Thursday started out once again in the outpatient department. Dr. Chen saw around 24 patients in 3 hours, with disorders ranging from breast cancer to anemia. It was the same routine as I described in the day 2 post. I was surprised by how little time each appointment took. I understand there are time limitations in the OPD, however, there are some patients who took less than 3 minutes! The patients get their BP and HR taken before they enter the room, and if they didn't have any questions, Dr. Chen would just enter those numbers, tell them to continue their previous Tx and the meeting is over. I believe partly appointments are so short because the smart card system is so quick and convenient. The patient's entire medical Hx can be accessed within seconds of inserting the card and all that is left for the doctor to do is enter new values/findings.
Another thing that really stood out to me in the OPD was the lack of privacy. There are times when impatient family members or patients would just barge in during the middle of another patient's appointment. I thought it was incredibly rude, but it seemed to be a common enough occurrence because both Dr. Chen and the nurse allowed it and made nothing of it. In addition, the blunt doctor-patient relationship was an interesting thing to observe. Several times we heard Dr. Chen tell patients that their disease is incurable and they will die. We have also heard him tell family members to give up treatment on the patient because it will just be a waste of money and the patient will just suffer. Though everything he said may have been true, the informality of the way he conveyed the message was a bit shocking. Despite Dr. Chen's bluntness and the short visits, all the patients appeared super thankful. Perhaps it's a simple difference in cultural conditioning, but the patient's somewhat excessive gratitude here was a sharp contrast against the sense of entitlement commonly seen in many American patients.
In the afternoon, we sat in on a meeting with the family members of the Multiple myeloma patient (mentioned in the D1 blog). The patient's condition has deteriorated rapidly and he is now in acute renal failure with pulmonary edema. Dr. Chen advised the family members to transfer the patient to a larger, better equipped hospital when his condition has stabilized. (This hospital does not offer treatments for leukemia as it is not equipped for radiation therapies). His suggestion was to do dialysis on the patient to increase urine output and relieve the pulmonary edema. It is likely that this patient will lose his kidney functions and will remain on dialysis for the remainder of his life--given that he can be treated successfully for the MM.
Today (Friday), David and I got quizzed (pimped) by Dr. Chen about myeloproliferative disorders. After that, we went on rounds again. The MM patient who was admitted on Monday was now in the ICU. His rapid deterioration was due to acute renal failure causing his pulmonary edema. Dr. Chen explained that the ARF may be caused by the deposition of the free light chain from IgM antibodies in the renal tubules which eventually led to the obstructive damage in his kidneys.
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