This weekend (Friday-Sunday), we went to Guanshan in Taitung county to observe the doctors from the Guanshan Tzu Chi General Hospital. This small Buddhist hospital (32 beds) has a few regular doctors, and most of its specialties are staffed by doctors who rotate from other areas. Due to the small size of this hospital, many of the more complicated cases are sent to larger hospitals in Hualien or Taitung (the city). Every Tuesday and Friday-Saturday, a team of healthcare providers (doctor, nurses, assistant) go to some of the aboriginal villages in the mountains to provide health care to the people. So, soon after we arrived at the hospital on Friday, we joined the healthcare team and drove up the mountains (about 1 hour trip) to visit 3 villages. At the first village, a small clinic was set up outside and in the second and third villages, the clinic was set up in a small building. Patients could come in any time during the clinic hours. The doctor, Dr. Shiao, also made house visits to bedridden patients who were unable to come to the clinic. Dr. Shiao explained to us that one way to pay for medical education in Taiwan is to serve in a rural area for 6 years after the doctor has completed his training. Rural medicine is not popular in Taiwan, so this program allows for people living in rural regions to gain access to medical care.
On Saturday afternoon we returned to the hospital and observed some of the doctors in the Emergency Department (ED), including Dr. Shiao. The ED was divided into 5 levels: Resuscitation (1), Emergent (2), Urgent (3), Less Urgent (4), and Not Urgent (5). We were told Levels 4 and 5 often see patients who are experiencing diarrhea, UTI, etc. It was in non-urgent side of the ED that we met Dr. Chang, an OB/GYN who also served as an ER doctor, since the ED doctors at this hospital were not specialists. He is also the doctor that goes up to the clinics in the mountains on Tuesdays. He gave us a tour of the hospital and we got to see the CT machine (which is unusual for a hospital of this size), the OR, the empty ICU (4 beds), and empty nursery (2 beds+ transport incubator). Because the hospital lacks the resources for ICU patients, they are often transferred to a larger hospital. Additionally, only about 6-10 babies are born at this hospital per year. Some pearls of wisdom that Dr. Chang bestowed upon us included:
1. The doctor-patient relationship is very important. Legal problems can stem from this relationship.
2. Never tell a patient that "the baby is normal" or that "there is an absolute cure"; you can say that "I have found no major abnormalities right now" because medicine is scientific and uses statistics; it is not absolute.
3. Observation is very important in medical training because it is a method of learning.
4. Always know the side effects of a treatment and why they occur.
5. You should object/question your teacher's opinion (in your mind). Do not blindly accept what they are saying; they may be right or they may be wrong. It is through questioning what you are taught, that you may surpass your teachers.
6. Check the patient's condition prior to looking at lab data, which is objective. If you think something is wrong, re-confirm the data.
During our (Angela, Arthur, and my) turn in the ED, we saw a case of the common cold, 2 cases in which the patient had gotten into a fight (2 friends that were beaten up by others; one had 5 broken ribs), a case of cut finger that needed stitches, and 1 case of a headache, most likely caused by drinking alcohol the day before.
This weekend was a good lesson in rural medicine. Since so few doctors practice in rural areas, a rural physician needs to know a great deal outside his/her own specialty and must learn how to practice medicine with fewer resources. This experience has given me a better understanding about practicing medicine in underserved areas and my respect for rural physicians has grown greatly.
No comments:
Post a Comment