A Visit to the Taiwan Society of Internal Medicine

A Visit to the Taiwan Society of Internal Medicine

ACP Leaders On The Road:

Jock Murray, MD, MACP

It was a great pleasure to accompany ACP President Jeffrey P. Harris, MD, FACP to the Taiwan Society of Internal Medicine (TSIM) 22nd Annual Meeting in Taipei, November 29-30, 2008. Our host was Professor Ming-Fong Chen, FACP, President of the TSIM and Superintendent of the National Taiwan University Hospital, who was gracious in arranging for us to meet other prominent physicians in Taiwan medicine.

The TSIM Annual Meeting was well attended, and of the more than 8,000 internists in Taiwan, over 5,000 participated. Many trainees were also in attendance at this very busy and active meeting. Although most of the meeting was conducted in Mandarin, many speak very good English and they pointed out that many of their textbooks are in English. Many of the physicians train in the USA, and they contribute actively to Western medical journals. In some areas of medicine, such as gastroenterology, they are leaders on the world stage.

Taiwan has developed an innovative health care system over the last decade and provides not only coverage for physician and hospital care, but also includes drugs, alternative health care providers and medicines, glasses, and other services. They have a smart cards system for access to health care services, and the lowest administrative costs of any system in the world (less than 2%) and provide a wide variety of services to all citizens for 6.23% of GDP, less than half of the USA system. The system is beginning to feel the financial strains of such wide coverage. We heard that it was very popular with the Taiwanese but not so popular with the physicians who were not paid well for their services, resulting in clinics characterized by high volumes and rapid assessments.

We were invited there to address the challenges in the USA and Canadian health care systems. Dr. Harris gave a very interesting, informative, and frank discussion of the problems and challenges in the USA. I spoke about the history of the Canadian health care system, and the challenges arising after a half century. I pointed out that every country in the world has evolved an approach that fits their history and culture, and all are struggling with balancing care with costs. None have all the answers, and although each has to find their own answers, we can all learn from each other. This was clear in the recent position paper and Annals of Internal Medicine article, "Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries".

At our lunches and dinners there was lively discussion and we all learned many things from each other. This is one of the best reasons for supporting these international exchanges. There are also continuing links and communications between individuals long after we have all returned home, so the benefits are not confined to the meeting. I have particularly enjoyed e-mails from an enthusiastic young faculty member who has returned to Taiwan after postgraduate training in the USA.

There was also time to see the sites and scenes of this interesting country. The Portuguese sailed to the island in the 16th century and named it Formosa, meaning beautiful island, as they viewed the lush landscape and volcanic mountains. There is a long history of occupation by Dutch, Chinese and Japanese, and vestiges of these cultures and architecture are still visible. I looked out over the Tamsui River from Fort San Domingo, one of the oldest buildings, built by the Dutch in 1628 and most recently used as a consulate by the British. At the huge memorial to Chiang-Kai-shek, I entered through the beautiful and majestic gate where I noted (a sign of the changing times) a group of students quietly protesting a recent visit of a Chinese official from the mainland Peoples’ Republic of China.

One has to be impressed by the Taipei 101, the current tallest building in the world (soon to be overtaken by one in Dubai) where the fastest elevators in the world take you up 90 floors in 37 seconds, and down just as fast. It was fun to lunch on steamed dumplings at Din Tai Fung, a busy and crowded restaurant, listed by the New York Times as one of the 10 best gourmet restaurants in the world. The National Palace Museum has 650,000 Chinese treasures and I admired especially the calligraphy display and porcelain collection.

Two of the most memorable visits were to the Lungshan Temple and the Danshuei Church. At the latter, I heard of the Reverend Doctor George MacKay, a Canadian from Ontario who brought medical services (even though he was trained as a dentist) as well as spiritual teaching to Taiwan in the later 19th century. He is, like Dr. Norman Bethune on mainland China, regarded as a great hero. He started many medical clinics, numerous churches, and a university. When I was there I happened upon a ceremony for him under his statue in the Danshuei town square. I will be researching my countryman further, an impressive man of whom I was totally unfamiliar.

The ACP in recent decades has been more outward looking in its relationships and I applaud the increasing international activities and the recognition that medicine has no borders. I am grateful to the Taiwan Society of Internal Medicine and the ACP for the opportunity to attend and speak at this meeting.