The days in HUP (Hospital of the University of Pennsylvania)    　M4 Female

 

From March 31 to April 25, I studied in HUP at the Division of Endocrinology, Diabetes and Metabolism as a visiting student. I met other two visiting students, one from Nagoya University and one from Taiwan. They were assigned to CHOP (Children's Hospital of Philadelphia) and we seldom meet at the hospital. However, all of us stayed at the International House by chance, we could exchange information and experiences. The International House is a kind of dormitory for international students, and I had an opportunity to be friends with students from many countries, such as Taiwan, China, India, and Korea. Some of them were studying or researching at Penn and some are studying at other universities. Although I’ll try to focus on what I experienced in the HUP, I want to mention that I learned as many things during the time I spent with them as in the hospital.

What I did in HUP                                               

The Division of Endocrinology has no floor for inpatients, and I spent most of the time in the outpatient clinic or inpatient consult rounds. The following is the schedule of a week.

 

	Morning	AM   9:00~12:00	Lunch	PM  13:00~17:00(18:00)
Monday		Clinic		Clinic/Consultation
Tuesday	Grand Round	Clinic		Clinic/Consultation
Wednesday		Dr. Sterling’s clinic and lecture	Conference	Clinic/Consultation
Thursday		Dr. Sterling’s clinic and lecture		Clinic/Consultation
Friday		Clinic		Clinic/Consultation

 

I didn’t have a chance to work up new patients as they are admitted, but I met patients with a wide variety of endocrine problems in the outpatient clinic and inpatient consult rounds. Sometimes I was left alone with patients and their family members in the examination room while waiting for doctors, and I used that time to converse with them.

 

Outpatient clinic

In the outpatient clinic, fellows first see patients by themselves and take a history. The fellow then get out of the examination room and present the patient to an attending. After that, they go back to see the patient together. This time, the attending talks with the patient and explains the disease and treatment. Because of this method, patients have to wait for a long time even after they are in the examination room. But patients seem to take this situation for granted. One of the patients told me that as long as she could get full attention from doctors and could use her time freely in the examination room, it’s worth waiting.

 

Consult rounds

Many of the consultations are about perioperative glycemic control, and some are about electrolyte abnormalities caused by thyroid, parathyroid, adrenal abnormalities, and pituitary dysfunctions. A fellow or a resident first see patients, and just like the outpatient clinic, they go back to see the patients again with an attending. I was amazed at how fellow doctors decode hand-written past records, pick up what is important and write their consult charts quickly. During diabetes consult rounds, I learned about the different types of insulin and how to combine them according to patient’s status and their eating habit. During endocrine consult rounds, I learned how to interpret and correct electrolyte abnormalities.

 

At the VA hospital

I was also given wonderful lectures from Dr. Sterling at the VA hospital, which is located near the HUP. Every Wednesday and Thursday, I went to the VA hospital to see his outpatient clinic. He is an elderly gentleman and retired already, but still working in the VA hospital voluntarily. While we were waiting for patients, and when we took a coffee break, he gave me lectures. His lectures begun with basic science, especially biochemistry, and he managed to make it all relevant to clinical conditions.

For example, when he explained me about bone metabolism, he began with vitamin D and PTH metabolism. It is only after his lectures that I realized how important basic science is to fully understand endocrine disorders. He asked me many questions to confirm that I really understood what he said, and if not, he explained it again from a different angle. He was a wonderful teacher, and I was so lucky to get private lectures from him.

 

General impression

The thing I noticed in the U.S. was that asking questions is highly recommended and you can get detailed answers to all the questions. For example, in the homepage for the first year students, they offer a lot of information to solve problems students might face with. There is a guidance of how to attend the lectures, how to choose books, and even how to find the right place to study. If it was in Japan, teachers might think students should find out such things by themselves. This “all the questions are welcome” policy is also found among the patients and doctors relationship. In the outpatient clinic, if patients and their family members ask questions, doctors give full information to all of them.

One day, during consult rounds, the fellow decided to change times of insulin injection of one of the patients from twice a day to four times a day. When his wife heard of it, she got really upset and asked why he had to suffer from such a pain. The fellow tried to calm her down, but in vain. I held my breath and watched what would happen next. The fellow never lost her temper and kept explaining to his wife about the benefit he would gain from the change. At the end, she understood and said thanks to the fellow. I admired that fellow’s attitude.

 

I’d like to thank all the teachers and doctors to help me realize my dream to study in the U.S.

Also thanks to my parents to allow me to go despite the war at the time.