiography, I feel that the opportunity to watch all the echo procedures this week has given me a better understanding of echo as a tool to diagnosis cardiovascular disease. I definitely know more about echo today than I did at the beginning of the week.