An overwhelming day...I think that sums it up. But I will share a few more details with you :) So to start I went to bed last night at 8:30 pm (with the help of a Tylenol PM) and slept until 7am. I had breakfest which included cereal with warm milk out of a bag. It actually wasn't too bad. I met up with my group and headed to the hospital around 9am.
The hospital is actually nicer (no cleaner) than I expected. It is quite large with a lot of different sections and a variety of services. I am on the general medicine ward. The medicine wards are spilt into two - female and male. I am currently on the male side. There are 60 beds on each side and there are two people in each bed. There are two teams per side - so that equals 60 patients per team. For my fellow residents in the USA - WAY OVER CAP :)
So the team leader is called the Registrar (he comes a couple of times a week) and we have two interns who pretty much do all the work. There is an attending, but they do not come very often from what I hear. Then there are a variety of medical students that come every now and then. Finally, there is me and a 4th year medical student from Indiana.
We rounded from 9am until 1pm. We walked from bed to bed and talked about (we didn't talk to the patients) and occasionally examined a patient. I quickly discovered that the are many limitations to medications you can order and labs/radiology you can get. A quick example...we have a patient that has rheumatic heart disease and suspected endocarditis (infection of the heart valve). They have been treating him for 4 weeks for endocarditis. On rounds I asked what bacteria they were treating. I discovered they cannot order blood culture and they were just treating him empirically for 6 weeks of IV antibiotics.
The other big difference here is that the patient has to pay for everything. You have to record every pair of gloves you use and they will be billed for it at the end of their hospital stay. They are not allowed to be discharged until they have paid their bill. They have guards at the doors to make sure the patients don't leave until they pay. If they can't pay then they don't get the procedure. We had a guy today with suspected gastrointestinal bleeding, he was vomiting up blood. He needed and endoscopy which costs $45. He is unable to pay for it at this time so he is going to go home and try to raise the money in his home town and get the procedure done as an outpatient. You really have to think about every little thing you order or use because the patient has to find a way to pay for it. Another patient has metastatic cancer and the Oncologist wanted us to order a CT scan of the abdomen. The Registrar said no because he knew the family had trouble affording food for their family.
Sorry if this seems a little depressing. If you read this blog you might have to get use to some sad stories. Hopefully there will be some success stories I can share too.
An overwhelming day, but I really liked it. I am going to hit the text books before bed to try and learn about all the crazy diseases my patients have.