Disclaimer: I’m writing it from perspectives of a foreign educate doctor(me, myself and I) , viewing how the Taiwanese medical system works
Clerkship is indeed much tedious than anything else. This is my 5th week into a total 48 weeks clerkship, every weekend I’ve been counting down to the last day of eventual clerkship ends. 43 weeks to go. (Sigh*)
There are plenty of things that amazed or overwhelmed me. System is polar opposite to the European ones, I’m talking about hardware wise, the doctors here rely much on CT, X ray images, especially in Surgery departments, I’ve barely seen any physical examinations.
There are times I was really freaking out by they didn’t even check the patients on their own but rely on nurses data and everything. I thought that was risky. There were also times I don’t really agree with what they do. For example, operating on a severe delirium patient that has high infection marker, broken thigh bones and multiple hemorrhages in the brain. Let along the patient has anemia and thrombocytopenia. I could see why they make the decision to fasten the process that patient might be able to move and go home sooner, however, I personally thought the patients condition was way worse. Eventually he got operated and stayed in ICU for a period of time, still ongoing treatment for unknown pneumonia.
‘ The patient seems to complain about intermitten claudication, do we do ankle-brachial index?’ I asked.
‘ Oh, we don’t do it here.’ They replied.
‘ Do you maybe want to check the patients limb?’ I asked carefully.
‘The CT is enough telling us his problem.’ They replied.
It was frustrating when the medical industry isn’t reaching my expectation. I really miss those days when I have my own patients and every week I got one hour to discuss cases with my supervisor. I learned so much from him, in terms of patients cases and how to solve problems.
When it comes to software wise, Taiwan is way worse than European countries. I mean, the attitude toward the patients, how patients and families got involved with decision making, and how they run the vicious cycle by educating the younger doctors with threats and fears.
I remember vividly how the doctor was teaching the CT readings, he casually said things along the line ‘ if you miss this CT diagnosis, then prepare being sue to death.’ Honestly, I was so shocked how people casually make this comment without considering whether its proper or not. I mean, me I’ve personally never encountered any education like this that was full of threat and fear.
The younger doctor seemed to adapt to this education, as he nodded and agreed. That was another shock for me that he found this speech so normal and acceptable.
This is the toxicity of the vicious cycle.
Do doctors in Taiwan learn their way up with fears and in threats?
It was probably just the case I have encountered. But it was mind-blown for me.
There were again times that I had a discussion with the educational boss, he mentioned how to properly write the patients record, to protect yourself and to avoid being sued in the future.
I was indeed shocked.
‘ You’ll get used to this environment, where family of the patient will sue you and you need to have the prove for the judge to make them believe you are innocent.’ He continued. ‘ unfortunately, this is what’s going on in Taiwan. If they find any complains, they will bring you to the court.’
I was speechless. How does working as a doctor becoming such a stressful and fearful job that you need to protect yourself first? And how sad it is, when doing the patients record for judges to justify your righteousness?
In Sweden, I was taught to write the journal so the next doctor will have a better insight of what the patients have been going through. And thinking about most journals will be read by the GP, so write as short and clear as possible. Versus in Taiwan, they jokily said that the journal is for judge to read.
To be honest, everyday I’m going through the hard times accepting this is the environment I’m living in and I’m not happy.
I talked to my friend about this and she described this is a extremely toxic environment that I’m encountering. Not only the system is mal-functioned but people’s mindset is built with hierarchy and discrimination toward their own past experiences.
‘ Just because it happened to themselves, doesn’t mean they should educate people with this toxicity with fear. And just because this happened, it doesn’t justify this is right.’ She said angrily.
‘ They are not realizing the system is twisted, and just because it happened, doesn’t mean it will happen to others.’ She continued.
Now lets go into software wise, I’ve found many times the doctors don’t communicate or explain clear enough to the patients, instead they gave very vague answers.
There are times I found doctors yelling at patients or not greeting with patients when they come into outpatient clinic.
That really amazed me.
I mean, in Sweden you care about patients feeling alot. They can get hurt, too. I feel like doctors here ( I’m saying majority) don’t necessary love their jobs. It seems like many are just doing it to make a living.
It is draining for me.
I feel so exhausted all the time trying to adapt but finding those things I don’t agree with. I feel so sick and stressed that I need to keep up my assignments which is double of amount of other PGY doctors whilst I don’t even get extra paid.
I’m tired of this system and people-people interaction.