Medical Culture Shock

Today I saw my first patients in the clinic and experienced medical culture shock.  When a patient arrives the nurse brings them to wherever I am (hallway, work room).  I then awkwardly try to communicate with them.  We did find a treatment room I can use for exams and I am going to try to see patients there.

My second problem was records.  Patients carry their own medical records (Sort of like our own blue folder project).  In the clinic there is a master book listing every patient and their dates and cycles of chemotherapy (essentially a giant flow sheet of the entire patient population) and an individual folder on each patient with a discharge sheet from each chemotherapy "admission" - inpatient or outpatient - which lists the drugs given.  If you need more information you ask the patient.  Today I asked a woman to see her records and she opened her purse and dumped a jumble of papers.  Most of the record is hand written (including pathology reports) and sometimes difficult to read. By pooling these various sources I was able to put together patients' stories. Orders are often written on lab result print outs or progress notes or given verbally (Upon my return I will never complain again about EHR's or CPOE).  The system is actually quite efficient though information is sometimes difficult to pull together.  As always, the staff is very kind and tolerant of my hearing impairment and language barrier.

In general we have been eating at Bhutanese Restaurants which are family run and serve traditional Bhutanese fare which is heavy on chili peppers, rice, and noodles often with small amounts of meet as an accent.  I find it quite good.  Tonight for a change of pace my friends Ed and Hiller (anesthesiologist) and I went to the Ambient Café, the rumored hang out for American ex-pats.  It reminded me a bit of Jorgenson's back home with coffee, Latté's, espresso, and vegetarian wraps and sandwiches with American music in the background.  There were more Anglo's than I have seen in one spot since I got here.  I had my first salad in a week!  It was a nice change of pace, but I am anxious to get back to trying the various Bhutanese establishments.  Meals are inexpensive, generally 200 to 400 Nu which is $2.50 to $5.00.

We are hoping to make a road trip to Punakha this weekend if our road passes come thru.  If so I should have some great pictures.  All for now.  Peace and take care, all.