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NATMA 2G 返 Taiwan!!

Updated: Jul 28, 2023

July 6, 2023

Taichung Veterans Hospital & Changhua Show Chwan Hospital Visits

After a delicious breakfast at the Fairfield Taichung, we boarded our 小朋友 tour bus (impromptu Chinese lesson: 小朋友 means little friends, or the Taiwanese way of saying "children"; so our tour bus company specializes in trips for children, very apropos for 2G's, the children of Taiwanese immigrants), and proceeded to 台中榮總 Taichung Veterans General Hospital for a morning of introductions and discussions with members from our own group.

Dr Jeffrey Chen, PM&R and Pain Specialist at UCSD

First we heard from the vice president of the hospital, who briefly described the hospital's experience with AI and precision medicine. He states that the Taiwanese government formed an AI in Medicine Committee, which consists of hospitals, government officials to discuss the future of AI in medicine. He describes how Taichung Veterans Hospital has already implemented Precision Medicine in several patient cases. He describes a hospital physician who was recently admitted for spinal infection due to staph aureus; after two weeks of vanc, the physician-patient wasn't improving and began to have rising LFTs. Using precision medicine, which could identify more than 10,000 pathogenic strains, they were able to identify a quite rare bacteria. The bacteria was actually sensitive to PCN, but not vancomycin!

Next we heard from Dr 陳昆輝 Chen Kun-Hui, who is an orthopedist and in charge of the Smart Hospital Initiative. He described the long path to a smart hospital, since 1987 (when outpatient medical records are integrated into the hospital's main system), to modern wide scale integration of "Data Everywhere". This initiative includes cloud and edge computing, implementing AI within the outpatient EMR (which is nation-wide due to the single payer structure), data from digital health tools, and e-telemedicine. Don't ask me to elaborate, as Dr Chen rapid-fire presented all that in 10 minutes!

I asked Dr Chen about privacy laws and patient data integrity. He states generally, there are privacy laws in Taiwan, which aren't as strict as the US and Europe, but are marching in that direction. However, Dr Chen did explain that when patients sign into the hospital, due to the fact they are receiving a governmental benefit in the form of national insurance, they do sign a waiver releasing their healthcare data ownership to the hospitals. As well, due to the fact that there is only one EMR system on the entire island, as long as entities obtain IRB approval, they are able to access depersonalized data from the national EMR system to do research and scaffold digital healthcare products.

Next we heard from the director of the Cell Therapy Department Dr 李冠德 Li Guan-De, who described how the hospital uses mesechymal stromal stem cell therapy to treat conditions from cerebral palsy, to lupus, to idiopathic pulmonary fibrosis.

We then heard from our various 2G members and their topics, Dr Peter Hou from Boston, Dr Linda Hou from LA, Dr Sheng-Han Kuo from NYC, and Dr Jonathan Hsu from UCSD.

We had a delicious lunch with our colleagues from Taichung Veterans Hospital, as the hospital arranged two long lunch tables with seat assignments. NATMA physicians sat across from hospital physicians, which allowed for maximal interactions. One of the staff physicians found out he went to the same church as a NATMA 2G pediatric dentist, Dr Christina Lin, while living in the US! Lots of photos and Line ID exchange happened; it was like a reunion of sorts! It was quite a heartwarming scene.

After the filling lunch and more presents (two gift bags! We got a mug and a beautiful book on the history of Taichung VA), we boarded our bus to proceed to Show Chwan Hospital in Changhua, which is just south of Taichung. Show Chwan was founded by one of our Taiwan 2G members, Wayne Huang's father, Dr Huang Min-Ho in 1980, in order to bring cutting edge medicine to a relatively secluded area in central Taiwan. Since the '80s, Changhua Show Chwan has expanded to include the concept of a "health park" (the concentration of medical buildings set against a beautiful backdrop of sprawling greenery and park activities) as well as a "hospitel". Dr Wayne Huang explains that as a private hospital, Show Chwan offers an experience that combines the act of going to a hosptial with the luxury of staying at a hotel. Even the auditorium we were seated in doubles as a theatre, and certainly many patients and their families have watched films right where we were sitting. The hospital atrium was filled with small-scale eateries and gift shops that's reminiscent of an open-air market (minus the frenetic energy). It was fascinating to me, as Taiwan has a single-payer system, but before our eyes we were certainly witnessing fierce competition in a free market where patients still voted with their feet (the lack of competition is often held up as the dreaded outcome and reason for the US to NOT adopt a single payer system, aka Medicare for all). Ultimately, I thought, if a hospital could reduce the stress of patients going to the hospital for admission, chemo, or ambulatory surgery, then that's a plus in my book. As we well know, stress has been shown to increase morbidity, prolong hospitalizations, increase readmission rates, and impact mortality rates, just to name a few.

After the presentation in the most comfortable hospital auditorium I've been in, Wayne walked us to the Minimally Invasive Training Building. Yes, Show Chwan believed in robotic surgery so much that they made an entire building JUST to teach people how to use it. Our robotic surgeon-urologist, Dr Gerry Sheu, was in heaven - she tried out some machines she had never used before in the US. Our endoscopic gastroenterologist, Dr Linda Hou, also successfully tried out another robot that mimicked robotic scoping. Wayne tells us the building hosts medical trainee programs from all over Taiwan and Southeast Asia, as well as companies who want to send Taiwanese physician clients to learn how to use their robots. Of course I had to ask about finances, and it turns out the building was in the red for the first seven years. In Chinese, we use the gallbladder as the organ metaphor to signal courage (vs the American urological counterparts) - and I would say that took some major gall 大膽. Kudos to them for believing in something so fiercely! I don't even want to imagine what the board meetings were like in the first seven years. The rest of the afternoon was scheduled with small group discussions, and I chose to hear more about the minimally invasive urology panel. Afterwards, I also heard our two dentists, Drs Christina Lin and Rita Chuang, took a tour of the general and pediatric outpatient dental clinics at the hospital side. We made sure there was something for everyone!

Once we are done with our visit to Show Chwan, we all went back to our hotels with an empty stomach. Just kidding! You are never, ever allowed to be hungry in Taiwan. Everyone asks if you'd eaten, literally, every 2-3 hours. Wayne treated us to another night of delicious food, and more karaoke! At dinner, I talked to two Show Chwan physicians: a gastroenterologist who has a physician daughter in MN and a pediatrician wife (he confirms that Taiwan also reimburses for pediatric services the least), and a pathologist, who is also the chair of the research department, and holds a PhD in Veternary Medicine. He got all of his degrees from NTU. Turns out we are the same exact age, and I joked he probably just finished school and training a few years ago. But seriously, I feel everyone we meet in Taiwan on this trip is majorly accomplished. At this point, I was showing my age and got tired; so I went back to the hotel. But I heard the other 2Gs tried to go visit a Mazu Temple, couldn't find it, so got shaved ice instead. Did you know 2G memories are made from the exact combination of getting lost just enough, and the sweet taste of Tswa Bing 刨冰? Just another perfect ending to another full day.

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