Tuesday, April 26, 2011

doenças infecciosas

being that i was able to spend some time in the infectious disease (doença infecciosa ), aka “ID,” department of hospital são joão, i came to realize that there’s not such a big difference after all between medicine in america and medicine in portugal. as it is, i’ve spent time with three infectious disease teams, each very distinct in its own regard. those three being: med team k at unc hospitals (chapel hill), the ID department at madigan army medical center (MAMC—fort lewis, tacoma), and most recently doenças infecciosas at hospital são joão. it’s very interesting that each department works very differently, whether it be from being military versus civilian or american vis-à-vis european (portuguese specifically).

in chapel hill, when i was with the infectious disease team, med team k was a medicine team. we rounded on patients in the mornings, we went to morning report daily, we did any work that needed to be done during the day, and we admitted patients on our call days, as the medicine department was on the long call – short call system (if you don’t know what that means, don’t worry about it). afterwards, the attendings went to clinic, if they had clinic, or they did whatever else they had to do. we didn’t solely admit infectious disease patients to our service; since we shared the floor with the pulmonary department, and since unc is a tertiary care center, we also managed quite a few cystic fibrosis (CF) patients. while we saw patients with COPD exacerbations, patients with CF exacerbations, and patients with cellulitis and/or osteomyelitis, our most interesting and most prevalent patients were our HIV/AIDS patients. these patients comprised the bulk of our patient population, and they presented with some of the more interesting cases.

out at MAMC, the ID department was completely different. ID was still apart of medicine, but worked more or less independently of the medicine department. there at madigan, there were only 3 attendings: the head of the department and two other doctors. one of the doctors was in charge of seeing and following up consults and the other doctor was in charge of seeing patients in the clinic. as opposed to having a maxed-out to maxed-out plus service everyday, as was the case at UNC, the ID department at MAMC had only a few patients per day in clinic (vast majority was HIV/AIDS management), as well as a few patients per day as consults/follow-ups. it was grand. the hours were great, i was able to do a lot of reading, and i received one-on-one lectures daily, as i was the only student on the service.

here at hospital são joão, there was a larger team of doctors dedicated to the infectious disease department, more comparable to that of UNC. there were a couple of doctors on the wards, and there were a few doctors in clinic. i had the opportunity to see both sides of the department. in the clinic i worked with dra. carmela (who was actually of spanish origin), the doenças infecciosas department at hospital são joão was typical, as infectious disease departments go. the vast majority of patients were there for HIV/AIDS management; however, the clinic setup was the same as the other ambulatory clinic setup for portugal, with all patients coming directly to see the doctor in her office. on the wards i worked with two residents: one who was a resident at hospital são joão and the other from another hospital but who was doing an ID rotation there. what was interesting about the wards here was that since portugal has a higher TB patient population, we were managing more TB patients. i had to walk around all morning with an n-95 mask, as i had not been vaccinated against TB, as the rest of the team had been. 

i find the fact that portugal has a higher prevalence of TB peculiar because, thinking of western europe of which portugal is apart, i wouldn’t think of portugal as a higher risk area, as we usually think sub-saharan africa and southeast asia. nevertheless, the entire iberian peninsula is an area of increased (moderate) risk of tuberculosis infection, on par with the majority of the south american continent, and we learn in medical school, as americans, that originating from a south american nation is a risk factor for TB infection. also of note, portugal has the highest prevalence of HIV-TB coinfection in western europe, with rates as high as those found in southeast asia.

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