I have spent my second week here at St John’s Hospital in Dermatology. In the morning we start rounds on inpatients at 9AM. We round with the interns (actual 5th year Med Students), a resident or 2, and faculty seeing patients assigned to Derm as their primary team as well as patients they are consulting on. On Monday we saw severe Psoriasis, Pemphigous vulgaris, a curious case of vasculitis with muscle weakness?, and the most severe case of septic shock in the ICU I have seen in my short medical career. It was though this last patient was suffering from Staph aureus toxic shock syndrome which only occurs 10% of the time in males. On rounds, the faculty heavily “pimp” the interns and residents on pathophysiology, signs/symptoms, and treatments of dermatologic diseases. They don’t ask us questions but are happy to answer any we have for them. It is actually quite difficult to understand what is going on with most patients as the interns/residents speak very quietly, it is a loud hospital, and although they use English there is still a thick accent. Also, on rounds I have seen the newly built air-conditioned section of the hospital for which patients pay an extra daily fee to stay in. It was pretty empty when I saw it. One day we had sit-down rounds that made me feel like I was in a movie like Shutter Island, or A Beautiful Mind. The patient was brought into a closed room and told to sit down in a chair in the middle with us surrounding them. We then talked about the patient usually in English which the patient may or may not have understood and asked them to show us their backs, stomachs, legs, or even to walk across the room while we assessed their gait and skin. Very strange, but the patient was informed of the plan afterward if there were any changes and they were always very willing to show us their skin findings.
In the afternoons, after a team coffee break, we are in outpatient Derm clinic. There are 5 clinic rooms assigned to Derm. Some have 2 physicians seeing patients simultaneously so HIPAA is not in strict practice here. In 4 hours, one of the physicians saw 22 patients (5.5 patients an hour) which she stated was a “slow day”. You can compare this with the Family Med I worked with in MN who saw 37 patients in 10 hours (3.7 patients an hour) which was considered the maximum amount a doc at that clinic could see. Therefore, it is extremely efficiently run with the Derm docs knowing within 1-2min of the patient entering the room what the diagnosis was and usually being able to write a prescription and finish with the patient and the note within 10min. The docs have a keyboard of sorts on which they press the number assigned to the next patient to be seen. This number appears with a beep sound on a screen outside the door so the patient knows he or she is up next. I have seen multiple times patients entering without their number appearing and being quickly ushered out back to the waiting area. I have also seen the docs become inpatient multiple times and continuously bang on the beep button until the patient comes in. Things must run quickly here!! At the same time the doc is seeing one patient, a previous patient who was sent to the lab for a blood test or to buy a prescription will return to the doctor and interrupt the new patient’s visit to sort out his business first. This all sounds extremely chaotic, and it is, but really it is controlled chaos.
At the end of the day, clinic is over at 2PM, drug representatives come in one by one to present information on their latest drugs available for patients. This would absolutely never be allowed in the U.S. Here, the docs may not always want to hear what the reps have to say but they are always very attentive and open to listening. Also, sometimes they get free samples which can be given to patients. So there’ s a plus too.
Thus far in clinic I have seen: Hansen’s disease (Leprosy), Eczema of all severities, multiple skin sun reactions, arsenic keratosis from arsenic poisoning, contact dermatitis, psoriasis, pemphigus vulgaris which is closely followed for some reason, Tinea, pityriasis versicolor, cellulitis, acne (everyone hates acne), and skin graft follow-up. I have been very excited to have the opportunity to see some diseases I may never get to the chance to see at all, or to the severity I have here, again.
In the afternoons, after a team coffee break, we are in outpatient Derm clinic. There are 5 clinic rooms assigned to Derm. Some have 2 physicians seeing patients simultaneously so HIPAA is not in strict practice here. In 4 hours, one of the physicians saw 22 patients (5.5 patients an hour) which she stated was a “slow day”. You can compare this with the Family Med I worked with in MN who saw 37 patients in 10 hours (3.7 patients an hour) which was considered the maximum amount a doc at that clinic could see. Therefore, it is extremely efficiently run with the Derm docs knowing within 1-2min of the patient entering the room what the diagnosis was and usually being able to write a prescription and finish with the patient and the note within 10min. The docs have a keyboard of sorts on which they press the number assigned to the next patient to be seen. This number appears with a beep sound on a screen outside the door so the patient knows he or she is up next. I have seen multiple times patients entering without their number appearing and being quickly ushered out back to the waiting area. I have also seen the docs become inpatient multiple times and continuously bang on the beep button until the patient comes in. Things must run quickly here!! At the same time the doc is seeing one patient, a previous patient who was sent to the lab for a blood test or to buy a prescription will return to the doctor and interrupt the new patient’s visit to sort out his business first. This all sounds extremely chaotic, and it is, but really it is controlled chaos.
At the end of the day, clinic is over at 2PM, drug representatives come in one by one to present information on their latest drugs available for patients. This would absolutely never be allowed in the U.S. Here, the docs may not always want to hear what the reps have to say but they are always very attentive and open to listening. Also, sometimes they get free samples which can be given to patients. So there’ s a plus too.
Thus far in clinic I have seen: Hansen’s disease (Leprosy), Eczema of all severities, multiple skin sun reactions, arsenic keratosis from arsenic poisoning, contact dermatitis, psoriasis, pemphigus vulgaris which is closely followed for some reason, Tinea, pityriasis versicolor, cellulitis, acne (everyone hates acne), and skin graft follow-up. I have been very excited to have the opportunity to see some diseases I may never get to the chance to see at all, or to the severity I have here, again.
This is the glass house at the Lalbagh Botanical Gardens a short tuk-tuk ride from the Annexe. It was a very beautiful and quiet garden area, popular for families, and with trees from around the world. It was actually pretty large with a man-made lake as well.
Here is a type if Ficus. Apparently both Sasha and my husbands like the word Ficus so I had to take this picture.
We are off to the world-renowned beach destination of Goa tomorrow. It is an overnight bus-ride starting tomorrow to our 3-day mini-vacation on the beach and we are ecstatic!! We have Fri off as a religious holiday so no, we are not skipping out ;)
Namaste!! -Abby
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