Saturday, April 17, 2010

On the Wards

Hospital São João is the largest teaching public hospital in Portugal. It also trains residents in all medical and surgical specialties, except for emergency medicine (emergency medicine is not yet a separate specialty) your day will begin in the medicine units. There are 8 units, and 200 dedicated beds solely for the medicine staff. 4 attendings are attached to each unit. The medical units unlike in the United States are separated by gender. your day will start at 8 am and your team will be composed of a Senior Attending, a 6th year medical student, an internal medicine resident and a common intern. Unlike the United States, all residents regardless of a surgical or medical career do a common internship and rotate through all the major specialties, similar to a Transitional year stateside. Don't worry, most of the residents and attendings speak English. The patients usually do not speak English, but when you get acclimated to the wards, you'll pick up a lot of information. I am always asking my colleagues how to ask something or what certain phrases patients are saying, and they have been more then happy to help. Diseases are varied, from patients with glomerulonephritis, heart failure, pneumonia, stroke, etc... There are many similarities and differences in the day to day ritual of managing patients when thinking back on the rotations I did back in the States. In the mornings, our team collect vitals on each patient, discuss nursing notes from the night, perform arterial blood gases as needed, and complete a review of system and physical exam (called observation here). My job on the team was to do the physical exam, and report to the team my findings and whether they have changed since the last exam. I find that physical exam are relied on to a larger degree than stateside, and the residents here are really good at picking up subtle signs. After our morning physical exam and review, we head down to get a snack in the ground floor. There are several coffee/pastry shops in the Hospital with really good options. The coffee is really good, but there will be no Starbuck sizes. If you ask for coffee (café) you will get an espresso, you can also try a café pingado (coffee with a drop of milk), or Meia de leite (half coffee, half milk). The pastries and bread items are all good. I am attempting to try most of them. When you come definitely try the pastel de nata, a very typical Portuguese pastry, and the folhados (literally meaning leaves), which will be stuff with all kinds of goodness. After our break, we check the electronic system to get labs/ x-rays that were ordered on all patients. We also review the patients medicines and determine which ones to keep or to remove. You will usually leave the hospital at 2pm along with the medical students, which gives you plenty of time to travel and sightsee.