I have been looking forward to this week for a long time. Ever since my undergraduate years I have been striving to become a gastroenterologist. Something about understanding and treating the digestive system really intrigues me. Maybe this stems from my love of food or possibly my father's problems with GERD. Either way, I want to learn more about exactly what being a gastroenterologist entails.
I began the day observing gastroscopies performed by Dr. Wu. I have observed such procedures before in the states and right away I noticed a lot of differences that really amazed me. First of all, no sedatives are used in Taiwan. Patients are completely alert and oriented when the endoscope is inserted into their bodies. The only drug they get is a xylocaine spray that acts as a local anesthetic to ease the initial insertion. Once the endoscope is approximately past the pharyngeal constrictor muscles, the majority of the discomfort is over for the patient. Interesting as it was to perform without sedatives, the craziest fact was how many gastroscopies he could perform in such a short period of time. I think each patient took approximately only 5-10 minutes. Although very quick, every patient seemed to have been thoroughly checked. He viewed the esophagus, stomach, and duodenum from multiple angles. Every time some aspect stood out, he took a quick picture. On top of all this, he also performed at least one biopsy on each patient to test for H. pylori infections. Any patient with ulcers had additional biopsies performed at the site of ulceration.
Later on, Dr. Wu had his colonoscopy patients. The basic idea is the same as the gastroscopy and once again, the patients are not sedated. They are given a local anesthetic, lidocaine hydrochloride, lubricated along the endoscope. As a side note, Dr. Wu explained that most patients can tolerate endoscopies without significant complications but those who cannot tolerate the procedure or wish to be sedated can have it done. The colonoscopies seemed to take about 5 more minutes than a gastroscopy. There was a lot more area to be covered and many instances required nurses to help straighten the intestinal tract (by pushing on the abdomen) for ease of endoscope movement. Like above, pictures were taken of areas that stood out and biopsies taken of abnormal findings like polyps (to determine if cancerous). Similar to recommendations in the states, patients over 50 are recommended to have a colonoscopy every 10 years. Those who have familial colon problems are encouraged to get checked as early as their 20s.
I ended the day by shadowing Dr. Wu in his outpatient clinic. If I was surprised by how fast other physicians saw outpatients, I wouldn't know how to describe Dr. Wu's speed. He probably saw at least 15 patients/hour. The most intriguing thing was how the patient queue worked for his room. He always had the next patient ready to be seen in the same room as the current patient. The patients were probably no more than 6 feet away from each other and could hear every detail being said by Dr. Wu. This greatly increases the speed but where did privacy go? Despite this, none of the patients seemed to mind. Dr. Wu probably would have seen even more patients if he did not continually converse with me and experience computer problems.
Even though I shadowed gastroenterologists in the past, I feel I observed and learned so much in just one day compared to the months I spent in US hospitals. That being said, today felt really repetitive. Everything seemed so routine that I got a bit bored. However, whatever interest I may have lost in the profession, I gained back in curiosity of more serious ailments. The only reason things seemed repetitive is because none of the patients had any rare or serious problems. Hopefully the rest of this week will provide some more insight into the range of ailments treated by gastroenterologists and help solidify or dissuade me from pursuing my current ambitions.
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