Programs which see the largest path spectrum

[fedor]

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Are Cook (now Stroger), Bellevue, and Charity considered to be the programs which see the largest path spectrum or are they just the most famous programs among the lay public?

 

[FoughtFyr]

I don't know about the lay public's perception, but we see a very wide variety here at Mayo. About 10% of our ED traffic comes from either self referrals to the clinic (to the PMDs out there, stop telling your patients that they can get a clinic appointment "faster" if they show up at our ED!) or patients who "fall out" while accompanying others to the clinic. We get another small, but very interesting sub-population from those who deteriorate during their scheduled transfers to the clinic for treatment.

- H

 

[FlemishGiant]

Although I did not personally see this... How's this one for path: One of my buddies who was rotating w/ me at the time at LA County+USC had his senior resident told him to look in a patient's ear, but not to "disturb" anything. So he did and his patient's ear was (as my buddy said it), "I sh#t you not, a mushroom patch. Head, stalk and all!"
I'm a little baised, but I think that you see more interesting path working at places where patients tend not to take such good care of themselves, ie. County places. USC, Cook, Bellevue, Parkland, wherever: County=Fun.
FG

 

[NinerNiner999]

At Hopkins we see arguably the most diverse pathology in the nation. Our downtown (inner city/county) ED sees the urban/low SES/poor health maintenance population, our outside community hospitals (Bayview and Howard County) see outer city and suburban pathology (really sick, high acuity), and Shock Trauma manages major traumas from the entire state area.

 

[southerndoc]

I think any program with >75,000 visits annually will see enough path.

Academic programs get more tertiary care stuff and the zebras, but keep in mind that academic centers primarily see routine ER stuff that the county hospitals see.

There are stupid people everywhere, so it doesn't take just a county hospital to see this.

 

[FoughtFyr]

There are stupid people everywhere, so it doesn't take just a county hospital to see this.

Amen! Thanks to methamphetamine, we are seeing stabbings, GSWs and beatings; yes, even up in the Great White North. The only difference here is that our patients are more honest (either that or "these two dudes" or "some guy" don't know how to get here). Not too long ago I asked a GSW patient "what happened?"; I realize that I should have known better than to even ask. But his answer floored me. He said, "I deal meth. These two guys I know, Dave S**** and Steve T**** (names made up by me) came over and said 'Give us your money and all the meth you have!' I said 'f**k you' and walked away so they shot me and took the stuff." I almost passed out in surprise!

- H

 

[southerndoc]

One of our residents did a rectal on a GSW patient. When they rolled him and told him what they were going to do, he said "you'll have to take out the cocaine packs first."

 

[Apollyon]

One of our residents did a rectal on a GSW patient. When they rolled him and told him what they were going to do, he said "you'll have to take out the cocaine packs first."

Got you one better - and this is a true story - during the rectal, the patient squirms, struggles, reaches behind, and pulls the baggie out of his ass. He then rips it open, and eats as much of the cocaine as he can.

 

[GeneralVeers]

Although I did not personally see this... How's this one for path: One of my buddies who was rotating w/ me at the time at LA County+USC had his senior resident told him to look in a patient's ear, but not to "disturb" anything. So he did and his patient's ear was (as my buddy said it), "I sh#t you not, a mushroom patch. Head, stalk and all!"
I'm a little baised, but I think that you see more interesting path working at places where patients tend not to take such good care of themselves, ie. County places. USC, Cook, Bellevue, Parkland, wherever: County=Fun.
FG

Agreed. The pathology at county hospitals is much more interesting than at tertiary facilities. If you can get past the smell of most of the patients, you get to learn about really rare diseases, and really serious forms of common illnesses.

 

[Sheerstress]

I too, would agree. I saw a decent amount of pathology during my years in Kalamazoo, but saw much more advanced and unusual disease when I rotated at Cook County's ED in Chicago.

 

[EctopicFetus]

I rotated at county this yr and saw some absurd stuff. I dont have the experience of some of the people on this thread but it was my 3rd EM rotation and the stuff at county was much stranger than things you see elsewhere. On one of my shifts we actually got a call from someone claiming to be the red cross and they said they were sending 70 Katrina victims. Turned out to be a hoax, cops got involved and thats just the stuff on the side.. Not even the actual patients.

 

[OSUdoc08]

Are Cook (now Stroger), Bellevue, and Charity considered to be the programs which see the largest path spectrum or are they just the most famous programs among the lay public?

I bet you that Texas Tech-El Paso has a pretty large path spectrum (or so I've heard from residents) due to the hospital caring for the large population of El Paso AND Juarez, Mexico.

Preventive health care is lacking in this population, as you can imagine, leading to all sorts of zebras.

 

[beyond all hope]

Is best at programs that rotate through a diverse set of hospitals.

Sure, county hospitals see a lot of untreated pathology, but having a transplant patient with a med list as long as your arm (and compliant) and at least five regular doctors who take care of him/her is a very different beast. Also I've noticed county hospitals tend to see less enormous MIs than community hospitals. Also the entitled patient (very common at community hospitals) who knows the CEO of the hospital and will talk **** about you if you don't suck up to them (and the five others who SAY they are friends with the CEO, etc).

In some ways, the crazy untreated pathology is easy to deal with. It's the mixed pathology scenarios that throw a wrench in the mix. How do you treat a severly hypothermic coagulopathic dialysis patient? Not warmed fluids, and hold off on your chest tubes. Just an example. Sure, you can poke your county patients a hundred times for your central line, but what about the entitled patient?

I think spectrum of pathology is overrated. All patients are unique. I'm sure no matter where you'll train, you'll eventually see it all.

 

[peksi]

All right, a program for our plug here in DE!

I have worked at a few reisdency programs and residency affiliated hospitals. That being said, still, the pathology at Christiana Care continues to amaze me. our outside trained new faculty, and fellows ,who all have trained at well respected programs consistently are in awe of the pathology they see on a daily basis!

You would think that DE as such a small state would have little to offer medically or for education, but this is sooooo far from the truth.

140,000 ED visits between only two hospitals, a large tertiary community, and an inner city ED, over 3,000 traumas per year, 150 aortic dissections per year, 1500 AAA's per year and averaging 2 ruptured AAA per month eek: . Door to balloon times of 60 min. Thousands of intubations, central lines, reductions, CPR's concious sedations etc per year.

All with a hopsital that is expanding to over 1200 IP beds and an expansion to Christiana's ED that makes it over 80 bed, has a passive patient tracking system, scanned ED charts for online review within 12 hours of the ED visit as well as the same private/academic group that has been there since 1968!! Talk about history!

The reality is that it has of the sickest patients I've seen with more bread and butter than yoy can shake a stick at due to our volume!

Plus all goods including short carbon chained beverages are TAX FREE in DE!!

Just thought i'd lay it our there. I think the issue for many applicants is once they get to look at Christiana, they are very glad they did! Mind you, this is not the place for someone looking for a cushy program, or a 40-60K volume ED.

Paul

 

[GeneralVeers]

All right, a program for our plug here in DE!

I have worked at a few reisdency programs and residency affiliated hospitals. That being said, still, the pathology at Christiana Care continues to amaze me. our outside trained new faculty, and fellows ,who all have trained at well respected programs consistently are in awe of the pathology they see on a daily basis!

You would think that DE as such a small state would have little to offer medically or for education, but this is sooooo far from the truth.

140,000 ED visits between only two hospitals, a large tertiary community, and an inner city ED, over 3,000 traumas per year, 150 aortic dissections per year, 1500 AAA's per year and averaging 2 ruptured AAA per month eek: . Door to balloon times of 60 min. Thousands of intubations, central lines, reductions, CPR's concious sedations etc per year.

All with a hopsital that is expanding to over 1200 IP beds and an expansion to Christiana's ED that makes it over 80 bed, has a passive patient tracking system, scanned ED charts for online review within 12 hours of the ED visit as well as the same private/academic group that has been there since 1968!! Talk about history!

The reality is that it has of the sickest patients I've seen with more bread and butter than yoy can shake a stick at due to our volume!

Plus all goods including short carbon chained beverages are TAX FREE in DE!!

Just thought i'd lay it our there. I think the issue for many applicants is once they get to look at Christiana, they are very glad they did! Mind you, this is not the place for someone looking for a cushy program, or a 40-60K volume ED.

Paul

I still think MLK has you all beaten. You'd be hard-pressed to find a poorer (and stranger) group of people than in South Central. They stick crack in every orifice possible, and assault each other with every weapon concievable.

 

[bartleby]

"Beyond All Hope" has a great point in the post above. While the depth and expansiveness of human freakishness and cruelty is breathtaking, it really has nothing to do with learning to be a good doctor. Exposure to a wide range of pathology in a _variety of clinical environments_ is key. Where I went to med school, I didn't see any non-cocaine induced MI's. As 90%+ of EP's aren't going to work in a hardcore inner city environment one needs to consider that there is a whole other set of skills which are key to your success in the community. For starters, admitting patients requires more than calling the MOD (medicine admitting resident). You need to learn to move patients and keep an ED running when there's no hand coverage and the general surgeon on call ain't coming in at 3am to do a consult and there are eight people still waiting to be seen.

Don't misunderstand me... I think that the inner city experience has a great deal to contribute to any resident's education. But it's only one piece of the puzzle. In my opinion, residencies which offer both a community and inner city experience are optimal.

 

[EMIMG]

One program which perhaps does not have the names of the other programs, but sees a tremendous amount of acuity is Sinai-Grace Hospital (one of Wayne State University's Program).

They tend to be the busiest trauma center in the city of Detroit. The acuity is intense and the clinical experience is very in depth.

On the interview trail, ask the residents to see their procedure logs. The amount of procedures the residents do at SGH will be very impressive. And, it is intern year when they get many of their first exposure.