In this issue of AUBMC News, we are featuring the Outpatient Department at AUBMC. We would like to thank chairpersons of clinical departments for their input and acknowledge the help and contribution of Dr. Mahmoud Choucair, director of the Outpatient Department, and Ms. Hanadi Masalkhi, RN,MSN, towards the completion of this article.
The Outpatient Department (OPD) at the AUBMC has been playing a prominent role in providing medical care for all people in Lebanon and the region. Patients receive the best quality medical care at minimal fees. The Department also supports the educational and clinical training of medical students and housestaff (residents and fellows) within the ambulatory health system. It collaborates with the AUB School of Nursing and LAU Pharmacy to facilitate the training of their students.
A team of attending physicians, residents and fellows, and nursing staff caters to the needs of patients on a daily basis. In most departments, patients are seen Monday through Friday. The OPD offers a unique opportunity for third-year medical students to have their own patients and take part in their follow up. The student is normally assigned a new patient whom he attends to, which entails performing a physical examination and a detailed history before presenting the findings to the attending physician on a one-on-one basis. Patients then return for follow-up and continuity of care. This process not only creates a strong relationship between the student-physician team and the patient, but it also leaves an indelible mark on the students who value one of their first experiences in patient care.
Needy OPD patients may be referred to the Social Services Department for financial help from a number of funds, mainly the Women’s Auxiliary Association fund, the Brave Heart Fund, and the Mamdouha El Sayyed Bobst Fund.
The availability of greater financial help would enable more patients to be treated at AUBMC OPD. Furthermore, it would make their admission to the inpatient setting more affordable, whenever needed. During the year 2008-09, the number of patient visits to the Outpatient Department was 29,861.
The OPD Dermatology at AUBMC provides premium quality and invaluable services for skin care in health and disease. Its patient-friendly facilities are located on the second floor of the AbouKhater Medical Arts Facility (Building 23). These clinics are staffed by highly qualified dermatologists who are specialized in either one of the subspecialties namely dermatopathology, dermatologic and cosmetic/laser surgery, and phototherapy. In addition, a hair and nail center has been established to offer patients specialized care in diseases of the hair and nails. The spectrum of care provided to patients ranges from banal skin diseases such as acne, psoriasis, eczema among others, to the more complicated and difficult-to-treat conditions such as birth marks and genodermatoses. The total number of patients seen in OPD Dermatology during the years 2007-08 and 2008-09 was 4727 and 5604 respectively - a growth rate of 16 percent - which is one indication of the superior quality of service in the Department.
OPD Family Medicine
The OPD of the Department of Family Medicine or the “Resident in Training Clinic” was founded in 1979 as part of the Faculty of Medicine five year academic development plan. Establishing the Family Medicine program was considered a priority in order to satisfy training and accreditation requirements. The program was the first of its kind in the Arab world and was designed by a task force headed by Dr. Haroutune Armenian and Dr. Caesar Shediak, with help from Drs. Vincent Hunt from Rhode Island and Hiram Curry from Medical University of South Carolina among others. Dr. Shediak was recruited as the first department chair to implement the program. The vision was to change general practice in Lebanon from basic curative care to care with a social, preventive, and psychological perspective. The “family doctor” had to have a “bio-psychosocial” perspective to the care of each individual and be well trained in common ambulatory medical problems. The Department has maintained the number of its residents at around six per year. After its inception, numerous changes were introduced by Drs. Marius Chaghoury, Samir Sidani, Ghassan Hamadeh, and Mustafa Khogali. The most recent changes were implemented by Dr. Bassem Saab who, in his capacity as program director, reformed the program with the help of Dr. Umayya Musharrafieh to include systematic training for both students and residents in communication skills, doctor-patient relationship, medical ethics, informatics and used objective structured clinical examinations as final graduation certification exams.
Currently the Family Medicine resident in training clinic is integrated in the Family Medicine Clinics along with the private self pay practice and the pre-paid University Health Services practice. The three clinics operate on the ground floor of Building 56 as one unit with the OPD managed by the Family Medicine residents and their preceptors who are always available to supervise and assist them. The Family Medicine Residents are trained and prepared to manage common physical, emotional and chronic disease conditions, as well as provide counseling and advice regarding disease prevention and health promotion for all age groups. They offer routine well baby and child care, adolescent and adult medicine, geriatric care, women’s health, family planning, and minor surgery.
OPD Internal Medicine
On a normal day, between 40 and 60 patients are received at the Internal Medicine Outpatient Department (OPD Med) on the fifth floor, Phase I of the Medical Center. Patients are admitted to the appropriate specialty depending on the presenting symptoms. Furthermore, they may be referred to other OPD Departments (Ophthalmology, Otolaryngology, Gynecology, Psychiatry, Dermatology) if needed for specialized treatment at OPD rates. The OPD Med has gained popularity due to word-of-mouth of patients and their families, who while maintaining a loyal following to the Department, also spread the word of the high quality treatment they receive there.
The OPD Med also includes specialty clinics where patients are followed up by all the subspecialties of Internal Medicine (rheumatology, gastroenterology, hepatology, endocrinology, geriatrics, nephrology, cardiology, pulmonary, neurology, and hematology/oncology). Moreover, patients are provided holistic care in the Diabetes Clinic where they are followed up by a specialized team on diabetes management, including dieticians.
Visiting doctors in training from various medical schools in Lebanon and the region have also witnessed the proceedings at the OPD Med at AUBMC, an experience that has proven to be memorable for them. Medical students and physicians from Europe and the United States visit the OPD Med where they spend a month of elective enjoying a stint at the Department.
The OPD Med has also played a role in various research studies within the Faculty of Medicine, the Faculty of Health Sciences at AUB, the Clinical Research Unit at AUBMC, as well as the School of Nursing.
The OPD Med is actively involved in community education where informative health-focused lectures are presented on a regular basis. In another step towards increasing community awareness on health and medical issues, the Department marked Osteoporosis Week with bone densitometry studies free of charge for OPD patients. Patients were also presented with educational material to increase their awareness on osteoporosis.
The OPD Med exemplary services to the community were further demonstrated during the July 2006 war, when hundreds of displaced patients were treated at AUBMC after being screened at OPD Med by the nurse and referred to the appropriate service. A budget was allocated to the displaced people and victims of war. Their treatment continued well into 2007 when a decision was made to continue with the outpatient and inpatient programs for the people who suffered from the July war. Overall, some 5000 patients were treated from the war emergency fund. Moreover, the Department of Internal Medicine has established a Volunteer Outreach Clinic at the Palestinian refugee camps that helps in referring patients in need of medical attention to the OPD.
The efforts of the OPD Med over the years have not gone unnoticed, with the American Nurses Credentialing Center's (ANCC) Magnet Recognition Program making note of the Department’s hard work during the war, the special community services that are being provided, as well as the multidisciplinary efforts that ensure the best quality patient care. Numerous appreciation and recognition letters have been sent to OPD Med staff and its administrator from patients, medical students, visiting doctors, and housestaff.
OPD Obstetrics and Gynecology
The OPD in the Department of Obstetrics and Gynecology at AUBMC has a long history of caring for the health needs of women. Whether a woman comes in for a routine gynecological examination, is preparing to give birth, or needs treatment for conditions of the reproductive organs, the OPD offers an outstanding breadth of services and options. Pregnant women with significant risk of birth defects are offered prenatal testing. Amniocentesis, chorionic villous sampling and genetic counseling services are available for patients, as well as for referred high risk patients. The opinions of multiple sub- specialists are sought in an effort to provide each patient and her family all the information they need to make the best choices for the mother, baby, and family. The Department works to ensure that each patient receives highly personalized, seamless care. Problematic cases are presented in a weekly Morbidity Conference to get consensus on the optimal therapeutic courses of action. The recommended program of care, complete with follow-up is outlined and coordination with the referring doctor is observed. Pregnancies that are associated with risk factors are seen on a special OPD day for intensive ante partum care with feto-maternal medicine subspecialists and medical consultants.
Special subspecialty clinics referrals are seen on separate days; hence, infertility/gynecologic endocrinology patients are seen following referrals from general OPD patients on two days every week. A full range of diagnostic and therapeutic facilities for the care of the infertile couple as well as patients with complaints related to gynecologic endocrine dysfunction are conducted. In addition a state of the art In Vitro Fertilization Unit (IVF) provides the full range of assisted reproductive technologies to an average of 70 couples per month. Likewise our gynecologic oncologists perform colposcopies and biopsies and discuss the management and care of cancers of the reproductive tract with residents and students once weekly. Patients with gynecologic urologic complaints are investigated by a battery of testing tools to determine their optimal management.
The OPD services provide the residents and students a unique opportunity and exposure to women’s reproductive health issues. The hands-on experience in OPD is essential for student and resident education. They learn that gynecologic assessment is an integral part of every woman’s general medical evaluation. They appreciate the significance of establishing an effective physician-patient relationship. In addition, it helps them build core knowledge of the common diseases encountered in obstetrics and gynecology and the cost-effective methods of diagnosing them, as well as the evidence–based support for managing them. The OPD service is currently located on the seventh floor of AUBMC Phase I.
The setting of the Ophthalmology OPD, currently located on the seventh floor of AUBMC Phase I, was originally inspired from the Iowa University Ophthalmology clinics where a good number of the senior staff had completed some training in the past. Typically there is one chief resident who runs the clinic and handles cases that require surgeries inside the eye; a second year resident helps the chief resident in administrative issues and also manages extra-ocular surgical cases. Two first year residents handle non-surgical cases. From 8:00 am until 1:00 pm, a comprehensive Ophthalmology clinic goes on every morning staffed by two to three attending physicians. Sub-specialty clinics are run in the afternoon where a specialist attending physician is consulted followed by a teaching session. An average of 40 patients are seen and handled throughout the day.
OPD Otolaryngology-Head and Neck Surgery
The OPD in the Department of Otolaryngology-Head and Neck Surgery, currently located on the sixth floor of AUBMC Phase I, is an essential and key part of resident and student education. Clinics are divided into subspecialties (otology, pediatric, sinus surgery, head and neck, facial plastic and laryngology) and covered by a faculty member. All cases are considered teaching cases and discussed with the covering faculty after presentation. At the end of each clinic, a lecture with pertinent discussion is given by the faculty to the residents and students. The limiting factor as a surgical clinic remains the availability of more ward beds. Hopefully, these will expand in the future.
The Outpatient Department of Pediatrics and Adolescent Medicine is located on the sixth floor of AUBMC Phase I and offers its patients a unique combination of medical skills in the field of pediatrics and adolescent medicine.
Patients’ age ranges from a few weeks to 21 year olds. Adolescent patients are seen in OPD Adolescent clinics whereas younger patients are seen in Pediatric clinics. 3000 visits are made annually from remote areas of the country as well as from the Greater Beirut area. The General Pediatrics clinics are run daily by two pediatricians who deal with the walk-in patients and decide if referrals are needed to subspecialty clinics.
The OPD medical team is composed of the third-year medical students and two house staff (an intern and a chief resident) working all together, under the supervision of the OPD director. The OPD Pediatrics staff has been serving its patients for many years with great dedication and care.
There are 14 subspecialty clinics in OPD Pediatrics covering major areas in pediatrics: nephrology, neonatology, endocrinology, infectious diseases, cardiology, neurology, cerebral palsy, developmental, pulmonary, allergy, hematology-oncology, inborn errors of metabolism, genetics, gastroenterology and nutrition.
The OPD at the Department of Psychiatry offers a unique clinical and learning experience for medical students and residents rotating in the Department. Psychiatry OPD first started as part of the internal medicine OPD, but later became an integral part of the Department of Psychiatry with the establishment of the Department in 1993.
A few years later, and with the recruitment of more faculty members, the OPD grew to encompass more subspecialties in adult and child psychiatry and psychology. OPD also moved to the third floor of Building 56, with the move of the department’s offices and private clinics.
The OPD presently runs on a daily basis in the afternoon, with the following subspecialties: adult psychiatry, adult psychology, child and adolescent psychiatry, and child and adolescent psychology. It is staffed by active medical staff and/or clinical associates on a daily basis. The OPD rotation constitutes a major part of the Med III students psychiatry clerkship and offers the following services to patients: psychiatric evaluation of adults and children, psychotherapy, and psychological/cognitive testing.
The OPD Surgery Unit, currently located on the fifth floor of Phase I of AUBMC, provides healthcare services to the community. There are seven specialty clinics in OPD Surgery covering the following areas: general surgery, vascular surgery, general pediatrics, neurosurgery, orthopedics, plastic surgery, and urology. In addition, the OPD physicians perform “Removal of Sutures” every day from 8:30-9:30 am. Patients identified to require surgical interventions may have their procedures scheduled depending on their pathology, OR time availability, and insurance status at AUBMC, Najjar Hospital, Rafic Hariri University Hospital and Mount Lebanon Hospital.