Three weeks have gone by, and it´s starting to feel like I just got here. I have really enjoyed the past week in the clinic. Similar to my experience during my Internal Medicine rotation third year, I find it much more gratifying to participate in the prevention of disease and the maintenance of health in an outpatient setting, than to drown in the frustration of inpatient medicine with patients who have already passed the threshold of salvaging their quality of life. I like the idea of preventing hospitalizations and enabling patients with chronic disease to live a full and healthy life. And that is certainly what is done in the HIV clinic. With the limited resources available in the hospital and the discrimination against patients with HIV by the inpatient attendings and hospital administration, it is in the patients´ best interest to stay out of the hospital. Over the past week I have seen several patients following up as an outpatient after having been treated in the hospital for diseases such as Toxoplasmosis, PML, Disseminated Histoplasmosis, Cryptococcal meningitis, and of course, TB. I was able to see a patient in follow up that I had cared for during my first week on the hospital floor who had herpes zoster of the first branch of the trigeminal nerve (right forehead and right eye) with bacterial superinfection of the cornea - he looked great, and was only complaining of some itching around the healing skin wounds.
Something that I learned this week that blew my mind was that all admissions to Hospital San Juan de Dios are free. All medications while inpatient are free as well. X-rays are free, food is free. The only thing that requires payment is CT scan, since the CT scanner is not owned by the hospital, but rather by an outside company. After all the complaining that I have done in regards to the quality of care at the hospital, the fact that they are able to provide free care to all patients is pretty amazing.
And for some follow up on the trivia question in a previous post (the man with the rash that itched). A punch biopsy was performed, and it demonstrated lymphocitic and eosinophilic infiltration consistent with insect bites. So, we gave him treatment for scabies, which is most likely the insect causing his rash. Congratulations to Dr. Jen Genuardi from Delaware who emailed me her diagnosis of Norwegian scabies!! She won the trivia question of the day.
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Norwegian scabies? What the heck are Norwegian scabies? Why do I feel that everything in dermatology is not what we learned in school. The scabies I learned about had nothing to do either with huge flaky rashes or forearms, legs, and buttocks. Booo!
I am disgruntled.
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