Christine Le, Week 3: OB/GYN, Day 1-2

Day 1

First day of my OB/GYN rotation! Even though we have not yet covered the reproductive system in our pre-clinical education, I wanted to gain some clinical exposure. There are only 2 OB/GYN doctors in this hospital, so they each see a large number of patients per day.

In the morning, Angela and I joined Dr. Cao in the outpatient department (OPD). He showed us what to look for when doing ultrasound

            -black indicates water or fluid density (bladder)

            -white indicates bone density

            -in between black and white indicates soft tissue density (uterus)

Some patients were given a pelvic ultrasound in order to examine the uterus. The ultrasound revealed some patients as having myomas, which are benign tumors or nodules that develop within the muscle tissue of the uterus, but many of the ultrasounds revealed no particular findings.

Over one-third of the patients came to receive a Pap smear and several came to receive the results of their Pap smear. The hospital recommends women over the age of 30 to get Pap smears and since it is free of charge to the patient, many patients do come see the doctors for their Pap smears.  Dr. Cao explained to us that providing free Pap smears allows for earlier detection of cervical cancer, thus cutting down future treatment costs and increasing prognosis. This service, covered by the National Health Insurance (NHI) is a great example of the saying by Benjamin Franklin: An ounce of prevention is worth a pound of cure, since cervical cancer is the easiest gynecological cancer to prevent. In contrast, Pap smears are not free in the United States. According to the CDC, only those with low income or no health insurance may be eligible for free or low-cost Pap smears through the National Breast and Cervical Cancer Early Detection Program. Also, screening guidelines in the US recommend that women over the age of 21 get regular Pap tests. http://www.cdc.gov/cancer/cervical/basic_info/screening.htm  Since Pap smears are not covered by insurance in Taiwan until a woman is 30 years of  age, isn’t it possible that a subpopulation of women (ages 21-29) are not being screened for cervical cancer due to the fact that they will have to pay out of pocket for the test?

Other cases we observed included: vaginal yeast infections –Candidiasis, Trichomoniasis (sexually transmitted infection caused by the parasite Trichamonas vaginalis, suspected polycystic ovary syndrome (PCOS), bleeding after taking emergency contraceptive, bleeding after taking RU 486 (medication that causes abortion), condylomas (anogenital warts), and ovarian cyst. We saw 32 patients in about 3 hours.

In the afternoon, Dr. Cao used a Powerpoint presentation to explain common diseases seen in OB/GYN and their treatments. This crash course in clinical medicine pertaining to the female reproductive system will help set the foundation for all that I hope to learn this week and will hopefully prepare me for the reproduction block in 2^nd year.

Day 2

We started off the morning with Dr. Cao in the OPD. One interesting case was a 58 year old patient with a PSH of abdominal total hysterectomy due to myoma who presented with a chief complaint of difficulty passing stool. She said something was physically getting in the way of her stool passage. Upon examination, the doctor found that the patient had a rectocele, which occurs when weakening of the fascia that separates the rectum from the vagina causes the front wall of the rectum to bulge into the back wall of the vagina. After the exam, she told the doctor that when she went to another clinic, all they gave her was a stool softener. Why didn’t the other clinic do a physical exam? It took very little time for Dr. Cao to determine her diagnosis upon examining the patient. Then we went into the operating room to observe Dr. Cao perform electrocauterization on the condylomas that a patient had yesterday. Then we returned to the OPD to continue seeing patients. Interesting cases included a 22 year old patient who was pregnant, but did not receive regular pre-natal care, a 35 year old developmentally challenged patient who came in with her mother to change her IUD (intrauterine device), a 22 year old patient who possibly had a herpes infection and a yeast infection, a 36 year old patient with a carbuncle (skin infection that often involves a group of hair follicles) that involved pus. We also observed many Pap smears. We saw 26 patient in the morning session

In the afternoon, we observed Dr. Tung (the first female doctor I have encountered in the hospital) in the OPD. One patient, 33 years old, had been trying to get pregnant and asked the doctor for a HSG (hysterosalpingogram) test, which is an X-ray test that uses dye to visualize the area of the uterus and fallopian tubes. Soon after Dr. Tung called the radiography department, she was able to perform the procedure. It was interesting to find out that a radiologist was not needed to do this imaging procedure and that the OB/GYN doctor performed it. The results showed that the dye did not enter the fallopian tubes, suggesting an obstruction. Other cases included other patients who wanted to get pregnant, amenorrhea, bleeding after taking RU 486, and adnexa cystic lesion. And of course many Pap smears. The continuous stream of patients provideed me the opportunity to learn about many diseases and conditions involving the female reproductive system and I hope I can remember all of what I have learned and apply it to the material we will learn in the upcoming academic year.