|Posted by vsig.vcu on June 23, 2017 at 5:10 PM|
It was a typical Tuesday clinic at the Veterans Affairs Hospital: 60 patients on the schedule being seen by two attendings, two interns, and several medical students in their clinical years.
Clinic was in full swing when I arrived, with the interns doing an initial interview and exam before presenting patients to the attendings, who would then go see the patient and make a final decision with regards to treatment, testing, and follow-up. All pretty standard, no matter what specialty the clinic belongs to. What seemed different to my eyes, at least, was the sheer acuity of problems the patients came in with, and the number of admissions to the hospital straight from clinic. In the first hour of clinic, three patients in a row were admitted to the hospital. The first was admitted for a constellation of symptoms (some vascular, some not), whose pain at a site of previous intervention concerning for claudication met the criteria for admission. The second came in to clinic status post a previous below the knee amputation with gangrene in his remaining foot. The third had also already had an above the knee amputation, and had a wound down to the bone on the toe of his remaining foot.
While shadowing in clinic, I also had a chance to see a critical component of the vascular practice: the vascular lab. This is where talented techs perform noninvasive imaging such as duplexes, dopplers, and ABIs to help monitor disease progression and determine optimal treatment plant.
Vascular surgery sees a sick population where, when something goes wrong, you don’t have time to wait weeks or days before treating. You don’t have to worry about filling up the surgery schedule in advance; it fills itself up (and quickly) when you’re admitting so many people from clinic. I was later told that for any given clinic, vascular surgery at the VA hospital will admit 10% of the patients they see in clinic that day.
President VCU VSIG