Dec 3, 2011

Cranberry Juice and Herbicides

Been in nephrology for 2 weeks now slowly adjusting to life in internal medicine as a whole. We had another TMAC (Taiwan Medical Accreditation Council) evaluation this week so things were hectic with lots of spruced up decors and model answers.
On the whole I enjoyed nephrology thanks to being empowered to give orders and perform tests under supervision. Depending on your chief and his level of confidence, capable and credible medical students are allowed to order tests and prescribe medications under supervision. Although this is widely practiced in the States, care is still very centralized around the attendings and residents in Taiwan. Medical students are usually just the "observer" and "note taker" shadowing during rounds and morning reports.
Being empowered means we are considered a team player during rounds - making decisions, determining severity, and planning treatment. This means you have to see your patients before round begins, update on their previous tests, and have an impression in mind by the time the attending calls.
Just to to emphasize how far we've come over 1 year - we were struggling with our hospital's crash-prone system, remembering to press save every lucid moment, and suffering writers' cramps on patients' notes. Now we simply breeze through pages of chart, extracting information like a vacuum cleaner, and synthesizing impression and plans with very little help.
One heritage I brought back from New York is how important patient education is. For too long Taiwanese hospitals emphasized only inpatient care, with dismal patient-doctor mutual understanding and long-term discharge plans. Eventually they snowballed into the burden called the National Health Insurance and aimless doctor shopping.
Being medical student I'm not as busy as my residents. So I endure to teach every one of my patients something they possibly don't know - I encourage patients with urinary tract infections to drink cranberry juice, and patients with postoperative ileus (abdominal distention and discomfort after surgery) to chew gum. They might sound surprising to you, but the aforementioned examples had been proven via large scale studies to be cheap and effective. This gives me a superior feeling over my patients. The truth is, why stay in hospital for a condition you could handle at home? I wouldn't want to stay in hospital even if my private insurance pays me - it's filthy, noisy, gloomy, and absolutely boring being a patient in hospital.
Nephrology also handles cases of suicide via ingestion of toxic compounds. I had a patient who drank a cupful of herbicide after a fight with his brother. We later found out their parents had passed leaving them a huge piece of land. My patient, being unemployed and poor previously, will inherit a quarter of the land. This makes him ineligible for government assistance of NT$12000 (USD400) per month. He has no family, friends, or any means of supporting himself.
As we slowly got him to talk, we realized medicine is powerless against psychosocial loopholes. This is when the social workers come in. Within hours they arranged for a full-time carer, settled the family issues and got him relocated to a long-term care facility. Although they still haven't got rid of the remaining herbicide at home and his government stipend (which he insists on receiving), I think they did a great job given the complexity and multiple parties involved.
There is so much medicine can do. But there are more that fell through the sieve of medicine, like curing cancer, psychiatric problems, and caring for people who are socially challenged. Where modern science couldn't provide for now, we are at least responsible in educating patients on sustainable medical habits and comforting those in need of non-medical assistance. Quoting Dr. Trudeau as my ending - to cure sometimes, to relief often, to comfort always.