San Francisco General Hospital (SFGH, aka "The General" or "The County", officially the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital), serves as the public hospital and only Level I trauma center for the City and County of San Francisco. Located in the Mission, over 80% of the patients seen here have publicly-funded insurance or are uninsured, allowing trainees to give top quality, compassionate care to otherwise marginalized communities. This includes San Francisco’s large homeless and marginally housed population, diverse immigrant communities, patients struggling with the effects of drug and alcohol abuse, and many with advanced HIV/AIDS. SFGH was one of the epicenters of the original AIDS epidemic of the early 1980s, and its Ward 86 continues to provide outstanding care for many of our city’s HIV-positive residents. Many patients have recently arrived from developing nations, and here you may encounter infectious neurological diseases or advancement of disease due to lack of care not typically seen in the industrialized world. SFGH moved its inpatient clinical services to a brand new building adjacent to the prior hospital building in May 2015. Claude Hemphill III, MD, MAS serves as Chief of Neurology and Director of Neurocritical Care at SFGH.
San Francisco General has a Ward Service, a Consult Service, and a Neurocritical Care (NCC) Service. Residents do one to two months on the Ward Service as an R2 and two to three as a senior (late R3 year and R4 year). Residents spend 1 month on the Consult Service as a senior resident (usually during the R3 year) and one month on the NCC service during the R3 year. The Ward Service ranges from 5-20 patients. The ward and NCC services provide extensive clinical experience in coma, stroke, head trauma, post-cardiac arrest cooling, intoxications, severe convulsive disorders, and complications of alcoholism and AIDS, as well as experience with ICP management and brain tissue oxygen monitoring (Licox). Because the city's major emergency room is located here, a significant proportion of patients have acute neurological or neurosurgical problems.
The Consult Service has approximately 425 admissions and over 750 consultations yearly. While on service at SFGH, residents staff two new patient clinics a week and one additional follow-up clinic per month on site. Each year there are about 3900 clinic visits. There are ample opportunities to engage in teaching medical students and other rotators. Residents also have 2-3 two-week night float blocks at the General, covering the wards, ICU and consult services 5 days per week. The other two days are covered by rotating residents on other services.