美國2018 RUTGERS姐妹校實習心得（102001097 醫學六 盧立修）
It is my first 2 weeks in Robert Wood Johnson Hospital, and everything seems intriguing to me. I took part in the grand run of family medicine, Mortalities & Morbidities of internal medicine, 3 clinic sessions (Dr. Wang and Dr. Ambrossa) in endocrinology department, and a speech of strauma ovarii (teratoma predominantly composed of mature thyroid tissue).
The clinic sessions were the most impressive to me. In Taiwan, in average, there are almost 40 patients in a session. The doctors have to try their best to finish it in 4 hours. Medical students can’t approach the patients on their own because the doctors are in a rush and have no time explaining to student. Therefore, “教學門診” was created. With at most 5 patients come to one clinic session, students are allowed to ask and do physical examination to 1 patient.
However, in RWJ hospital, third- or final-year medical students can approach 3-4 patients independently in a session. I met a student, Allison, on Friday. Seeing how she taking the patient’s history, I know students here manipulate the skills for asking question. Besides attending doctors are willing to listen to her opinion and discuss with her before seeing the patients.
Patients’ privacies are well protected. Every patient has his/her own room seeing the doctor, mostly without presence of nurse. That is totally different in Taiwan. A doctor, nurses, medical students or even other patient would be in the same room.
On Friday morning, after the performer finished his presentation about strauma ovarii, the audience asked questions very actively. It is almost impossible in Taiwan, even if we don’t understand completely. I also asked a question why some patients with nodules need FNA and some need only observation. He said it was according to how the nodule looks under the ultrasound. FNA is not recommended if it is low suspicion of malignancy.
I appreciate doctors and students I met this week. They treat me as if I am one of their teams. Hopefully, I can learn a lot in this four-week rotation.
These 2 weeks, I worked with Dr. Yu in family medicine in Eric B. Chandler Hospital on George St and Church St. I am so fortunate to shadow Dr. Yu.
To my surprise, Hispanic people are one of the main groups in this area. More than half of the patients coming to hospital speak only Spanish, so interpreters or phone-interpreters are important. Therefore, it takes at least 20 minutes in order to communicate with a patient. I met a student, Zac, this week. He told me he really wishes he could speak Spanish, so that he can talk to those patients directly. Besides it is said that interpreters cost a lot on insurance.
Instead of Medicare, patients here mostly use Medicaid as the primary insurance, and some even don’t have medical insurance. If a patient goes to a specialist or emergency department directly, he/she can barely afford the costs. As the results, a primary care doctor is responsible for curing patient with uncomplicated disease and making referral based on the patient’s condition. Since the primary care system is well proposed in the United States, less medical resources are wasted.
I don’t think Taiwanese government do a good job in classifying primary and secondary medicine. One of the reasons is that “全民健保” brings about the low price seeing a doctor. Patients visit a specialist or emergency room as they want. Moreover, medical centers are so common in Taiwan that it takes short time going to doctors in general hospital. People rather spend more money going to a famous doctor than wait for the referral by a family physician.
Patients over visit hospital and the workload of doctors increase consequently. Hopefully, the situation in Taiwan will improve gradually.
Healthy Aging Symposium – A multispecialty conference
The lifespan of human beings increases abruptly in decades. The case of geriatric diseases, therefore, becomes more common. More and more people dedicate themselves in studies about aging and diseases.
In this conference, lots of moderators and specialists share the results of their research to the audience. Although I couldn’t get every point due to the language issues and the difficulty of those studies, I learned a lot in that day. The section of Neuroscience and Aging was the most interesting to me.
The topics include the pathogenesis of Parkinson’s disease, emotional regulation and aging-related cognitive decline. Besides from the pathologic change in the brain, one of the speakers mentioned that cortisol, one of the endocrine affected by the emotion, makes significant influence on our memory and cognitive function. Therefore, it is important to stay in a good mood. Recalling positive experiences play a role in emotion regulation, and it is also very helpful by finding positive meaning in the negative past.
It doesn’t matter that we become in a bad mood due to unpleased experience or failure. There must always be a positive meaning in these events. It not only help us stay in a good mood, but also maintain our function of the brain.
What should I have prepared if I had known before working in RWJ Hospital
Read articles or introduction to medical insurance systems in the United States, esp. in New Jersey.
Why family medicine is so important in the United States?