The Division of Endocrinology sees slightly over 19,000 out-patient visits per year (including over 2,000 new consultations), without counting the Antenatal Diabetes Clinics (around 1,800 visits per year of patients with gestational diabetes). On average, 15% of out-patient visits are new patients. The in-patient service sees about 800 patients in consultation. Endocrine patients are admitted to medical or surgical wards, depending upon the admission diagnosis. Several out-patient clinics are organized to allow ample opportunity for teaching as detailed below.
Diabetes teaching comprises out-patient clinics and in-patient consultations. A Self-Management Education Program is run regularly by a multidisciplinary team directed by Dr. T. Kader . Trainees can actively participate in the teaching of insulin self-administration, capillary blood glucose monitoring, and diet counseling. The Gestational Diabetes Clinic is run jointly with the Department of Obstetrics and Gynecology by Drs. T. Kader, B. Sidler and A. Rizzo.
As noted above, teaching in out-patient General Endocrinology is available around the week. Dr. M. Tamilia runs a General Endocrinology Teaching Clinic that concentrates most of the new out-patient consultations to the Division. The number of patients seen at the clinic is maintained relatively low to allow time to see the new consults. Selected in-patients seen by the attending with the trainees are also channeled to this clinic for follow-up by the corresponding trainee. This clinic also provides the opportunity of seeing and then performing short dynamic tests (e.g. LHRH-, TRH-, ACTH- stimulation tests).
Thyroid diseases account for about 40% of consultations and feature both common thyroid issues as well as difficult problems both from inside and outside the institution. The Clinic is structured to allow time to review cases and the pertinent area of pathology, with immediate access to a collection of bibliographic and graphic materials. Trainees also have the opportunity of learning thyroid ultrasonography and fine needle aspiration, and examining with Dr. M. Tamilia and Drs. Alpert and Rochon (Department of Pathology) interesting cytology. Likewise, the Clinic allows on-site discussion of radionuclide scans and ultrasounds with Drs. Stern and Rush (Nuclear Medicine) and Dr. Pinsky (Radiology). There is also ample opportunity for trainees to join or conduct clinical and basic research projects.
A Thyroid Tumour Study Group meets on the third Wednesday of each month to discuss cases presenting diagnostic or therapeutic difficulties. These rounds have become highly popular among medical and surgical residents in addition to our own trainees. The Group is formed by Drs. B. Sidler, T. Kader and A. Rizzo (Endocrinology); Drs. Black and Heir (Surgery); Drs. Rush and Stern (Nuclear Medicine); Drs. Pinsky and Casoff (Radiology, Ultrasound); Drs. Alpert and Rochon (Pathology, Cytology); and Dr. G. Shenouda (Radiation Oncology). All documents (scans, ultrasounds, cytology, pathology, etc.) pertaining to a particular patient are reviewed on-site by the corresponding specialists with ample opportunity for discussion.
Two Calcium and Bone Metabolic Disease Clinics are each directed by Drs. M. Trifiro and A. Karaplis. Although the scope of these two clinics is the same, the emphasis of the former is osteoporosis and bone disease associated with rheumatic disorders and steroid-induced osteoporosis, whereas the latter concentrates on different mineral disorders, metabolic bone diseases, and post-menopausal osteoporosis.
A Lipid Teaching Clinic is directed by Dr. M. Schweitzer. This clinic concentrates the cases of more difficult management from both internal and external referrals. In addition to a clinic in Endocrinology (Thursday afternoon), another clinic functions on the premises of the Cardiology Division where Dr. M. Schweitzer follows patients with coronary artery disease within programs of secondary prevention.
The Neurosurgery team is directed by Dr. G. Mohr, who has a special interest and expertise in the management of pituitary tumors. Neurosurgical cases are seen jointly by this team and the Division of Endocrinology. A monthly Neuroendocrine Rounds conference has been instituted with the participation of these two groups as well as Radiology, Nuclear Medicine and Radiation Oncology, functioning in a manner akin to the Thyroid Tumour Study Group, described above.