a q&a with fellow tsaiwei cheng

Tell us about your role at MAHEC and how you've seen it transition from your first year to your second year of service?

My first year at MAHEC has actually been full of all kinds of transitions. I was trained at the main campus first, then transitioned out to the Enka Satellite for my fellowship position. For my medical assistant role, I room patients by getting their vitals, histories, and chief complaint. I am able to complete certain labs such as urine analysis, urine drug screens, A1c, lipid panels, and conduct EKGs and NSTs. My community role is around Hepatitis C care. I helped my clinic’s Next Step Clinic develop and later maintain our HCV registry to help keep track of patients and their treatment progress. Another component of what I do for HCV care is helping uninsured patients get their HCV medications for free from the manufacturer via the Patient Assistance Program. Now that I am a second year, I am looking forward to getting trained in phlebotomy soon! 

Now that COVID-19 is among us, I have transitioned back to the main campus and am learning new skills in scribing and assisting in our Lower Level Clinic This change from providing longitudinal care to acute point of care has actually further confirmed my desire to work in primary care settings in the future. 

Has this experience in any way changed or challenged your values or preconceived notions about primary and rural healthcare?

Before this fellowship, the only clinical experience I had was shadowing. I thought that family medicine was not very exciting because I saw so many of the same issues over and over-- hypertension, diabetes, edema, etc. While those are still very prevalent health issues, being a part of the care team to care for patients battling those health problems actually turned out to be more rewarding than just watching someone examine and connect with those patients. I found myself getting excited with the patients when they get their A1c checked. They tell me how hard they have been working in making lifestyle changes as we anxiously wait for the lab. We cheer together when it comes back as improved.

Tell us about the people you've met during your service that have impacted you.

First things first, I wouldn’t be a MedServe Fellow without our education program director, Amanda Greene. I first met Amanda from my MAHEC summer internship back in 2015, and later, I reached out to her to ask about getting clinical experience. That’s how I even knew of MedServe’s existence. Amanda has always been there to listen and offer words of encouragement and wisdom to keep me going. 

The teams I work with at MAHEC have not only taught me so much about being a healthcare professional in a clinical setting, but they are also like my cheerleaders. One of the interesting phenomena I have come across as a MedServe Fellow in the WNC region is how people with very different backgrounds in culture, religion, and beliefs can come together and be a tight work family. From a physician resiliency project, we found that having a shared mission is a factor in resilience. To hear and write about it was one thing, but to actually experience it is different. The team here truly showed me how much of a team sport healthcare is. 

Countless patients have impacted me in my first year of MedServe. There was this one male patient that we saw in the HCV clinic, we’ll call him Tyler. He was one of those patients that was referred to us only for HCV care, rather than to establish primary care. Halfway through Tyler’s HCV treatment, we found out that he had died from suicide. We never administered the complete PHQ9 with him, just the PHQ2 from the new patient intake form. Perhaps completing a PHQ9 would not have changed anything, but I’ll never know. My brother passed from suicide in 2016, and I have always wondered if his battle with depression would have been different had we established primary care and completed PHQ9s routinely in appointments. Maybe then someone would have noticed how much his condition fluctuated. Tyler’s suicide reminded me of how important it is to remember why we do these screening tools. They are not just another set of clicks in the EHR so we can check off a box in our QI measures. They are life-saving tools. 

What has your experience been like scribing and working in the COVID clinic?

Hot and busy. It’s been a learning experience for sure. Every day is a new adventure with new policies and guidelines. My favorite analogy is from our nurse practitioner who said, “we’re building the airplane as we’re flying it”. Patients look to us for guidance and leadership. I think it’s hard to be a healthcare provider and not know the answers. It’s also what keeps the job interesting. 

Whenever I see patients that I know from pre-COVID-19 days from the satellite office, it’s like seeing old friends. For example, there was one patient that I had connected with based on our single-dog parenthood. We saw her in the COVID-19 clinic recently, and she was so excited to show me pictures of her all grown up puppy. 

The pandemic is the epitome of the phrase, be a humble sponge. I have learned to be flexible and just meet whatever unmet needs that are around. It has given me a larger perspective of how problematic the healthcare system status is in this country. Every day I see new ways in which a person’s zipcode or socioeconomic status is a predictor of their health. Except in the case of a pandemic, when one community member suffers, the whole community takes the hit.

When not in the clinic, how do you spend your time in WNC?

Pre-COVID-19, I spend my free time doing things like going to the farmers market, hiking, and mountain biking. I also was volunteering with the Buncombe County Child and Family Services. At MAHEC we do see a number of kids in welfare custody, and I have always wondered how the bigger system works in this type of social service. My role was to sit in on what they call child family team meetings as a non-paid party without any interest in either party’s side. On Fridays, some of the other MedServe Fellows in the WNC area and I used to have biweekly “Pay Day Fridays”. We would go get food, enjoy happy hour or some kind of get together. 

Currently, I spend a lot of time tending to my foster animals and garden projects like my own bed in my apartment community garden, my balcony garden, and the MAHEC garden. I use my bathroom as the “kitten quarantine room”. My current bottle baby kitten actually lives in a 65L Rubbermaid storage tote, so he doesn’t even take up a whole room. Fostering the tiniest little lives given me a lot of hope, joy, and sense of purpose outside of work. It’s also good companionship for my dog, Schpoozi.