So, this guy walks into a neurologist’s office with one side of his face sagging and twitching.
He says, “Doc, yesterday my vision went all weird and I got a big headache, but it didn’t last long. Then this morning, I woke up and my face was like this.”
Doc says, “You caught a cold.”
Sounds like I should be posting in the bad jokes thread, doesn’t it?
The real joke is that it’s no joke!
Did you know that if a doctor orders an MRI and it shows no problems, the patient must pay for the test? It costs about 10,000 NT. So, unless a doctor is SURE that there’s a problem, he/she will not order an MRI because people will complain about the expense!
Save your money, not your life. How VERY Taiwanese.
Personally I think that’s a pretty sensible way of doing things. If somebody needs some unusual expensive test/drug/procedure then they should expect to make some sort of financial contribution. MRI machines cost a sphincter-clenchingly huge amount of money.
What isn’t sensible is that doctors here simply tell you “你感冒了” regardless of what’s actually wrong with you. I don’t think it’s about saving money - they just have the diagnostic skills of a lobotomized cockroach.
Incidentally, I eventually discovered that “你感冒了” does not mean “you have a cold”, as the textbooks tell you. It means something like “you have an idiopathic illness”, i.e., you’ve got the lurgy - some unidentified bug that will go away by itself (but take this random assortment of pills anyway).
Yes, an MRI machine is expensive. And I just bet it uses an unGodly amount of electricity.
You pay that money for the machine to USE it.
I know ten thousand NT is a lot for most Taiwanese people, but it’s peanuts to an American. From my perspective, a ten thousand dollar all clear is worth the peace of mind.
Sorry, but I gotta keep my confidences confident. I wrote the bad joke to illustrate the point. You know, in Taiwan you always have a cold, no matter what’s wrong with you.
As far as I know, EEG is not for stroke. It is for diagnosing epilepsy. We still need computerized tomography (CT) or MRI of brain to diagnose stroke, but in a skilled hand of neurologist, clinical symtoms and careful history is enough.
And I guess that this scenario probably is an extra-ordinary example. I don’t know if this doctor is a REAL neurologist or not, but under the stress of strict economy about health insurance nowadays, to arrange MRI of brain at the first sight is really uncommon. WE have been constantly threatened by the Health Insurance Bureau. So my wild guess is, if it were true, this doctor might seldom see a foreign patient entering his clinic and simply be stunned. Although the diagnosis is obvious, he/she decides to order an MRI just in case to avoid making the rare but probable mistake. Is it possible?
Anyway, how about take a note at the doctor’s face and the way he/she talks next time? You will find that this person sitting right opposite of you might be more nervous than you.
As far as I know, EEG is not for stroke. It is for diagnosing epilepsy. We still need computerized tomography (CT) or MRI of brain to diagnose stroke, but in a skilled hand of neurologist, clinical symtoms and careful history is enough.
And I guess that this scenario probably is an extra-ordinary example. I don’t know if this doctor is a REAL neurologist or not, but under the stress of strict economy about health insurance nowadays, to arrange MRI of brain at the first sight is really uncommon. WE have been constantly threatened by the Health Insurance Bureau. So my wild guess is, if it were true, this doctor might seldom see a foreign patient entering his clinic and simply be stunned. Although the diagnosis is obvious, he/she decides to order an MRI just in case to avoid making the rare but probable mistake. Is it possible?
Anyway, how about take a note at the doctor’s face and the way he/she talks next time? You will find that this person sitting right opposite of you might be more nervous than you.[/quote]
The way I see it, the Doctor should have taken a CT scan anyway because it’s faster and only for the purpose of canceling out the possibility of a hemorrhage. Then eventually giving the medications for thinning the blood.
But just saying, “it’s a cold” is just too bad. My grandma had done better!
You’re not seriously suggesting that a doctor is entitled to the most lame-ass diagnosis I’ve ever heard … because he’s freaked out by the presence of a foreigner? Grief. Hope he never gets called to the scene of an accident; it’ll be him being taken away in the ambulance.
My granny could have done better than that, and she’s dead.
You’re not seriously suggesting that a doctor is entitled to the most lame-ass diagnosis I’ve ever heard … because he’s freaked out by the presence of a foreigner? Grief. Hope he never gets called to the scene of an accident; it’ll be him being taken away in the ambulance.[/quote]
I don’t think that’s what he meant. I think he was referring to how “VIP” patients or difficult-to-understand patients will sometimes receive different management because the doc isn’t quite sure what to do with them:
This happens in every medical culture. Imagine the opposite situation, a western doctor dealing with a Taiwanese patient; the roles are reversed, but the cultural and language barriers are still there. Imagine a western physician dealing with a patient who doesn’t want to hear about the risks involved in a procedure, or an elderly person with a terminal illness whose family insists that information be directed through them rather than directly to the patient. If you are treating a patient whom you cannot relate to – you just don’t “get” them – that will affect your management choices. If you don’t 100% trust the history the patient is telling you, for whatever reason, you will rely on diagnostic tests moreso than with other patients.
Also, imagine the anxiety you would feel if you were Taiwanese and went to Canada, and now the doctor is telling you “I don’t know how this will turn out, it depends on many different factors,” “i’m going to explain every detail about this new medication I’m giving you, because you need to know,” “you need to be aware of a 5% risk of major complication with this procedure,” if previously your doctors just confidently decided your treatment plan for you and carried it out, and the cultural expectation of everyone around you was that this was normal and OK, with a certain rate of bad outcomes acknowledged generally as unavoidable and not worthy of extended discussion.
I see from prior posts that Dr. kau826 is a rheumatologist in Taiwan. What is your most common inflammatory arthritis there Dr.? Do you have any strange infectious arthritides in Taiwan? In my region, Lyme disease is becoming more common and occasionally stumping our local rheumatologists.
Yes, we are more anxious about some ordinary conditions, thanks for your additionals, like facing a celebrity or simply a foreigner, yet dealing with an emergency is another story.
Osteoarthritis is the most common arthritides, inflammatory and non-inflammatory, like in other countries. But when it goes to the most common inflammatory arthritides in Taiwan, I would say gouty arthritis. Following these two came reactive arthrits, I guess. Reactive arthritis might be more prevalent than rheumatoid arthritis, but was hampered by the vague criteria of the former.
And yes, Lyme disease also stumped the doctors here, but it seems that this disease is less common than expected in Taiwan. Because of the in-a-hurry nature of our outpatient clinic, this disease could be overlooked much easier. Basically we should trace the travel history, then carefully examined the skin, and finally went to this diagnosis. When talking about strange infectious arthritis in Taiwan, I wonder if anyone will disagree with tuberculosis arthritis. Tuberculosis is prone to inhabit in joints than other bacteria, so I will check its existence whenever I cultured the joint fluid.