Today marks the 1st day of my one-week TCM internship at Taipei Hospital with the TIHTC training program. I was assigned with two different doctors during the day and in the afternoon. I arrived at the TCM department at 9am, where I found a group of patients already waiting in the general sitting area, while some of them are measuring vitals themselves (patient can measure their body temperature, BP and pulse themselves with a special machine and bring the print out results to the doctor). One unique technology that the Taiwanese healthcare system has adapted is that each patient carries their own personal "smartcard". The smartcard contains all of the patient's medical records. Each patient's chart consists of three main categories: Subjective, Objective, and Assessment. Patient will come in and hand the card to my morning proctor Dr Liao, then he will ask them general questions regarding their sleep, bowel movement, urination, general constitutional questions, and other specific questions according to their chief complaint. Some patients will be at the clinic for acupuncture treatment only, so Dr Liao may be seeing 5 patients at a time since the clinic rooms consists of 5-7 patient treatment beds as well. I realized that patient privacy is not really an important issue here at the TCM clinic. Dr Liao will be talking to one patient, and others can hear the conversations while receiving treatment since they are all in the same room. Patient can also knock and walk in to ask questions anytime. Because of these arrangements, however, Dr Liao was able to see 10+ patients within 1 hour. It was rather difficult to understand the conversation between Dr Liao and his patients as most of them were speaking Taiwanese instead of Mandarin. I was able to have a general idea of the situations, however, by reading the patient charts myself.
My second proctor in the afternoon was Dr Kuo who practices general TCM. Dr Kuo does not perform any treatment and he focuses on outpatient cases. In most cases, patients usually see Dr Kuo for upper/lower respiratory symptoms and insomnia. Post nasal dripping is also a rather common CC among patients who regular TCM clinics. Dr Kuo believes that there are 4 main causes for PND and acid reflux is only a minor cause (at most 10%). The 4 main causes for PND are allergic rhinitis, chronic nasosinusitis, influenza and past cold. We went through several patient cases with PND. It was interesting to note that a patient can develop chronic PND due to a common cold from 50 years ago. A generic formula that Dr Kuo follows for PND treatment usually consists of coptis root, American ginseng and Licorice, 1.5g BID. These specific herbs, however, are not covered by the universal healthcare system of Taiwan so patient will have to pay for them out of pocket. Patients who visit the TCM doctors often walk out with a bill of only <200NT, due to the universal healthcare system here in Taiwan. This is comparatively much cheaper than seeing a doctor for a regular visit in the States. Dr Kuo has also mentioned that getting a surgery done here at the hospital usually only costs ~10,000 NT including 1 month stay in the hospital.
When I think of traditional Chinese medicine, I often imagine throwing a lot of herbs in a pot and boiling it for hours to concentrate it down to 1 bowl worth of "soup". But the medications here at the hospital are made into powder form, so patients can first take the powder then drink 1 cup of warm water after to wash it down. This way of manufacturing the medicine allows for better shelve life and convenience. They do not offer capsule form at this hospital since it is too costly and time consuming to package them. There are definitely some similarities between the philosophy of TCM and osteopathic medicine. Both practices and emphasizes on the health of the entire body, and has strong emphasis on the overall flow of systems (blood, lymph, "Qi" for Chinese medicine). Acupuncturist also studies trigger points, like osteopathic physicians. While observing the treatment of a 60+ y/o female for LBP and neck pain, I realized that Dr Liao will be softening the tissue tension of the areas prior to the acupuncture treatment, also similar to our practice of soft tissue prior to any treatment modality.
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