Christine Le, Week 2: Cardiology, Day 5

On our last day in the Cardiology department, we observed Dr. Wang in the outpatient department (OPD). In less than 3 hours he saw 23 patients! Obviously each patient visit had to be rather short in order for the doctor to see all the scheduled patients. Each patient brought their smart card, which is a patient ID card that carries the patient’s medical record, including the cardholder’s status (catastrophic disease, number of visits and hospital admissions, use of NHI prevention programs, records regarding medical expenditure, and amount of cost-sharing), medical service information (drug prescriptions and drug allergies), and public health service administration information (immunizations and information for organ donation). http://www.pacifichealthsummit.org/downloads/hitcasestudies/economy/taiwanhit.pdf. Before beginning the visit, Dr. Wang put the patient’s card into the smart card reader and he instantly had access to the past medical records. Then he asked the patients some questions and listened to their heart. Some patients brought a record of their home BP readings and others were told to get a home BP monitor and record their BP. Many patients came to get a prescription for a refill of their medication. Something that I found fascinating was that when the doctor ordered an ECG and/or chest x-ray for some patients, they were given the test immediately in another part of the hospital, and the patients returned to the doctor to have the results interpreted right then and put in their medical record, which does not seem to happen in the US. Additionally, the subject of herbal remedy use came up again. A female patient had felt heart palpitations for the past few days and came to the OPD for a doctor visit. During the examination, Dr. Wang asked he if she took Chinese herbs, and when she disclosed that she did, he asked her to stop using them, as the herbs can cause drug interactions or nephrotoxicity, especially if the herbs are not purified. I think that in a culture where herbal remedy use is pervasive, this is a very important question to ask patients because the use of these drugs could cause some serious interactions or complications. It may also be valuable to know where the patients obtain their herbs, because some places are regulated, such as the Traditional Chinese Medicine (TCM) department in the hospitals, while other herbal medicine shops are not.

My learning experiences this week have given me a better understanding about the clinical medicine pertaining to Cardiology. It was so informative to apply what I have learned in the classroom to the observation of the catheterization lab and echocardiography procedures, in order to put my pre-clinical knowledge into perspective. I would like to thank Dr. Huang, Dr. Chen, and Dr. Wang for allowing us to observe them and for taking the time to teach us about the clinical practice of cardiology.