Tuesday, September 25, 2012

Last Day at NTUH

It is hard to believe that my NTUH APPE is coming to an end!  During my time here, I have met with many great preceptors, physicians, and students, who have all been a part of my educational experience here in Taiwan.  In my opinion, the greatest benefit I got was seeing the difference between Taiwan and U.S. pharmacy practice.  

Generally speaking, the treatment approaches at NTUH are highly dependent on the personnel in charge of that particular medical team.  In both Family Medicine and PSICU, I noticed that the treatment decisions were based on a combination of evidence based medicine as well as experience based medicine.  Just as in the U.S., they referred to IDSA guidelines for infections, CHEST guidelines for antithrombotic therapy, and ATPIII guidelines for high cholesterol treatment.  As for experience, they referred to their attending physicians.  The main difference that I found was that, often times, experience trumped evidence.  Guidelines are there as a reference, however, they were not always followed.  In contrast, I felt that in my rotations at UCDMC, guidelines were followed much more closely.  This is an example in which the culture of Taiwan has a profound effect on the overall treatment approach of patients.  The difference in culture was especially apparent towards the beginning of my time at NTUH, during the Ghost Month or 鬼月.  During this month, it is believed that ghosts and spirits of the deceased return.  Many of the locals, including my family, make trips to pay homage to deceased loved ones.  Since this period of time is associated with death, many people tend to postpone medical procedures as well.  As a result, the patient load for many of the services was much lighter than other times of the year.     

In a hospital setting, Taiwan pharmacy personnel is estimated to be 1/8 ~ 1/16 that of the U.S.  The number of patients each pharmacist manages is much greater, and therefore, it is impossible to devote as much time to each individual patient.  For this reason, not all clinical pharmacists attend daily rounds with the medical team.  On the Family Medicine service, the pharmacists do not ever round and interventions are made primarily via telephone.  On ICU services, including PSICU, the pharmacists round with the teams on a daily basis.  The type of team dynamic I observed in the ICU was more similar to my experience at UCDMC, where pharmacy support is not only appreciated, but sought after.  In order to have an established pharmacy department, rapport between the pharmacy personnel and other members of the healthcare team must be established.  This simply cannot be done without working together on a consistent basis.  Clinical pharmacy is a much younger field in Taiwan, and many aspects of pharmacy are still in the process of becoming established.  

Photo of some of the pharmacists at PSICU on my last day.

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