Today marked the start of our global health internship in Taiwan. This week I will be rotating within the Hem-Oncology department. I originally selected this department because it is one of my weaker areas of medical knowledge. After being quickly introduced to my preceptor, Dr. Chen, who was the only physician in this department, we began rounds on his inpatients with another physician, Dr. Luo.
Due to a small number of patients, I was only able to observe interactions with four cancer inpatients before the day came to an end. However, each interaction had a different etiology (Breast cancer, colon cancer, multiple myeloma, and stomach cancer) and yielded a wealth of information and experience. After each patient visit, Dr. Chen gave us a brief summary of the case and asked us if we had any questions. The summaries were quick, concise, and in Chinese, which made following along even more difficult. Despite listening very intently, I was still piecing together information minutes after the conversation. This just reminded me of the sheer level of knowledge required to be a good physician.
Although Hem-Oncology is one of my weak points, I was surprised to discover that my knowledge of the subject allowed me to reason out of a lot of the Chinese terms Dr. Chen used. I feel I was at least exposed to each of the topics Dr. Chen discussed in relation to his patients. As the day went on, I realized my inadequacies lay in clinical medicine. My mindset has been so focused on studying for and doing well on tests that I neglected the practicality of medicine. Due to insurance issues, the best drugs are not always used for initial treatment and cost often fuels decisions for the course of treatment.
Similar to above, there is much more to medicine than what is on the boards. The most interesting case was a 95 year old female with gastric cancer. What peaked my interest was not her ailment but instead the ethical situation that arose from it. The patient elected to abstain from making a decision and left it to her immediate family to decide whether or not to perform surgery to excise the tumor. However, the family has been unable to reach a consensus, while their mother's health continues to decline. Dr. Chen has spoken to many of the patient's children individually and has received mixed responses ranging from empathetic understanding to threats of a lawsuit. My preceptor made an important note that his patient is actually very blessed to be in a smaller hospital, where he actually has the time to try to explain the entire situation to the family. At a larger hospital with more patients, there would be very little time set aside for such interactions.
Going into today's rotations, I expected to be overwhelmed with medical knowledge but at the end of the day, I felt I was instead hit with the reality of applying medicine.
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