Outpatient Department

The outpatient department (OPD) is where all the surgical services at TUTH conduct consults and follow ups. Each service has 2-3 / week at approx 2-3 hrs each. Clinics are crazy busy and I'm not sure there are appointment times. It seems everyone shows up for OPD X, register, and then cluster outside the door waiting to be called. So far I've been at OPD with GI team 3 and neurosurgery (which I just started with yesterday).

Within the clinic equipment is old and worn but familiar. Encounters proceed in the usual fashion: history, focused physical exam, and plan. Biggest change is that whereas at home there would be one exam room per patient, here 2-3 doctors would sit at one desk interviewing one patient each - there is no concept of confidentiality. Privacy is protected by a drape in front of the examination table.

As elsewhere in TUTH, cleanliness is lacking. There is a sink but I never saw it used. There is also no paper or sanitation of the examination table between patients. The one exception to this is a neurosurgery resident who carried hand sanitizer and was good about using it between OPD patients.

Desk in OPD. A doctor sits at each blue chair and each interviews a different patient.

Examination table

Pathology

In terms of pathology there is the same mix of hernias, gallstones and anorectal problems found within general surgery in Canada. Since the GI team also does minor procedures, lipomas and sebaceous cysts are also common.

Pathologies common here but rarer at home include:

- acute pancreatitis

- gall bladder cancer

- tape worm

- liver abscess

- tuberculosis and its systemic sequelae

- necrotizing fasciitis

- diabetes type 2 in people with normal BMIs

- extra hepatic portal venous obstruction. (which is considered a diagnosis here though I was unable to find mention of it in the western literature)

- infection in general