Saturday, October 31, 2009

Let's get to work...

Monday, Oct 26 was my first day in the hospital. Dr. Basto left me an envelope at my residence in Campanhã, which I received upon my arrival. The envelope contained my ID badge for the hospital, and detailed directions on how to arrive, when to arrive, and who to look for upon arriving to the hospital. I had to be at the hospital at 9am, so I left my room at 8:15 to give me enough time. To get to the hospital I have to take the train to the center of the city (Trindade), there I change to a different line that takes me directly to the hospital.

The Medicine beds are on the 3rd and 4th floor. I was to go to the 4th floor. There I met my team: Dr. Pestana (attending), Mafalda (senior resident), Mara (intern), and Antonio and Rui (6th year med students). By 9am, they had finished rounding on their patients. Mara introduced me to the nurses caring for our patients, to the other medicine teams that share our work room, and she also gave me a brief introduction to how things work.
Here is a brief explanation:

Rounds start at 8am.
Our team sees all of the patients together as a team. The medical students ask the questions* and do the exam, while the residents supervise.
*Everyone on my team speaks English, but our patients do not. My team is very good at translating for me, and keeping me involved. I don't ask the questions, but I do the physical exams.

Our team works on the women's side of the medicine wards.
All of our patients are/will be female.
There are 4 teams on the 4th floor. 2 teams work on the women's side and 2 teams on the men's side.

Patient information
H&P, labs, imaging studies, etc can be found in the paper charts as well as on the electronic medical records on the computer.

After rounds, we go for coffee and discuss the plan for our patients.
My usual: A croissant with café pingado. The lady at the counter doesn't even ask me anymore, she already knows what I'm going to order!

New patients
The medical students do the detailed history and physical exam, and also write the report. The residents write the daily notes.

Between 11:30 and 12, we go downstairs for a snack break.
My usual: Pão cereal com queijo (Bread with cheese). Delicious.

7. Conferences
If there are conferences, we go.

8. Our day ends at 2pm.
Med student schedule for medicine rotation is M-F 8-2. I was told that Medical students do not take call, nor do they work in the hospital on the weekends. Medicine residents do take call and work on the weekends, but they are not to exceed 42hrs a week.

The rest of my first day was spent meeting people:
  • I met our patients (we only had 2)
  • The internal medicine professor for the medical students (I've forgotten his name)
  • Dr. Sofia Gramaxo (she is in charge of the international/ERASMUS/visiting medical students)
  • I met most of the Erasmus** students at a meeting later that afternoon
  • I also met a lot of other doctors and administrators, but I don't remember all of their names and what all of them do. BUT, I do remember that they were all very nice.
**ERASMUS (European Region Action Scheme for the Mobility of University Students) is a European student exchange program for students (and teachers) from the EU and a few other European countries. It's very popular, every year about 150,000 students across Europe take part. Dr. Gramaxo said that there are nearly 100 medical Erasmus students at U.Porto right now!

Our patients are on the 4th floor of the medicine wing. The rooms are large and open, and they each have about 8-10 beds that are pretty close together. My first thought was that this set up does not allow for any patient privacy. There are dividers that are placed when something (a procedure, changing a foley, etc) that requires more privacy is being done.
Mara and I talked about this, and she was surprised that at UNC there were private and semi-private patient rooms, and that the floors are not divided by gender. She could not understand how nurses can have more than one patient if the patients are separated in different rooms.
She gave me a different perspective on the room set up. She told me that they allow for the patients to talk to each other, look after one another, and also witness things that may happen to other patients (seizures, falls, etc) and tell the medical team what happened. HOW INTERESTING! I would never have seen it that way! Mara gave me a good example:

Last week, she had a patient who was admitted for heart block. The patient was instructed several times not to climb out of her bed. One night she suffered a fall. One of the other patients saw what happened and pulled the cord to call the nurse. When the medical team arrived, the heart block patient told the medical team that she doesn't remember what happened, but she thinks she just rolled off of her bed while sleeping. As she was saying this, the patient that pulled the cord and witnessed the event interrupted and told the medical team what really happened. She said that every night the heart block patient would wait for the nurse to leave, then climb out of her bed and wander around the room. Unfortunately, this time she wondered a bit too much and was not able to make it all the way to the bed before falling to the ground. Luckily she was ok.
So, the room set up can allow patients to help each other out, but it can also cause interesting situations. For example, we had a stroke patient that was discharged on Tuesday. Mara told me that after we finished informing her that she could go home that day, the patient in the next bed over (who belongs to the other team which is just a resident and attending) told her nurse that she is very angry because it was unfair that our patient could go home. It was unfair because from her point of view, our patient had 6 doctors, and she only has 2. So since our patient had 6 doctors, she was able to get better faster, and therefore go home earlier.
I think it's fair to say that there are pros and cons to every system, and just because something is different doesn't mean it is better or worse. I think it's the differences that make things interesting!

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