November 2014: Normally I have great things to say about healthcare in Taiwan, but its Universal Health Care system failed me today. I know I shouldn’t complain too much as I get excellent care here for the most part. While healthcare in Taiwan is cheap compared to what patients pay in North America, there are still major oversights in the system that can make life miserable for patients like me.
In short, I’ve just learned that a major drug interaction is mostly responsible for some rather serious symptoms that I’ve been experiencing over the past three months. I’ve been light headed, I’ve experienced numbness in certain parts of my body; I’ve had instances of extreme sensitivity to light and noise, and I’ve had extreme anxiety. The worst symptom by far has been a racing heart and heart palpitations, which has been so severe that I thought I was having a heart attack on several occasions.
Had my doctors taken the time to review my medical history and the medications that I am already taking, all of this could’ve been avoided.
Update August 2022: One of the benefits to having a blog is being able to look back and see how life was 10 years ago. In my case, since this site was started in early 2007, I have the benefit of seeing A LOT of changes that have happened in Taiwan. Imagine my surprise to see this entry from 2014, which is still spot on and relevant after all this time. Nothing has changed. Taiwan’s NIH still has massive gaps in their system that allow chronically ill patients like me to fall through the cracks with virtually no help from specialists here.
Healthcare in Taiwan
My complaints are nothing new for the health system in Taiwan. The Taiwan Healthcare Reform Foundation lists a number of problems with Taiwan’s current medical system.
The following is the list of major advocacies from the Taiwan Health Reform Foundation:Healthcare System:1. The Fiscal Supervision for the Health Institutions in Taiwan
There is currently no effective government policy to regulate hospital’s financial activities and no SOP for hospitals.2. Medical Malpractice
The medical malpractice crisis in Taiwan is a multiple dimensions issue that range from flawed court system to mutual distrust between the health providers and the patients. Update May 2022: Taiwan Passes Bill To Resolve Medical Disputes Through Mediation3. Healthcare Staff Shortage
Information Transparency:1. Medical Record Accessibility
Accessing ones own medical record is not an easy task in Taiwan. Many healthcare institutions still refuse to provide the complete medical record to the patients.2. The Surgery Consent Forms
Unnecessary and ill-diagnosed surgeries are hurting patientsin Taiwan. Surgeons and staff do not take time to take patients through consent forms properly.3. Drug Prescription Reform
Drug scripts in Taiwan generally lack of information and clear format, which make them vulnerable to abuses.4. Medicine Bag Improvement
Medicine bags in Taiwan are made by plastics or paper containing prescribed drugs. These bags play a major role in providing crucial medical information to patients. Due to lack of regulation, most drug bags are labeled with limited information. A clearly labeled drug bag will help improve drug safety in Taiwan.
Cultural Problems with Healthcare in Taiwan
Medical professionals in Taiwan do not like to be questioned, challenged, or spend a lot of time in discussion with their patients. They tend to overprescribe medications and they don’t go into detail about possible drug interactions, side effects, or proper medication usage with their patients.
On several occasions, I’ve left my doctor’s appointment with details on how to take my medication only to have it completely contradicted at the pharmacy.
I’ve also returned home to find additional medications included in my prescription that simply aren’t needed.
For example, I’ve seen my ENT many times and returned home with ear drops for an ear infection. I was also prescribed antibiotics, painkillers, two antihistamines, and an antacid – none of which were needed.
Furthermore, no mention is ever made of the anti-inflammatory drugs and painkillers that I already take for Ankylosing Spondylitis and Fibromyalgia. I don’t need a doctor to tell me that taking additional painkillers and anti-inflammatories on top of the meds I’m already taking is a big no-no, but it continues to surprise me that my ENT never brings it up.
It is obvious to me that most doctors I see outside of my regular visits to my rheumatologist do not look at my medical history when I visit. As a result, I have had to become a stronger advocate for my health. I now look up all the drugs that are prescribed to me; I also research side effects and potential drug interactions, and I grill my doctors on everything. I’m sure they hate seeing me coming!
The other thing I’ve noticed here is that doctors MUST provide additional medications to prove to their supervisors that they are treating patients appropriately. I have learned from several doctors by asking pointed questions that I don’t actually need many of the meds they give me, but those meds MUST be on my paperwork for at least six months before they can take it off. This astounds me. I don’t know how many patients are taking meds they don’t need, but I’ve literally had doctors tell me to ‘take the meds in your prescription, but don’t actually take them.‘
Working with a Rheumatologist in Taiwan
I have been chronically ill for well over a decade, but it wasn’t until 2009 that doctors in Taiwan were able to pinpoint the cause of all my health issues. I have Ankylosing Spondylitis, and I have been seeing rheumatologists in Taiwan on a regular basis since my diagnosis in 2009.
Massive amounts of medications are needed to keep my diseases in check – all of which come with serious set of side effects that create new problems that I’ve had to learn to deal with. I have been working with the same rheumatologist since 2009, but this year (2014), my doctor retired. I have a new rheumatologist in charge of my well being.
For chronically ill patients such as myself, changing doctors can be a huge obstacle to tackle. It’s intimidating and frightening to start working with someone who knows nothing about what you’ve been going through.
Knowing that I’m in safe hands helps to reduce the stress of being ill, and stress, which as most autoimmune patients know, is a huge trigger for most of us. It can often exacerbate disease symptoms. Furthermore, I am afraid that my tendency to question and double check information will lead to me being labelled as a troublesome patient.
My new doctor’s first decision after seeing me was to change my medication without telling me, even though I wasn’t experiencing any disease progression. I decided to stay on the course of drugs I was taking and when I saw her next, I asked her why she had changed my medication without discussing it with me first. She agreed that she should’ve spoken with me and we decided that I would stay on my current course of treatment.
Obviously this decision of hers has caused some mistrust on my end. I may not be a doctor, but I am an expert where my body and disease activity is concerned, and it bothers me that my new doctor didn’t bother to consult with me about my condition before changing my course of treatment, especially when there was no reason to change it.
Within a few months, I was flaring again and I had to go back and see her. This time she decided to add a new medication to my course of treatment. However, she failed to go over drug interactions with me and I ended up having a bad reaction to the new medication I started taking. Eventually, I left her care and ended up at another hospital, only to go through the exact same thing again.
As of August 2022, I’ve narrowed down my search to find a rheumy who understands I’m educated about my disease and sees me as an expert that can assist him in treating me. It’s so important to find a doctor that acknowledges this, and yet sadly here, it is not the norm.
Lack of Information About Medications and Med Side Effects
I’ve noticed time and time again that doctors and pharmacists in Taiwan fail dismally at providing their patients with information about prescription medications. They gloss over common side effects, but they very rarely go into detail about all the side effects that a patient should keep watch for. This is something that doctors and pharmacists in North America really excel at. When I leave a pharmacy in Canada, I know exactly what to expect with the medications I’m taking, and I know what to avoid.
With my autoimmune condition, it’s extremely important that I know what to expect from potential drug interactions and that I know about potential side effects.
My doctors in Taiwan have talked to me about common side effects, but both of them have failed to mention the really serious side effects that could occur. For example, I just started on a new class of drugs three weeks ago. I just found out today that I’m not even supposed to be driving while on these new drugs for the first 4-6 weeks! That’s a pretty important detail to leave out, don’t you think?
In addition to being able to be on the lookout for serious side effects, which include dizziness, blurry vision, blindness, and bleeding stomach ulcers, being armed with this knowledge in advance has a huge impact on my overall health and comfort, and in my day to day life.
I don’t understand how my doctor can fail to mention that the drugs I’ve been taking since 2009 to control my juvenile arthritis cause extreme sun sensitivity (in the form of skin bronzing – which I now have) AND that it decreases vitamin B absorption (which could explain why I have been experiencing so much hair loss since having to double my medication this summer.)
Interestingly enough, I started weekly injections for my inflammatory arthritis in 2018. I received no training on how to inject myself at my hospital. A nurse basically showed me once and send me on my merry way. The anxiety and fear I faced having to inject myself the following week was real. I ended up finding some videos from Australia on how to inject my biologics.
As a veteran patient who is well educated on my disease and regularly attends global health summits, I am NOT a medical professional. There is no way for me to anticipate how some medications are going to interact with other medications, vitamins, and certain foods. The Internet, contrary to popular belief, doesn’t cover everything and information is often outdated. That said, I do track all my meds and supplements through a Drug Interaction Tracker, which was not available when I wrote this article in 2014.
Doctors in Taiwan should do more to work with their patients rather than against them.
I didn’t go to medical school, but I am an expert where my body is concerned. They should also do a better job of explaining these things in advance. Doing so gives the patient a point of reference to start with, but it also helps to instill trust and reliability with a health care provider.
There is a reason why chronically ill patients need to be their own advocate and why they need to be diligent about doing their own research. Over 26 million people suffer from autoimmune related illnesses in the US alone, and this is a perfect example of why I’m outspoken about my condition.
Drug Interaction Tracker: No matter what you see a doctor for in Taiwan, you should absolutely cross reference your meds and supplements so you are informed.
2015 AmCham Topics: Taiwan’s Medical Care At A Crossroads
“In addition, “there is currently discussion on whether foreigners should receive the same benefits as Taiwanese,” says Chu. “Some Taiwanese people believe that government subsidies should focus on people from our own country. Others think that regardless of nationality, as long as you live in Taiwan you should receive benefits.
The financial squeeze on the NHI system also has a direct impact on the types of treatments available to patients in Taiwan. Because of the low reimbursement prices the system offers, new and innovative drugs and medical devices often enter this market much later than in other countries.”
Note from Carrie: As of August 2022, foreign permanent residents of Taiwan who own businesses here, who employ locals, and who have invested decades of their life here, DO NOT qualify for the same benefits as Taiwanese. There is no road to full citizenship for foreign permanent residents either. As for the second point, as of today, there is still a direct impact on the types of treatments available to patients in Taiwan. Taiwan’s NIH has a step therapy policy which means patients are forced to try older medications for six months or more before they can move on to the next therapy. Rather than providing patients with treatments that might get them back into the workforce and participating in life here, this decision ensures many patients suffer for years and also suffer the adverse side effects of trying multiple drugs that take a toll on their health and well being.