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There is nothing so annoying as a good example
“There is nothing so annoying as a good example!!” — Mark Twain (1835-1910)
I recently returned from my fellowship program’s annual medical mission to Vietnam. These missions are a highlight of our academic year, as they provide unique opportunities to practice acute-pain medicine and regional anesthesia in challenging medical environments. The differences in medical practice between our two culturally and geographically separate nations are considerable. The ability of our staff, fellows and residents to integrate themselves into these foreign medical systems and effectively teach Vietnamese staff and trainees simulates some of the stress encountered with medical operations during conflict in foreign countries. I have always maintained that our American team learns as much from our Vietnamese colleagues as we teach them during these missions.
During these missions, we have heartwarming opportunities to directly impact individual lives of Vietnamese patients by providing advanced pain-management techniques, like regional anesthesia, that have not fully penetrated the otherwise sophisticated medical system in Vietnam. (Understand that advanced regional anesthesia for pain is also relatively new to our own system.)
I particularly treasure the memory of the effect I had on a 5-year-old female in a Ho Chi Minh City cancer hospital who had just undergone an above-the-right-knee amputation for sarcoma. We were busy teaching when she came into the recovery area, but I noticed she was in significant pain and, when I asked my Vietnamese hosts if I could intervene, they concurred. A few minutes later, I was directing a needle under ultrasound guidance to her femoral nerve, which was responsible for transmitting most of her pain. The young girl was not at all pleased with the large, frightening foreign guy with the needle and strange machine. Despite her fear, she bravely withstood the procedure and was fast asleep a few minutes later as the local anesthetic blocked the pain of her amputated leg. This young patient occupied my thoughts until the next morning when we had an opportunity to do pain rounds. I was rewarded for my efforts with a bright smile from the young lady when I saw her. The lesson of the effectiveness and importance of aggressive perioperative pain management was not lost on the Vietnamese physicians we were training.
While these all-too-rare experiences remind me of why I became a physician in the first place, what is more important is the example of acute-pain management we are leaving behind with our Vietnamese trainees. I am pleased I could impact on this young patient so profoundly, but the physicians we trained will impact thousands of patients long after our team has gone.
This was our sixth training visit to Vietnam. I am always delighted at the excitement and willingness of our Vietnamese colleagues to learn and adopt advanced acute-pain techniques. They recognize the power of this Western medicine example, and, despite the sophistication of their own system, they are willing to learn and adopt new ideas.
Over the years of visits to cities and towns throughout Vietnam, I have been exposed to Vietnamese traditional medicine but, perhaps arrogantly, I did not pay much attention. My first personal experience with acupuncture was in Vietnam, described in a previous U.S. Medicine editorial. My interest in integrative medicine (what the Vietnamese term “traditional medicine”) has grown significantly through my association with the Army Pain Management Task Force, which specifically called for greater study and utilization of these techniques in the management of pain.
During this last visit, I asked if my team might tour the School of Traditional Medicine at the University of Medicine and Pharmacy, Ho Chi Minh City, and visit an active traditional medicine hospital. Our team was treated to a comprehensive tour of the school where we were exposed to curricula for physicians, nurses, and other providers who complete two to four years of additional training in traditional medicine following primary certification as physicians and nurses. On our tour of the hospital, we visited various wards where acupuncture, massage and physical therapy treatments were being provided for large numbers of patients with a variety of medical issues. There is no question, in this system, that acute illness or trauma is first treated in facilities that practice medicine in a Western tradition. The important difference in this system is that there also is no question that traditional medicine will be offered to patients during their rehabilitation and recovery.
For most minor ailments, traditional medicine is a first-line tool for the primary care physician. I witnessed many hundreds of patients being treated in the hospital we visited, which is typical in this city with more than 10 million inhabitants that serves as a medical referral center for much of the former South Vietnam. I felt I was witnessing an example of healthcare practice that holds profoundly important lessons for Western medicine as it struggles to justify soaring costs without commensurate gains in population health.
I have maintained many times in this column that federal medicine has much to be proud of. We are the standard for the world when it comes to cancer, disease management and trauma survival. Our Vietnamese colleagues recognize this superior example of care for disease and trauma and are working to inculcate the best aspects of the Western allopathic tradition into their system.
I think few federal medicine providers would argue that, as a society, we are struggling with health maintenance in this country, with increasing rates of diabetes, obesity, chronic pain, substance abuse, as well asmany other health maintenance issues plaguing our culture. I hope our status as medical standard-setters will not result in such a myopic attitude toward other medical ideas and traditions that we possibly ignore the value of solutions that have served some cultures for thousands of years.
Examples of successful incorporation of integrative medicine into large health systems abound. They are only not American made, which is annoying considering all that American medicine has accomplished. Nevertheless the examples are there, and I am convinced learning from these examples will benefit our patients. The question is, are we medically sophisticated enough to notice?