not my clinic

clinic is interesting. the patients typically do what you say and listen pretty intently, unlike a lot of places in the U.S. of course, the private practice clinic I followed a couple months ago had some excellent patients (follow advice, good payer source). in the tertiary care hospital, there are a lot of specialists and even more patients. 60-80 in a day is typical. I think I saw more diarrhea and constipation in a day than I have all year. they all come home with some form of prescription. sometimes it's an antibiotic, well, a lot of times. some WHO approved oral rehydration source (apparently you can make your own in a pinch 1/2 tsp salt, 1/2 sodium bicarb, and 4 tsp of sugar in a 1liter of water), and sometimes some racecadotril (a seldom used drug available in the U.S too), and some Chinese medicine. I'm not sure if the antibiotic resistance patterns are much worse here than the U.S. It would like the case since antibiotics here seem worse than th ER docs giving vitamin R shots (rocephin).

the manners here are different than the U.S. you have patients barging in to check on their status to be seen and no sort of specific order. the nurse is no where as helpful in triaging patients in. they are really good at lab draw and getting the ultrasound done super fast. they don't even takevitals. some of this may stem from the fact that Western medicine is still relatively new here and their med school still emphasizes a lot of Chinese medicine. I know I would get burn out seeing 60+ cases a day though. There is still a big hierarchy system and the older attendings do not see much clinic and never take any sort of call. They do a lot of admin stuff. Some of the same stuff still occurs here though - parents bringing their kids in for basic common sense stuff (diaper rash, diarrhea when it's not really diarrhea, etc), over utilizers of the systems, and people using the ER during holidays as their clinic. I haven't been able to figure out how many people have a primary care doctor.

next is maybe inpt

setting

the hospital is really nice. it is set up sort of like our own in KC, with the Hospital and Clinics sort of model. It is a Women's and Children's Hospital. Like I was told before I came here, a lot of their stuff, like equipment and facility, is nicer than ours. It's about an 850 bed place with full tertiary care options for all. There is an older hospital too in the older part of town with another few hundred beds. They even have a separate ob/gyn ED. A hospital like this in the states would cost probably several times more for labor and land. The entire place is draped in white marble. Inpatient now is pretty light due to the holidays. All of their inpatient doc is via a computer system except for some areas in the ICUs. and of course , their heart cases are at a standstill too due to the holidays.. Radiology is a separate system and they do not have PACS. The patients take a lot more responsibilities like administrating their own meds by the parents. oh, and they also pay up front if the docs decide they need to be admitted - like a lot of other countries in the world. they pay a 3000 RMB account from which meds and other charges like nursing get deducted from. the family typically finds ways to get this and if not on the first night, they spend it in the ED under observation status. oddly enough, they even had a case of MSUD. their newborn screen is only 3 diseases though. it was pretty hard to understand everything, since unlike HK, everything is in Chinese, including the culture results and MIC/resistance patterns! plus, I really don't speak Mandarin at all, which a lot of docs use since they are from elsewhere in China and my Cantonese medical speak is horrible.

new post will be about the clinic

differences...

I guess this will be own journal for myself too, but here goes.

It's been really nice there thus far. It makes me apprecriative of the differences, however subtle or varied, they are of the two cultures. For those who are unaware, I'm spending the month of February in Guangzhou, Guangdong Provience, China for clinical rotations. I'll have to continue to thank my residency program for sponsoring me here. For starters, I happened to arrive during the New Year's. Chinese New Year is a full week long celebration and people seem really surprised that the U.S. only gets 1-2 days off for their Christmas/New Years. In general, everything stops. The construction zone that is the city halts since everyone goes back to the country side. In the hospital, even the patients that can go home do so, as long as they aren't hooked to an IV for anything. The hospital runs on a partial staff too. Once the week is over, things kick back to full gear. They follow traditions a lot and like many Asians, tend to be a bit too superstitious. The class distinction between elders both by age and job role is more marked as well. Everyone also tends to welcome guests a lot more than in the U.S.

Every day, both here abroad and in the U.S., I try to pay attention to something cool. What's cool to me is different than someone else, but for me, sometimes it's funny and sometimes it's an "ah-ha" moment and makes me more apprecriative of life and nature. Typically you can't quantify it and I hope that it's something can never be programmed into a computer code. Anyway, today I was walking around and heard John Mayer, except that on following it, it was being sung, not too shabby, by a Chinese kid. There are a lot of street performers around, he definitely stood out. I'm not sure how many others around knew what to make of him though. Guangzhou does not have a lot of non-Chinese visitors compared to other cities in China. I listened for a bit and gave him to what amounted to about 1 US dollar.

this is a note to myself, but I'm supposed to spend a little time in the hospital tomorrow, so I'll post about that next.

my schedule

wow, I can't believe it's been over a half a year since I said anything here. I guess this sort of mimics my silent life. my time management skills are definitely better, and I can prioritize stuff better too! unfortunately, road bumps keep sneaking onto this odd journey to an unknown place. it's nice to be over half way done with this part though. back to my hectic schedule at least until I think of a more definite path to take this diary. in the meantime, I'll just read my brother's log, although he wishes to be anonymous for now due to work conflicts. mood - strangely lackadaisical

my procastination

between work, work, and oh yeah, more work, this blog has sort of gotten the through shaft. I know I should write a bit - I enjoyed it back in undergrad years ago, and I often looked for a chance to write for the paper. It sort of sucks that there's deadlines and reading to be done, because, yes I do want to be good worker bee. I really have no interest in writing about every little tidbit about life, as I really have no purpose for doing so. In a selfish sort of way that I think I mentioned a while back, my audience is really myself in a certain number of years away. Like a teacher once told me, all writing is for an audience and should be for a specific purpose. My next big project will be finished, hopefully, in mid to late February. Until then, I will keep my half-finished, mid thought articles buried in some searchable form on my hard drive. One of life top 10 aspirations is still to have some form of my work(s) published - there is certainly some degree of coolness to that. besides work, I'm trying to organize a garage band. I realize that it's certainly something I should have done years ago, but damnit, I missed that part in the 80s and I have no qualms about re-living that part of it. sarcasm totally intended there...

speaking of life in general, I like facebook for keeping in contact with some friends both from now and the past. But, if I have had no direct contact with you in the past, don't expect me to be your friend. I have absolutely zero aspiration to have the most number of friends on there, which the same goes with myspace.

my year, almost

it's almost been a year of this mayhem, and I guess my mood would be fairly undecided. yes, the story of my life thus far. I've been meaning to compose a blog, oh, maybe once a month or something like that. Unfortunately for these pages, I've picked up some toys, including guitar hero, a piano, and some books. Good stuff. I'll try to beat those kids at GH next time at Walmart. addictive too, sort of like kiddie crack, except you get better finger dexterity. I like it.

I say undecided because I get asked quite a bit about med school and residency by the fellow med students. It gets me thinking, since about 90% of my answers during med school and the interview trail were fairly contrived and routine. I guess by the time I recited them so often, I sort of believe them myself. I still try to convince people to go into medicine, but I try to make sure they do so for the right reasons. boring? never. rewarding? occasionally. challenging? daily. I hope these reasons are still true 1 year, 5 years, and even 10 years from now. maybe I won't be too cynical then, but I am an optimist.

I will blog more later. these articles are literally sitting on the desktop, partially completed, partly funny, and poorly worded thoughts...

my patient's patience

"we should get those results to you today"

as soon as I heard those words from another resident, I knew it was too late. we were explaining some test and the approximate time frame when the results of said test would be known. I turned to my med student.

"today! you realize that we have just doomed ourselves to finding out those results and letting them (family) know. actually, I think she just doomed you, because that kid is your patient."

and they say I'm too nice to my med student... In all reality, it really sucks that we setup these unrealistic expectations once a patient is admitted to the hospital. I thought for a second during my own medical school that such practices were limited only there, but it was really an afterthought. After all, what patient or parent would NOT want to be given the answers and solutions to everything once they set foot and set up camp in a hospital bed and room? after all, you are now in the big great academic hospital (which shall remain anonymous).

this sort of reminds of the movie Sicko, where one explaination I read somewhere suggested that our insane health costs are partially to blame on the expectation that the American people demand and our own culture of fast food medicine. we want answers to everything, and we want them fast. if we are discharged from a hospital stay, we damn well better give them a magic elixir to solve them, or else ligitation reigns supreme.

unfortunately, medicine is very much the opposite. in many cases, we are trying to undo the years of bad health and this is only where we know what is going on. many other times, we have no idea what the hell is going on with our patients. We rule out all the immediate badness like cancer, infections, vascular abnormalities, cardiac oddities, and other quick kills, and discharge you home to follow up with your general practitioner and specialists. if it's something possibly rheumatologic, then it will show itself in a few months, or maybe not. lab tests are sent out and if they miss a courier time, then it's another day wait. our lab vampires suck out several tubes of blood and leave the patient's arms and legs all bruised, yet no one gets a chance to fully explain that some of those tests may have to be redrawn tomorrow.

I'm still learning, but I do know what my expectations should be now. Fortunately for that patient, the MRI results came back later that evening. I think I'll start setting up false expectations now though. it's like the directv guy telling you he'll be there at 3pm and showing up at 2.