Clinical Exchange in Japan

If I have to pick up what things must be done in my 6-year college student life, being an exchange student is definitely the most important one.

I. 総合診療科 Department of General Medicine 2022/12/12-2022/12/23

It is an honor to have the opportunity to visit Nagoya University Hospital during the Covid-19 pandemic. Japan is near Taiwan, and we have tight connections in history, even medical history; also, medicine in Japanese is quite advanced. Therefore, I choose Japan as the country to have my international clerkship. Nagoya University is a famous university, also one of the old imperial universities, so learning at Nagoya University is precious. As becoming a doctor in Family Medicine Department in Taiwan is one of my dreams, 総合診療科 in Japan is the most similar one, with hospitalized care, outpatient care, mental support, and home care. Thus, my first idea is I have to apply for 名大総診 and must grab the opportunity to visit here.

Learning with doctors here for 2 weeks benefited me a lot. The first two days I followed Dr. Motoki, Dr. Hiroyoshi, and Dr. Machi in the ward. There were many patients with problems of vasculitis, which I had never really met before in Taiwan, such as Takayasu arteritis, Giant cell arteritis, and ANCA-associated vasculitis. Those are important rheumatoid diseases for me to understand, but I had not read the part carefully in my textbook until this time. In Taiwan, as a medical student, we do not have much time to discuss with residents; however, after asking some questions, the resident could have time to teach me or search with me, which rarely happens in Taiwan. The other two days I joined outpatient care and emergency care, and both parts were different from Taiwan. In the hospital of my university, our outpatient area is always full of people, and a famous doctor may have to visit more than 60 patients in the morning; therefore, we do not have enough time to have communication with our patients. The condition in the emergency room is almost the same with lots of people there, we may have more than 300 patients a day, so doctors are extremely busy. I think that Japan might have a better referral system and the different level of care is well-conducted.

Photo with 森啓悦先生、森万知先生

In these two weeks, I got the opportunity to visit two local clinics, one is 阿木診療所, and the other one is 勝川よろずクリニック. The patient in the clinic is different from those in the university hospital. Some of them come for vaccination, some of them come for hypertension follow-up, and some of them come for a health check-up. What left a strong impression on me are rural medical service and home care. 阿木診療所 is in a rural area, and I think providing medical service in a rural area is quite essential. The rural area may have fewer medical resources compared to the urban area, so how to give people in the rural area enough medical support is important, and a clinic could meet their basic needs, which is awesome. 勝川よろずクリニック provides home care service, which is another significant part since our society now is an aged society and we have more and more elder people who have difficulty visiting a hospital. Home care could be exhausting but meaningful; we get into where the patient lives, which might be closer to their lives. I’m thankful to have the opportunity to participate in such important work.

Photo with 山田陽平先生

Kampo is a special part in 総合診療科. In Taiwan, we separated Chinese medicine and western medicine completely. Doctors in western medicine would not prescribe any medication of Chinese medicine to patients, and we do not have a lesson to teach us Chinese medicine so our knowledge of Chinese medicine is empty. However, Taiwanese usually buy some Chinese medicine in pharmacies and use it in daily life when we have a mild headache, sore throat, and runny nose. Thus, in my opinion, like in Japan, combining those two kinds of medicine together is great. Sometimes after the examination, we may still not be sure what kind of problem the patient has, or maybe the patient does not have a severe problem. At this time, prescribing Kampo is a good idea because it could recuperate and replenish our health. I feel like Kampo is interesting and worth learning.

I want to give 寿一先生 the greatest thanks to arrange such a great schedule for me these two weeks. When I was asked what did I want to learn, I feel like 総合診療科 put a lot of emphasis on helping me get a lot of harvests, and I absolutely get it. In these two weeks, so many doctors and staff took care of me, and I’m grateful for your support and help. Also, at lunchtime during these two weeks, there were different doctors having meals with me, which made me so touched because if I had meals alone, sometimes would be not sure where to eat and would feel lonely. Thank you for keeping me company. There are too many people I want to deliver my thanks to, so it may be difficult to show all the names here. All in all, 総合診療科 is like a big family, and I really hope we will have another opportunity to meet again in the near future.

II. 皮膚科 Department of Dermatology 2023/01/10-2023/01/20

Dermatology is always interesting to me. Being too famous in Taiwan, I would not have the opportunity to become a dermatologist in Taiwan in the future; also, I did not have enough time to get into the course of dermatology for students in my school. Therefore, I decided to have a two-week clerkship in the department of dermatology here, and I feel so grateful to have this opportunity.

In those two weeks, I took part in outpatient care and the operation, and I learned a lot from doctors. In the outpatient clinic, sometimes I observe the treatments, and sometimes I observe the patients to get the diagnosis. Treatments in outpatient care are various, from cryotherapy to biopsy, and I especially appreciate the guidance Dr.横山 gave to me, which really helped me a lot. I have heard from my classmate that cryotherapy in my university’s hospital is usually conducted with cotton swabs; however, cryotherapy here is conducted with a spray gun and a disc which has four different sizes of holes on it. As to the biopsy, it was my first time having such an opportunity to observe, so I was pretty excited. I admired how gentle the doctor was, and the procedure was conducted very smoothly.

As to the diagnosis in outpatient care, I joined Professor秋山, Dr.室, and Dr.横田‘s outpatient clinics. I observed many patients with Paget’s disease in Dr.横田‘s outpatient clinic. It was my first time seeing this disease with my own eyes. After the first day of the outpatient clinic, I borrowed a textbook of dermatology from the library, which benefited me so much. When I saw a patient with the disease, I could look it up in the textbook and discuss it with doctors; thus, I got more familiar with dermatological problems.

The operations were the most impressive things in the two-week clerkship. I joined two operations here; one is for Paget’s disease, and the other one is for the epidermal cyst. I remembered that the first time when I got into the operating room here, I was so nervous. However, everyone was so kind, which made me relieved. The equipment here was different from Taiwan. In Taiwan, we use reused blankets, but here we have disposable ones, which I prefer more. Also, in Taiwan, we use a brush when doing surgical hand disinfection; however, in Japan, we do not use a brush. The scrubs (surgical gowns) are different, too. In Taiwan, everyone wears green gowns, no matter whether they are doctors, nurses, or students. But in Japan, different identities can be distinguished by different colors of gowns. Also, the type of scrubs here is more good-looking compared with those in our school! The most amazing thing I found during the operation is that there is a face shield provided for the staff to prevent any splashings spattering to the eyes. I’m not sure if we have this kind of tool in Taiwan, but I have never seen it before. I had great communication with Dr.村上, Dr.茜部, Dr.堀崎, Dr.横山, and all the staff in the operating room. I feel so grateful for their help.

I extremely love the atmosphere of the department of dermatology. Professor秋山 even shared his paper which was published in a journal in Taiwan! Thank Dr.棚橋 for arranging such a great schedule in the department; thank Dr.横田 for inviting me to lunch; thank everyone in the department of Dermatology for taking care of me, and even giving me a farewell dinner on the last day, which made me feel so warm. I wish we will meet again in the near future.

Photo with doctors in the Department of Dermatology

Last but not least, I would like to express my appreciation to Professor粕谷, Professor長谷川, Miss大岩, Miss笠井プリンス, and all the staff in the Office of International Affairs. The situation had been so difficult in the beginning due to the Covid-19 pandemic. Thank you for always giving me prompt replies when I faced problems. Without your help, I cannot have had the opportunity to visit Japan and have the great experience at your school. Nagoya University is an awesome university, and the hospital acts as an important role in the Tokai area. I am so lucky to be able to have the clerkship here, and I will always remember these wonderful memories. Wish all of you a happy 2023! この四週間、お世話になりました！