Experience in U.S. アーカイブ


Arrival at Rockford

The announce said "the weather in Chicago is snow." I was very surprised to hear that.

After an-11h-flight from Tokyo, I at last arrived at Chicago O'Hare airport. As I looked outside, the ground was completely covered by snow. Yes, I reached Illinois.

After I passed through the U.S. immigration and customs, I expected to see Dr. Hunsaker right in front of the exit door... But I couldn't find him.

I soon called him and his friend Patty found me out from the crowd.

Dr. Hunsaker is a kind man. On the way to the parking lot, we saw a girl lied down the platform. She looked pale. Once we passed by, but Dr. Hunsaker stopped, went back and took care of her. He is also very friendly that Patty and I were made laugh all the way from Chicago to Rockford.

It was about one-hour-drive to Rockford. Then I arrived at the students' house where I stay on the first and fourth week. The students who host me are Matt and Beth. Beth is now on the vacation and goes to Costa Rican, so Matt welcomed me. He is also a nice man. I ate dinner that he cooked for me, and we talked a little bit about our medical school.

Tomorrow will be the first day of University of Illinois. Keep in mind the word "just do it" which Dr. Lo told me.


Overview of NCRHP

entrance of UIC-COMR

Today I visited NCRHP.

After I had breakfast at the school cafeteria with Dr. Hunsaker, Mr. Mark Meurer took me to the tour of NCRHP and met many people. Everyone has their own office each, so we knocked the door and saw them. Everyone told me what they were doing there. One does research to figure out how to deal with community problem, another gives students chance to see Mexican culture so that they can treat many things about Hispanics, not only medicine. Some teach health care people how to educate their Diabetes patients. There is also a person specific for publication or advertisement and there is even an Art Designer section for brochures or something. They have not only the person who put Rural Health System into practice but also the researcher to make their activity more effectively or reasonable and the press agent who advertise their activity and make it well known to many people.

UIC started the program called RMED(Rural Medical Educational Program) program in 1993 to provide apropriate health care to rural area or some underserved population. (About 12 million people lives in Illinois, almost the same population as Tokyo, though its area is 70 times bigger than Tokyo... You can easily see that there are many rual areas.) In 2000, Center for Rural Health Professions was built as a faculty of UIC-COM Rockford and it took over the RMED program. It became the National Center in 2003.
The Center have 4 main programs below:
1. RMED program
4. Interdisciplinary (inter-professional) preceptorship.

Today I heard about RMED program. Students who are in the Rural Area of Illinois can join RMED program. They study usual Medical course like other medical students in UIC-COM Rockford, but they have extra seminars or activities. When they are in 1st or 2nd year, they have a monthly seminar to discuss about topics on Rural Health or Community-oriented Primary Care. Until the end of the 2nd semester of their M3, they decide which County they will work in and they do 16-week rotation at their 4th year, building up Community-oriented Primary Care Project. Although they are busy, they have fun time. What is very intersting is the interview of students selection. The group of people called "Recruitment and Retention Committee" interviews applicants, not the Dean of NCRHP or other Directors. In the committee, there are health professionals, communit members, and even farmers!!

I'd like to see the researcher and hear about EXPORT, a program that aims to identify and solve problems specific for each community, develop health professions.

I'm afraid that my "super size me" diet started...


IAFP seminar

map of illinois

On March 7th and 8th, I went to Springfield to join the meeting of "Illinois Academy of Family Physicians(IAFP)". The first day, we had three sessions, "Women's reproductive health", "Emergency Preparedness," and "Medicare Part D."

In the women's reproductive health session, "morning-after pill" was discussed. This averts pregnancy for up to three days after sex. Some pharmacists refused to sell this "emergency contraceptive," because of their belief on Christian religion. But there is the low that bans pharmacists' refusing to dispense. This low was made by Governor's emergency power, which is carried out in case of emergency like a disaster. The speaker in the session, who is a doctor of a clinic, insisted that it was not the matter to be provided by law. We should teach patients.
This issue contains not only medical problem, but also political or ethical issue. In terms of ethic, we have to think about when is the beginning of the life. Is it when zygotes fertilize? Is it when the egg implants?
Unfortunately, one pharmacist who broke the law lost his job. (the reference:Chicago Tribune | No middle ground for pharmacist) I agree to the speaker. We should teach patients so that we don't need to priscribe "morning-after" pill. We can say the same thing about artificial abortion. The people who suffers the most for guilty feeling are patients, aren't they?

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Monthly M1 meeting

I left Springfield and went to University of Illinois at Urbana-Champaign (UIUC). It is a large campus becuase there are many kinds of department like Law, Agriculture, Education etc... RMED Program Students spend their first year (M1) at UIUC and study basic, scientific subjects like anatomy or physiology.

There, I joined the M1 class meeting. As I explained, RMED Program students study about Rural Medicine in addition to their regular medical course. So they have a meeting at night after the regular class once a month during M1 and M2 year. The meeting is not a kind of formal class, but it is held in the restaurant. The Director Dr. Hunsaker said that he wants to give the information on humanity or communication rather than science through the monthly meeting.
The theme of the meeting was "Research on Rural Medicine." Firstly, Lecturer Ms. Susan Farner, who is a reseracher of Public Health (especially in Rural Area), gave a lectur. She said what serves for Medicine is 10%-Genetics, 20%-Medicine, 20%-Environment, and 50%-Behavior. So Public Health is important to give people education. Interesting example is that we have to concern about the location of grocery store or residents can't have healthy diet. Research take its part on these sorts of issues. She also told that if you don't have time to research, you should ask academic people to help you. Physicians have resources and academics have technique to research.
Secondly, students asked her questions. Lecturer Ms.Farner as a academic and Dr.Hunsaker as a physician answered their questions. Some asked whether they can use their patients' information for research and some asked about how to major patients' outcomes. During the discussion, what impressed me was the phrase "both hospital and patients have to be saved in the Rural Area."

Reseach is a very useful to figure out what the problem is or how much the project succeed. It can also be used to make politicians understood and have their support. But when it comes to putting it into practice, I think physicians don't have much time to research. So as she said, cooporation between academic and physicians can make it possible.



I came back to Rockford on March 10th, Friday, and attended the teleconference with the people in Indiana. They try to start a new project like RMED program and asked NCRHP to give them advices.


Teleconference is a conference in which people in the different place talk together using video camera like this photo. This was a nice chance for me to know the important point of RMED program because I am also a beginner on RMED program. Director Dr. Hunsaker emphasized that "application is as important as the program." So they try to choose appropriate applicants by community people's interview and looking at their humanity, character, or honesty more than their MCAT(a Federal test for med school) score. There are some scholarships that give students money instead of their obligation to engage in Primary Care in Rural Area. But without doing so, 70% of RMED program graduates become Family Physicians in Rural Area and RMED program succeed in their goal[1]. Also he insisted that academic truly disconnect to communities, so it is important to go out and try to make relationship with them.

Like this, NCRHP exports their skill not only to other states, but also other country like China or Nepal.

[1] Glasser M, Stearns M, Londo R: Screening Applicants for Rural Medical Education Program. Acad Med. 75(7):773,2000


Dixon Clinic

On March 13th, I visited Katherine Show Bethea hospital[1] in Dixon. The population in Dixon(Lee County) are about 16000[2], it is one of the small towns. Dr. Hunsaker see outpatients there. The service provided was named "Convenient Service." In U.S., patients can't see a doctor without an appointment. If they can't make an appointoment when they don't feel well and would like to see a doctor on the day, they have to go to an emergency room, paying more money. In such case, they can have alternative to use "Convenient Service." They make an appointoment through their clinic and see a doctor at "Covenience Service". It costs less than ER. But in the Convenience Service, doctors don't give patients follow up care. Instead, doctors leave the record of what the patient said, his/her condition, diagnosis, and therapy to complete "Continuity of Care." (The way of leaving record was interesting. Doctors leave their summry on the phone and dictator made it into text. It's an amazing system, isn't it? Dr. Hunsaker said it is a common was in U.S.)

It is difficult to afford it because of the insurance system. Public medical insurance are not offered for all citizens though there are some public one like MEDICAID(for the poor) or MEDICARE(for the elderly). So this kind of service for outpatients are needed. But why patients can't see their family doctor without appointoment? It is a very controversial system.

[1] KSB hospital website: http://www.ksbhospital.com/
[2] Dixon demographic: http://dixonil.areaconnect.com/statistics.htm

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System differences:US vs Japan

   From March 14th to March 24th, I experienced Rural Medicine in Sycamore[see map below]. There, I shadowed Dr. Thornton and Dan, a RMED student of UICOM-R. I learn differences between medical system in U.S. and that of Japan a lot, so I'll write about them this section.


[Hospital and Clinic]
   In U.S. the place where doctors see inpatients and outpatients are separated. Doctors see outpatients at their offices/clinics and do inpatients at hospitals. And doctors work for both hospital and clinic. For example, Dr. Thorton works for both Kishwaukee Community Hospital(hospital) and Kishwaukee Medical Associates(clinic). These are located in close place, but 2 miles away, so he moved from one to the other by car. Not as hospitals in Japan, doctors don't see outpatients in hospitals. But because of it, they see inpts once in a day. As the Dr. T's talk, there are more hospitalists, who see only inpts in the city. They make team and rotate 3 or 4 members. So they can see pts a lot in a day, but pts are seen by new doctors everyday. Both systems have drawbacks.
   In addition to it, many doctors share their office. That is, it's more common that there are people who take care of business part of a clinic and they employ some doctors and these doctors works for the clinic.

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Physician Assistants

   In the afternoon on March 16th, I shadowed David, one of "physician assistants" to observe job of PA. He told me a lot of things about PA.

with a Physician Assistant
[History of PAs]
   1960s, the army was trained and got medical skills, especially first-aid, facing to Korean War. When they came back to U.S., they were introduced to medical service because of continuing medical need. That was the start of Physician Assistants. Some countries like Canada, New Zealand, Britain, or China are trying to set up same kind of professionals.

[What PAs do?]
   They can do most of the things that doctors do( David said 80-85% ). PAs diagnose, write prescriptions, or practice basic surgical skill like suture. Some PA do delivary, and some pick up grafts for coronary artery while cardiac surgeons open thorax. PAs see both inpatiens and outpatients.
   Now, almost 80,000 PAs are practicing in the U.S.

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Cultural Shock

[religious culture]
   Dr. Thornton who took care of me in Sycamore invited me to lunch in his house. He lives very near from his clinic, has horses, dogs. His house is surrounded by trees. Dr. Thornton, his wife Jenny, and I ate lunch together. Dr. Thornton said they pray to say thanks to food and farmers before they start. I really attracted by the before meal praying because it realizes me the value of food or meal and gives me time to think about people behind meal.

   Jenny also took me to the Sunday church. I went to church every Sunday when I was in the kindergarten because it was associated with the church. Then, I couldn't figure out its meaning and stopped. But this time, it was an interesting experience. One thing, in that church, people sang the hymns to the play of a band;piano, guitar, bass, and drums. That was very fun time, And the other thing that impressed me was a cleric's (a person who explain the words of bible) talk. He explained the words with very common example and sometimes made us laughing with joke.

[family culture]
   As you know the episode above, people welcomed me and invited me to their house. I stayed with students in Rockford, had lunch with the Thorntons, and visited Stephanie, who is a nurse in Dr. Thornton's office and enjoyed funny movie and pizza. I also surprised when I joined M4 students' party. Not only students but also their wives were invited to the party by school. Students made family to family relationship.


Continuity of Care

   On March 20th, I shadowed Jane and Peggy, "Care Coordinator", and saw their job at Kishwaukee Community Hospital. Their work is a kind of what Social Workers do in Japan. For example, they contact with a rehab so that patients can go after their hospitalization. In this way, Care Coordinators think about patients' life after discharge, explain pts about things that can improve their life, and set things up. They are not Social Workers, they are registered nurses and have worked as a nurse.

There are 3 or 4 Care Coordinators and they see all the patients in the hospital. Their protocol is below:
     1. new patient admission
     2. check patient's chart that doctors wrote
     3. think about what is needed for the patient and what should be figured out
     4. get the information from the patient/the family and talk about the life after discharge.
     5. plan discharge and set things up for patients (contact other facility, introduce new equipment for patient etc...)

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Continuing Medical Education (CME)

   Doctors in US have to take credits of continuing medical education(CME) to keep his doctor license valid. The number of credits they have to take is decided by each states. (website) These days, as information technology is developing, videotapes, journals, and the Internet is also used as a tools to provide CME.

   One that I joined was held by IAFP. I wrote about it at the article on March 8th 2006.
   The other one was held by National Kidney Foundation of Illinois(website). Doctors who are professionals of one field was invited and they gave lectures to the physicians. It is not so big meeting that participants well talked and exchange information each other.
   Also I attended Kishwaukee Hospitals's lunch meeting. There, one doctors who works for university hospital came and gave a lecture about Viagra.

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Giving talk to grade school students

   On March 23rd, I visited one grade school in Sycamore and saw the health talk to 5th grade students by one of the RMED students, Dan.

   In RMED program, M4 students do 4-month rotation in Rural Area of Illinois. During the Rotation, they also work on "COPC(Community Oriented Primary Care)" Project. From their M3 year, they started to research community helath problems and set up some project to solve the problem.

   Dan focused on grade school students and try to make them choose "good choice" by giving talk, "The Top ten ways to live to 100." He contacted with school nurse in Sycamore and set up the talk to students.

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School Nurse meeting

   Dr. T is so busy man. He attended School Nurse meeting at Dekalb during his lunch time. School Nurses in Dekalb, Dietisians, Family physicians, Pediatricians, and Dentists get in together and have a meeting once or twice a year.

   After he finished the last pt in the morning, he drove to the conference place. On March 24th, school nurses and doctors were talking about some topics. One that I was interested in was talking about obesity. School nurses worried about children's obesity and they talked about possibility to move in their lunch.

   I wondered if doctors can work with school nurses as a community activity, so I was really surprised that he does. But on the way back to his office, he told me that he could share and realize problems with nurses but he also realized there were few things that he could actually work on. His words show the difficulty of cooperation between people in different occupation. They work at different place and have own job. Though it is expecteed that they work on children's problems and do something together and they maybe wish they could, actually they afford to do.


Family Physician, Dr. Thornton

   I'm very proud of being in the team "Dr. Thorton."

   He took care of me during my stay in Sycamore. I spent most of the time shadowing him. In the morning, making a round in the hospital, then driving to his office, seeing outpatients, having lunch in the office, and seeing outpatients again in the office... this is the usual schedule of him. But in lunchtime, he attends sometime the lunch meeting in the hospital, sometime school nurse meeting and, when he is on call, he drives back to the hospital and sees the patient in ER. He is a BUSY man.

   I really respect him, especially in the three aspects; connecting doctors, teaching students, and seeing patients.

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Memories of Illinois scenery


downtown Sycamore beautiful sky

rockriver rockgardians

with Gracie At the millenium park

About Experience in U.S.

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