I was able to shadow abdominal ultrasounds, gastroscopies, and colonoscopies today. The latter two was pretty much more of the same from the prior two days except that I was even more attuned to what was happening. Abdominal ultrasounds are on a completely different level though.
In class, we have "played" with ultrasound while Dr. Wang was actually employing it as a method of diagnosis. I never really thought of the detail that ultrasound can give. During our use of ultrasound equipment, we were happy to find the heart, its chambers, the liver, and compress vessels. Dr. Wang was able to differentiate organ densities, cysts, organ segments based on tracing vasculature, and much more. He diagnosed many ailments such as masses, fatty liver, gallstones, kidney stones, and pancreatitis amongst others. Dr. Wang tried to explain a lot of the reasoning behind what we were seeing on the ultrasound. I understood some of it but I also got very accustomed to the "smile and nod" so as to not waste too much of his time. I was pretty amazed when he was able to quickly recognize that the pancreatic duct was 0.2 cm larger than normal... This just demonstrates the level of expertise that can develop over time. Not only was Dr. Wang finding the most minute abnormalities, he was conducting a thorough abdominal exam (checking all liver segments, kidneys, gallbladder, pancreas, aorta, and more) in under 5 minutes each. Despite all the information ultrasound supplied, it is not a very high resolution imaging modality, and thus, many patients were referred for CTs to confirm or clarify any problems.
I'm not completely sure how things are done in the states regarding abdominal ultrasounds, but I think ultrasound technicians trained in certain areas conduct them. In Taiwan, as I noted above, the doctors perform all these ultrasounds themselves. I am not sure which method is better, but it definitely seems like Taiwan's system works pretty well except for the fact that doctors are worked down to the bone. Another difference I noticed is the timing of appointments. In all the departments I have observed already, any patient that received a referral or needed more work ups done were able to be scheduled within 2 weeks. (sometimes even that same week!) In America, I am pretty sure most patients have to wait weeks to get appointments. Many of those who received ultrasound exams were scheduled tomorrow for colonoscopies!
To be honest, the amount of knowledge that Dr. Wang employed while performing ultrasounds was a little daunting. He tried to explain to me some things about the liver and to illustrate these points he brought out a textbook of ultrasound. The book was at least 1500 pages... Ultrasound is no joke.
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