Internal Medicine at SKMCH&RC, Lahore
The Department of Internal Medicine at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Lahore offers Critical Care Service, Endocrinology, Gastroenterology, Cardiology, General Internal Medicine, Infectious Diseases, Nephrology, Neurology, Orofacial Pain and Headache Service, Palliative Medicine, Pulmonary Medicine, Psychiatry services, and a Comprehensive Health Care Clinic.
The Division of Cardiology offers both Transthoracic and Transoesophageal Echocardiograms. In addition, this division conducts Exercise Tolerance Tests and Cardiology Clinics.
Comprehensive Health Care Clinic
The Internal Medicine Department runs the Comprehensive Health Care Clinic, which provides screening services for common medical conditions. Qualified consultant physicians conduct this clinic.
The hospital’s Critical Care team consists of qualified critical care physicians, respiratory technicians, and nursing staff. Together, they supervise and manage the Intensive Care Unit (ICU) and the High Dependency Unit (HDU) of the hospital. These units are equipped to provide services of mechanical ventilation and invasive monitoring.
The Division of Endocrinology provides comprehensive management of diabetes mellitus and all complications associated with the disease. It also manages patients with thyroid and parathyroid disorders, pituitary diseases including pituitary tumours and hypopituitarism, adrenal disorders and hypogonadism, as well as osteoporosis.
The Division of Gastroenterology runs daily consultant-led clinics for patients presenting with gastrointestinal disorders.
SKMCH&RC, Lahore is a tertiary referral centre for cirrhosis, in particular for patients with primary liver cancer or hepatocellular carcinoma. Our consultants are well-versed in innovative and comprehensive therapies, including complications of cirrhosis, as well as, relatively uncommon hepatobiliary procedures such as detailed below (in Endoscopy section). The multidisciplinary team of medical, surgical, and radiological specialists at SKMCH&RC work closely together to diagnose and treat all types of liver diseases and disorders.
The hospital houses a purpose-built, state-of-the-art Endoscopy Unit, providing diagnostic and therapeutic endoscopy facilities with the latest video-scopes and recording systems. International standards of cleaning and sterilisation of equipment are followed to ensure patient safety. Our computerised reporting system ensures that a permanent record of all procedures performed is maintained.
Our team of gastroenterologists offer the following endoscopy services:
- Upper Gastrointestinal Endoscopy
Diagnostic and therapeutic Oesophago-Gastro-Duodenoscopy (OGD) including dilatation, polypectomy, banding, metallic stent placement, Argon Plasma Coagulation (APC) therapy and Percutaneous Endoscopic Gastrostomy (PEG) placement.
- Lower Gastrointestinal Endoscopy
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 or pancreatic stone removal, as well as, stent placement (plastic and metallic).
- Spyglass Cholangioscopy
- Endoscopic Ultrasound (EUS)
- Diagnosis and staging of oesophageal cancer
- Diagnosis and staging of pancreatic cancer
- EUS-guided Fine-Needle Aspiration (FNA) of mediastinal masses/lymph nodes
- EUS guided pancreatic mass FNA
- EUS-guided aspiration of cystic lesions
- EUS guided aspiration of peri-rectal masses.
Under the supervision of consultant physicians and hospitalists, the Division of Hospital Medicine runs general medicine clinics for patients with a full range of general medical issues, including diabetes, hypertension and other chronic conditions, as well as those needing preoperative medical screening. SKMCH&RC is also recognised by the United Nations for medical examination of its employees, for both pre-employment medical screening, as well as, for the evaluation of general medical conditions. Our clinics are used by various external organisations for pre-employment and annual medical surveillance of their employees, as well.
The Division of Infectious Diseases offers inpatient and outpatient consultations for diagnosis and treatment of a wide range of infections caused by bacteria, viruses, fungi, and parasites.
Our team is equipped to manage meningitis, pneumonia, bloodstream infections, heart valve infections, device infections, joint/bone infections, complicated wound infections, urinary tract infections, enteric infections such as typhoid and infectious diarrhoea, tuberculosis, ophthalmic and Ear, Nose, and Throat (ENT) infections. At SKMCH&RC, we are also able to cater to infections in immune-compromised patients as well as those with malaria, dengue, and other topical infections. Aside from these, we also investigate and provide treatment services for fever of an unknown origin, transplant or surgery-related infections, HIV, and sexually-transmitted diseases. Our division also administers travel medicine and immunisations, and hospital-based antibiotic infusions.
Our team consists of infectious disease specialists and fellows. Our division offers a College of Physicians and Surgeons, Pakistan (CPSP) accredited fellowship training programme in infectious disease, which eventually leads to FCPS. Residents from the Internal Medicine Department rotate through all our sections. The Hospital also has an active infection control team.
The Division of Nephrology provides comprehensive assessment and management of both inpatients and outpatients presenting with kidney issues. Our nephrologists offer quality care to patients with acute kidney injury, including tumour lysis syndrome, and chronic kidney disease receiving cancer treatment. We also provide preoperative assessments and counselling for renal replacement therapy (RRT) in patients undergoing radical nephrectomies or extensive urological surgeries. The Intensive Care Unit at SKMCH&RC is equipped to provide acute dialysis and continuous venovenous haemofiltration facilities as well as plasma exchange, or plasmapheresis services. Similarly, outpatient services cater to a wide variety of patients who present with renal and metabolic issues.
The Division of Neurology conducts two outpatient clinics each week. It provides a comprehensive clinical assessment for various neurological disorders.
Our pulmonology team consists of qualified pulmonologists that provide interventional pulmonology and critical care services. Currently, we conduct bronchoscopies with lavage and biopsy, transbronchial biopsies, laryngoscopies, pleuroscopies, foreign body removals, endoscopic bronchial ultrasound (EBUS) and EBUD guided aspirations, and pulmonary function tests.
The service provides 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 and similar other disorders. Alongside clinical psychologists, a consultant psychiatrist is dedicated to providing mental health liaison service to assess and manage complex mental health problems for patients admitted to the hospital.
Orofacial Pain and Headache service
The division of Orofacial Pain and Headache provides a thorough and comprehensive diagnostic and therapeutic care to patients with headache disorders (migraine headache disorders, tension-type headaches, or cluster headaches), musculoskeletal disorders (myalgia, myofascial pain, or temporomandibular disorders (TMD), cervical myalgia), neuropathic pain conditions (trigeminal neuralgia, burning mouth syndrome, or atypical odontalgia), and other painful conditions, which may affect the head, face, jaw, and neck region.
In addition, we provide care to patients with benign oral lesions (lichen planus, fibroma, or pyogenic granulomas), Sjogren syndrome, and lesions associated with Graft-Versus-Host-Disease, as well as, post-cancer therapy-related illnesses such as oral or oropharyngeal mucositis, nerve damage, and trismus.
This division offers the following intervention services:
- Local anaesthetic nerve blocks (with or without corticosteroids),
- Trigger point injections,
- Botulinum toxin injections (Botox),
- Intra-taut band injections,
- Intra-joint (TMJ) injections,
- Chemical neurolysis,
- Dental orthotic devices for TMD and obstructive sleep apnea,
- Minor salivary gland biopsies, and
- Soft tissue biopsy of benign oral lesions
TRAINING OPPORTUNITIES FOR PHYSICIANS
SKMCH&RC is dedicated to training the next generation of medical leaders. In the Internal Medicine Department, we offer the following postgraduate training programmes:
FCPS in Internal Medicine
The four-year FCPS in Internal Medicine is recognised by the College of Physicians and Surgeons Pakistan (CPSP). Teaching within the department is a mix of classroom-style lectures and hands-on teaching at the bedsides of patients or in clinics. The classroom lectures consist of case-based discussions, journal clubs and exam-oriented multiple-choice question-based teaching.
The Internal Medicine Department also provides training geared towards the MRCP (UK) examination. Trainees preparing for the examination 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 before their PACES exam.
Fellowship in Infectious Diseases
The two-year Fellowship in Infectious Diseases, a CPSP-accredited programme, imparts training to fellows regarding clinical infectious diseases in both inpatient and outpatient settings as well as through rotations in microbiology. SKMCH&RC caters to an extensive range of infections, both in otherwise healthy and in immunity compromised patients. Elective rotations in other quality institutions are a mandatory part of the programme.
Fellowship in Gastroenterology and Hepatology
A three-year Fellowship in Gastroenterology and Hepatology is a CPSP-accredited programme that provides fellows with rigorous training in the various aspects of gastrointestinal, pancreaticobiliary, and liver diseases, including extensive experience in endoscopy.
After completing their residency in Internal Medicine, fellows are enrolled in the programme for Fellowship in Gastroenterology and Hepatology. 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 gastrointestinal endoscopy, fellows are trained in advanced gastrointestinal procedures including diagnostic and therapeutic endoscopic retrograde cholangiopancreatography, endoluminal stenting, and other such techniques.
Fellowship in Pulmonology
The Division of Pulmonary / Chest Medicine at SKMCH&RC, Lahore is a part of the Department of Internal Medicine and sees a wide variety of patients with cancerous as well as non-cancerous conditions including tuberculosis, Interstitial Lung diseases, Asthma, COPD, Bronchiectasis, pleural and infective lung diseases in immunocompetent as well as immunocompromised individuals. SKMCH&RC, Lahore offers a three-year dedicated fellowship training programme in Pulmonary/ Chest Medicine, recognised by the College of Physicians and Surgeons Pakistan (CPSP), which will lead to FCPS in Pulmonary/Chest Medicine.
At the end of the programme, fellows are expected to perform interventional procedures independently including flexible bronchoscopies with bronchial washings, endobronchial and transbronchial biopsies, endobronchial ultrasound examinations with fine-needle aspiration (EBUS -FNA), medical thoracoscopies with pleural biopsies, chest drain insertion (Seldinger and Trocar technique), thoracocentesis, and indwelling pleural catheter insertion. In addition, they will get the experience to perform rigid bronchoscopies, tumour debulking using APC (Argon Plasma Coagulation), and tracheal/bronchial stent insertion under direct supervision.
Fellowship in Endocrinology
We have a state-of-the-art endocrine service available at SKMCH&RC consisting of both US and UK trained and experienced endocrine consultants. The service runs on average, eleven endocrine clinics per week, and it is 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. The endocrinology fellowship training programme is approved by the College of Physicians and Surgeons Pakistan (CPSP).
Fellowship in Critical Care
The SKMCH&RC, Lahore has a fifteen bed Intensive Care Unit, which includes four High Dependency Unit (HDU) beds. All of the ICU beds are equipped with ventilators which are run by experienced Critical Care Consultants. A three-year critical care fellowship programme is being offered at SKMCH&RC, recognised by the College of Physicians and Surgeons of Pakistan (CPSP). It includes comprehensive training in all aspects related to critical care.
The Department of Internal Medicine runs specialist palliative medicine clinics. SKMCH&RC is a pioneer in the development of physician-led services in palliative medicine in the country and also has the distinction of being the only hospital which has been approved for second fellowship of two years in palliative medicine by the college of physicians and surgeons of Pakistan (CPSP).
Patients needing symptom management for terminal as well as chronic conditions are seen in the palliative medicine clinic and appropriately managed as inpatients or outpatients as necessary.
Palliative medicine clinics are multidisciplinary with specialist nurses, psychologist, nutritionist and physiotherapists working in tandem with the physicians to provide holistic patient care.
TOACS and Physical Exam Series
On alternate Fridays, our fellows teach internal medicine trainees practical clinical and physical examination skills to help them prepare for the TOACS exam. Special mock TOACS exams are held quarterly, in-line with the pattern of the CPSP examination to help trainees prepare for the exams.
PACES Preparatory Course
The Department of Internal Medicine offers a PACES preparatory course to prepare the candidates for the PACES component of the MRCP (UK) exam. The salient features of the PACES preparatory course include essential history taking and communication skills. Critical ethical issues are discussed in accordance with current UK laws. On the second day of the course, a full mock exam is held to simulate the actual clinical PACES clinical stations, with actual patients.
Advanced Cardiac Life Support Course
Training in both Basic Life Support (BLS) and Adult Cardiac Life Support (ACLS) is arranged monthly, in accordance with the guidelines of the British Heart Association.
Clinical observer positions or electives are offered at the Department of Internal Medicine at SKMCH&RC, Lahore to provide insight into the day-to-day responsibilities of physicians in their respective specialities. This is an excellent opportunity for medical students or fresh graduates to observe patient care practices under the direct supervision and guidance of consultants.
Observer positions are offered for four weeks. During these four weeks, students get the opportunity to rotate through general Internal Medicine and sub-speciality out-patient clinics (Pulmonology, Gastroenterology, Palliative Care, Infectious Diseases, Endocrinology, Psychiatry, and Cardiology) and to participate in inpatient rounds and to observe consultations. They also rotate through the Emergency Assessment Room (EAR) and the Intensive Care Unit (ICU).
As a part of medical / speciality teams, students participate in all clinical and teaching activities of the respective team that they are assigned. A schedule of daily activities, as well as orientation to relevant policies, is provided to all the students at the time of commencement of their attachment to the Department.