The Department of Internal Medicine provides a complete range of diagnostic and therapeutic facilities for adults. Our team of accomplished consultants, fellows, resident doctors and support staff allows us to offer a multidisciplinary treatment plan in conjunction with other departments at the Hospital to all patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC). We also offer postgraduate training in General Internal Medicine and post-FCPS fellowships in Gastroenterology and Infectious Diseases.
Facilities & Services
Comprehensive Health Care Clinic
The Department of medicine runs comprehensive health clinics. These clinics provide screening services for the public and are run under the supervision of consultant physicians from the Department. Patients can choose a package of tests according to their age, sex and pre-existing medical conditions. See more
Critical Care Service
SKMCH&RC houses state-of-the-art Intensive Care Unit (ICU) and High Dependency Unit (HDU) that offer facilities for mechanical ventilation and invasive monitoring. The critical care service is provided to our patients by a team of fully qualified staff consisting of respiratory technicians, ICU nurses, and critical care physicians.
We have a state of the art endocrine service available at SKMCH&RC consisting of US/UK trained and experienced Endocrine Consultants. We are involved in the care of a variety of endocrine related diseases, including but not limited to diabetes, thyroid disorders, thyroid cancer, pituitary diseases, adrenal disorders, osteoporosis and hormone replacement therapy in both cancer and non-cancer patients. We are supported by comprehensive diagnostic services including radiology, nuclear medicine and pathology. We are also running a robust endocrinology fellowship training program which is approved by College of Physicians and Surgeons Pakistan (CPSP).
The Department runs daily consultant-led clinics for Gastroenterology disorders.
- Liver Diseases
The Hospital is a tertiary referral centre for primary liver cancer or hepatocellular carcinoma. The Hospital is also a referral centre for cirrhosis and its complications, in particular for patients with liver cancer. Consultants are well-versed in innovative and comprehensive therapies for liver disease including complications of cirrhosis.
Medical, surgical, and radiological specialists cooperate closely to diagnose and treat all types of liver disease and disorders including liver tumours. The staff has extensive experience with relatively uncommon hepatobiliary procedures including resection of biliary tract cancer, resection of liver cancer, radio-frequency ablation of liver cancers and chemoembolization of liver tumours.
- Endoscopy Services
Shaukat Khanum Memorial Cancer Hospital and Research Centre provides state of the art diagnostic and therapeutic endoscopic facilities. The purpose-built endoscopy unit provides facilities for all endoscopic procedures and is fully equipped with the latest video-scopes and recording systems. A computerized reporting system ensures a permanent record is maintained of all procedures performed. International standards of cleansing and sterilization of equipment are followed to ensure patient safety.
- Upper GI Endoscopy (oesophago-gastroduodenoscopy)
- Diagnostic and therapeutic OGD including dilatation, polypectomy, banding, metallic stent placement, argon plasma coagulation (APC) therapy and percutaneous endoscopic gastrostomy (PEG) placement
- Lower GI endoscopy (colonoscopy)
- Diagnostic and therapeutic colonoscopy including polypectomy, dilatation, argon plasma coagulation (APC) and metallic stent placement.
- Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
- Diagnostic and therapeutic ERCP including biliary / pancreatic stone removal and / or stent placement, both plastic as well as metallic.
- Endoscopic Ultrasound (EUS)
- Diagnosis and staging of oesophageal cancer
- Diagnosis and staging of pancreatic cancer
- EUS-guided FNA of mediastinal masses/lymph nodes
- EUS guided pancreatic mass FNA
- EUS-guided aspiration of cystic lesions
- Diagnosis, imaging and endoscopic drainage of pancreatic pseudo-cysts
- Other Tests / Procedures
- Small bowel enteroscopy
- Liver biopsy
- PEG tube change
General Internal Medicine
The Department runs general medicine clinics under the supervision of consultant physicians / hospitalists. These clinics see patients with the full range of general medical issues, including diabetes, hypertension and other chronic conditions, as well as those needing preoperative medical screening. External organisations also use these clinics for pre-employment as well as annual medical surveillance of their employees.
The department is also recognized for medical examination of United Nations employees, for both pre-employment medical screening as well as for evaluation of day-to-day medical conditions.
The infectious diseases service is recognized for training leading to the FCPS in Infectious Diseases. The scope of services offered by this division includes, but is not limited to:
- Febrile neutropaenia.
- HIV infection
- Infections in immunocompromised and transplant patients
- TB and drug resistant TB
At SKMCH&RC, nephrology service provides comprehensive assessment and management of people with kidney problems in a variety of settings. The Department offers a number of education and training opportunities that include regular renal teaching programme for residents in training, renal continuous medical education (CME) activities and monthly Renal-Histopathology Multi-disciplinary team meeting.
- Inpatient Services in Nephrology The inpatient services at the Hospital include:
- Care of people with acute kidney injury (abrupt decline in kidney function) including Tumour lysis syndrome
- Care of people with chronic kidney disease (CKD- reduced kidney function) receiving treatment for cancer
- Pre-operative assessment and counselling for renal replacement therapy (RRT) in people undergoing radical nephrectomy/ extensive urological surgery
- Acute dialysis and Continuous veno-venous haemofiltration facilities are available in ICU.
- Plasmapheresis (plasma exchange) services are available in ICU
- Supporting people with advanced renal failure on palliative care
- Outpatient Services in Nephrology
People with a variety of kidney diseases are assessed and treated in outpatient setting at the general nephrology clinics. Some examples include:
- Diabetes and kidney disease
- Hypertension and kidney disease
- Management of chronic kidney disease
- Kidney stones and related CKD
- Management of people with an existing kidney transplant and immunosuppressant monitoring
- Management of CKD- mineral bone disease (e.g. hyperparathyroidism, vitamin-D deficiency)
- Care of people with specific forms of kidney disease such as Glomerulonephritis, Vasculitis, Haemolytic Uraemic Syndrome, Lupus and kidney disease, inherited and familial kidney diseases.
- Education and Counselling of people with End Stage Renal Failure (ESRF) regarding Renal Replacement Therapy
- State of the art facilities such as radiological guided dialysis catheter placement (Permcaths) and Ultrasound guided native and transplant kidney biopsies are performed
The Department runs three neurology clinics each week.
Orofacial Pain and Headache Service
The SKMCH&RC Orofacial Pain and Headache service provides a thorough and comprehensive diagnostic and therapeutic care to patients with various types of non-cancer and cancer-related pain disorders that may affect head, face, jaw, and neck region. In addition, this service provides care to patients experiencing cancer-therapy related conditions such as mucositis, nerve damage, and trismus.
The Department runs specialist palliative medicine clinics. SKMCH&RC is a pioneer in the development of physician-led services in palliative medicine in the country. Patients needing symptom management for terminal as well as chronic conditions are seen in the palliative medicine clinic and appropriately managed. These clinics are multidisciplinary, in concert with our highly trained physicians.
The Department has full-time pulmonologists providing pulmonology and critical care services. We run an interventional pulmonology service offering:
- Bronchoscopy with lavage and biopsy
- Trans-bronchial biopsy
- Foreign body removal
We provide inpatient and outpatient psychiatry services which are run on a daily basis by two Consultant Psychiatrists trained in UK alongside trained clinical psychologists. Daily clinics help deal with psychological distress associated with diagnosis and treatment of cancer. We also provide a full range of mental health diagnostic and management services for both adults and children for illnesses such as depression, anxiety, psychosis, dementia, personality disorders, ADHD, drug addiction etc. Alongside clinical psychologists, our full time consultant psychiatrist is dedicated to providing mental health liaison service to assess and manage complex mental health problems for patients admitted to the hospital.
Training Opportunities for Physicians
SKMCH&RC is dedicated to training the next generation of medical leaders. We offer the following postgraduate training programs for physicians
FCPS in Internal Medicine
The Department of Internal Medicine is an approved training site for residents in an FCPS Programme as per requirements of the College of Physicians and Surgeons of Pakistan. Three mandatory rotations are offered within the Hospital during the four year residency programme, including medical oncology, intensive care and gastroenterology. Teaching within the department is a mix of classroom style lectures and hands on teaching at the bedside or in the clinics.
The classroom lectures consist of case-based discussions, journal clubs and exam-oriented MCQ teaching.
The Department also provides training geared towards the MRCP (UK) examination. Trainees preparing for the MRCP have the opportunity to attend the in-house PACES preparatory course and a course in the UK. Trainees in the past have been helped in securing observer positions in the UK prior to their PACES exam.
Fellowship in Infectious Diseases
This is a two year fellowship programme recognized by the College of Physicians and Surgeons of Pakistan (CPSP). Training is imparted in clinical infectious diseases in both in- and out-patient settings as well as by means of rotations in microbiology. The institution sees a very wide range of infections, both in otherwise healthy and in immunocompromised hosts. Elective rotations to other quality institutions are a mandatory part of the programme.
Fellowship in Gastroenterology
The Fellowship in Gastroenterology and Hepatology is a three year programme, accredited by the College of Physicians and Surgeons of Pakistan (CPSP). Our comprehensive programme provides fellows with rigorous training in the various aspects of gastrointestinal, pancreaticobiliary and liver diseases, including extensive experience in endoscopy.
Fellows are enrolled for a period of three years, after completing their fellowship in Internal Medicine. During the first year, fellows are engaged in clinics, on the wards and are expected to learn upper and lower GI endoscopy. Fellows have a dedicated session each week for research related activities and are expected to publish at least two research papers during their time with us. In the second and third years, in addition to upper and lower GI endoscopy, fellows are trained in advanced gastrointestinal procedures including diagnostic and therapeutic ERCP, endo-luminal stenting and so forth.
TOACS and Physical Exam Series:
On alternate Fridays, the fellows teach IM trainees practical clinical and physical examination skills to help them prepare for their TOACS exam.
Special mock TOACS exams are held quarterly in keeping with the pattern of the CPSP examination to help trainees prepare for the College examination.
PACES Preparatory Course
The Department of Internal Medicine offers a PACES preparatory course for the PACES exam. The course is aimed at candidates preparing for the PACES component of the MRCP (UK) exam.
The salient features of the PACES preparatory course include essential history taking and communication skills. Important ethical issues are discussed in accordance with current UK law. On the second day of the course, a full mock exam is held to simulate the actual clinical PACES clinical stations, with actual patients.
Training in both Basic Life Support and Adult Cardiac life Support is arranged on a monthly basis, in accordance with the guidelines of the British Heart Association.
The Internal Medicine Department takes great pride in providing excellent research opportunities to its trainees. Currently, our department is actively involved in multiple research projects and we support fellows and residents to present their results in various prestigious meetings both nationally and internationally. See research publications