I went to King’s College Hospital in London for my elective placement in the Gastroenterology department.
Kings is a large (>1000 bed) hospital in central London, and one of the major trauma hospitals for the city.
It is also a large transplant centre, and has patients filtering in from all over Europe.
As a result of Kings’ size, departments are super-specialised so that gastroenterology, hepatology, liver transplant, nutrition and colorectal are all managed as different departments with different teams, different consultants and different wards.
This was no barrier, as my supervisor arranged for me to attend other clinics and procedures that I was interested, while still giving me plenty of suggestions and time to explore London.
A typical week for me was similar to one on a medical placement in Canberra.
It involved shadowing the junior doctors on the gastro ward and rounding, attending outpatient clinics, observing scopes in endoscopy suite or sitting in on multi-disciplinary meetings (such as radiology, pathology, clinical trials and Inflammatory bowel disease biologics).
I was able to assist the JMO’s with their daily tasks (bloods, writing notes etc.) who were very accommodating and happy to teach.
The cases I saw were quite diverse, but the patients were complicated with multiple co-morbidities.
Typical cases on the ward mostly consisted of Inflammatory bowel disease diagnosis and management, coeliac disease, functional vomiting disorders, investigations for GI bleeding and nutritional optimisation.
Clinics also had lots of follow-ups for hospital admissions, chronic undifferentiated abdominal pain, peptic ulceration and Irritable Bowel Syndrome.
The wards had a patient population as ethnically diverse as the medical conditions were.
I observed that literacy seemed to be generally quite poor leading to late presentations and multiple comorbidities in the patient. Much like Australia, the patients were lovely and very happy to have their histories taken and to be examined.
The National Health System provides free healthcare to citizens of the United Kingdom but has become incredibly stretched in recent times and is now is substantial debt.
It was quite a discussion point in the hospital, frequently discussed in the newspapers particularly in the larger setting of Brexit.
The NHS demonstrates a developed counry’s healthcare system that has been stretched to its absolute limits, and it will be interesting to see if Medicare follows the NHS in the future.
One of the consequences of the NHS is that referral waiting times have blown out. To accommodate for this, alternative cancer pathways have been established to ensure that potential cancers are identified quickly so they can be managed, which provided another set of clinics to participate in.
While at Kings, I was able to participate in a couple audits, the first one correlating the radiology reports of upper gastrointestinal imaging with findings on endoscopy and pathological biopsies.
The second was looking at the rates of bloodstream infections in patients receiving parenteral nutrition.
The results were quite interesting, and it would be good to know how The Canberra Hospital compares.
In conclusion, Kings hospital in London is a highly specialised centre that has many students (elective and local) coming through its doors so is used to teaching.
The patients were socially and medically diverse and the hospital is doing some pretty amazing state of the art procedures that are well worth checking out.