Gastroenterology at King’s County Hospital, New York
As we all know, the United States has been on the forefront of global health, and it was my desire to witness health care in such a setting. So in my final year of medicine I decided to pursue my electives there.
The Hospital
Kings County Hospital Center (KCHC) is located in Brooklyn, New York and was founded 175 years ago. Over the decades, Kings County has claimed many “firsts” in the field of medicine: it was the site of the first open-heart surgery performed in New York State; Kings County physicians invented the world’s first haemodialysis machine, conducted the first studies of HIV infection in women and produced the first human images using magnetic resonance imaging (MRI). In addition, Kings County has the world-renowned first Level 1 Trauma Center in the U.S.
Today, with over 627 beds, the hospital provides a wide range of health services, and specialties are offered in all fields of modern medicine. More than 200 clinics provide a wide array of ambulatory care services. An affiliation between Kings County Hospital Center and SUNY-Downstate Medical School has enhances the clinical, as well as the academic activities of both institutions.
Shaukat (left) outside Kings County Hospital
Speciality: Internal medicine (Gastroenterology)
My Elective Experience at KCHC
I had an excellent experience at Kings County Hospital. My daily routine was from 6:30 am to 5:00 pm. On reaching the hospital I had to see the consults placed in the system, had a quick review of the patient record then went to the patient’s bedside and took complete history and performed physical examination. Then I had to write down the notes in the computer and put it in the medical record system, for which I was given a password. Meanwhile I had discussions of my cases with fellows and residents. I am greatly thankful to Dr. Ziyad Wadi and Dr. Parakh Pallav who familiarized me with the electronic medical record system and always gave me valuable input. Then we had discussion with attending physician. My attending was Dr. Adam Goodman, the Director of Endoscopy. I presented cases to him and he always encouraged my effort. Then we had a sign out round by the whole team. Besides this we also had pathology and radiology conferences twice weekly.
During my elective, I learned the evaluation and management of patients with wide variety of GI problems such as upper and lower GI bleeding, hemorrhoids, hepatitis, alcoholic cirrhosis, peptic ulcer disease, oesophageal carcinoma and acute pancreatitis. I learned the recent advancement in determining the severity of acute pancreatitis. Early intensive care to the patients of acute pancreatitis is very important in preventing complications and it is only possible if the severe disease is diagnosed early. The recent test is the dipstick test, which quickly identifies the increased urinary Tripsinogen Activated Peptide (TAP) which is the easier way to diagnose the severity of disease rather than cumbersome Ranson Criteria.
I was also able to see various routine GI procedures such as endoscopy, colonoscopy and PEG placement. I still remember an interesting case of a 27 year old man came with GI bleeding, his Hb was 9 g/dl and spite of several blood transfusions, his Hb level was not rising. Our team reluctantly decided to go for colonoscopy as he was actively bleeding. Unfortunately, during the procedure his intestine got perforated (although risk of intestinal perforation is very rare, about 0.88 in 1000 procedures) so we immediately called the surgery team and it was successfully repaired.
I learned that being a doctor sometimes you have to take risky decisions in the interest of patient but patient should be kept aware of all the risks and benefits involved. Another important thing I observed is the difference in the learning style among the students of Pakistan and the US. In Pakistan, students are confined to learning their text books, but in US everybody seemed so up to date with the latest protocols and developments hence clinical medicine and research intermingle beautifully in the US. Research is an essential aspect of medical student’s career, this elective has helped me to set a new approach towards learning medicine.
Shaukat and Dr. Adam Goodman
Social Life
Besides gaining knowledge and clinical skills, another important benefit of the electives is that you meet students from all over the world. You make friends and your social circle increases, especially when you are living in New York, then you must hang out with friends on weekends. As King’s County Hospital is in Brooklyn, you must visit the places worth seeing in the area such as Brooklyn Bridge, Brighton Beach, Brooklyn Museum, Botanic Garden and New York Aquarium.
The Brooklyn Bridge
My Advice to Others
Register yourself on the first day to get ID. I recommend this elective to all those students who are interested in Gastroentrology and Digestive Diseases, you will certainly benefit a lot from this but remember that it is up to you how much effort you put from your side to gain knowledge. Try to participate in research, prepare presentations, actively participate in discussions and clinical rounds and you will get a good letter of recommendation from the attending physician. Don’t forget to take your evaluation at the end of elective and last but not the least do enjoy your weekends and explore New York.
New York Aquarium, Brooklyn
General Comments
Since doing elective, I have developed great interest in Gastroenterology. My rotation was a great experience for me; it increased my clinical knowledge and skills. I enjoyed the team work with residents and fellows and I will remember this good time throughout my life.
Shaukat Bashir is a final year medical student at Allama Iqbal Medical College in Lahore, Pakistan.
shaukat_sial(at)hotmail.com