Royal Victoria Hospital Endocrinology Division Yearly Statistics (2006):
- Out-patient consultations...1792
- Out-patient follow-up visits...16201
- In-patient consultations...734
As at the other teaching hospitals at which the Endocrinology Program is based, the trainees’ time is shared between seeing patients at the clinics described below, and performing in-patient and Emergency Department consultations, and following patients on the wards.
The Metabolic Day Centre directed by Dr. M. Sherman remains a pioneer in diabetes out-patient care in Canada. It is by far the largest of the ambulatory clinics in the Endocrinology Division. While most diabetes education centers conduct patient education over a four to five day period, the MDC is unique in providing continuous treatment and education in an out-patient setting. The multidisciplinary approach allows for a continuous input from physicians, nurses, dieticians and educators to improve the clinical care of the patient. Thirty to forty diabetic patients are seen daily by various physicians. A Diabetes Teaching Clinic directed by Dr. J. Yale and others, held on Wednesday mornings, sees new and interesting referrals and provides the follow-up of complex diabetic problems and formal teaching to residents.
The Lipid Teaching Clinic is directed by Dr. M. Sherman. It provides diagnosis, treatment and follow-up for around 170 new patients and around 1,500 follow-up visits per year, for patients with complex lipid disorders. Additionally attending are Dr D. Blank and Dr A. Baass who also teach in the clinic. The clinic provides instruction for endocrine and other trainees and recruits patients for multicenter lipid treatment research studies.
The Neuroendocrine Teaching Clinic is directed by Drs. N. Garfield, J. Rivera and C. Beauregard, sees approximately 60 new patients and 300 to 400 follow-up visits annually, comprising patients with complex pituitary and hypothalamic disorders. The clinic attracts new patients from neurosurgeons, neurologists, neuron-ophthalmologists, the Infertility Clinic, and from private physicians both from within the hospital and outside. In addition, it attracts out-of-town referrals of difficult neuroendocrine problems from other parts of Canada, the U.S.A. and occasionally from overseas. The clinic has a strong educational component for residents and undertakes research on pituitary tumors.
The Bone Metabolism Teaching Clinic is directed by Dr. D. Goltzman and additionally attended by Drs. R. Kremer and L. Vautour. It provides consultations and follow-up of around 700 patients annually with a variety of bone diseases, especially osteoporosis. The clinic provides instructions to trainees and has been instrumental in developing new hormone assays for PTH and vitamin D and for testing and validating new biochemical assays for bone turnover. The director has been at the forefront of basic research on mechanisms of hypercalcemia secondary to malignancies.
The Antenatal Teaching Clinic is directed by Dr. S. Meltzer and provides specialized care for around 2,300 out-patient visits for women with gestational diabetes and other endocrine problems associated with pregnancy. The clinic includes a teaching component and has been renowned throughout the province for the meticulous care provided.
The Reproductive Endocrine Teaching Clinic is directed by Dr. D. Morris who sees approximately 500 new and follow-up cases annually. Common problems encountered here are amenorrhea, infertility, hirsutism and polycystic ovary syndrome. The clinic is closely interfaced with the growing in vitro fertilization program in the Department of Ob/Gyn where Dr. Morris is cross- appointed. Residents undertake a 6-week rotation through the clinic. A Women's Centre is under development and will provide a coordinated multidisciplinary team approach involving gynecologists, endocrinologists, surgeons and psychologists for the management of the menopausal female with respect to menopausal symptoms, hormone replacement, osteoporosis and breast cancer screening.
The Resident Teaching Clinic is directed by Dr. N. Garfield and operates once a week with residents in endocrinology and internal medicine. It serves as a referral base for new endocrine consultations originating from the Emergency Room, Ambulatory Clinics from within the Hospital, and outside physicians. The clinic sees a complete cross-section of endocrinology, except for diabetes, which is reserved for the Metabolic Day Centre (MDC). If feasible, interesting new patients can be followed long-term by Endocrine residents in their year-long Continuity Clinic (during the second year of training).