Tuesday, January 19, 2010

Skool is hrd

So, let me start out by saying that internal medicine is not for me. I had guessed this before I even started by 3rd year. I didn't really have a reason for it at that point though. I knew I didn't like to round for hours on end, and that was as far as I ever got. Well, I've learned a lot about myself, internal medicine, aging, all sorts of stuff really, in the last 2 and a half weeks.

I ended up getting extremely lucky (again!) with my assignment for a rotation. I am spending this first 4 weeks at St. Joe's. I'm in love with the place. Internal medicine here would be wonderful, if you're into that kind of thing. They work on a night float system which means no overnight call unless your on Friday or Saturday. This makes for happy residents from what I can tell. Call on the week days involves admitting until 7, then finishing up what you've started, and leaving by 9. The day usually starts around 7 am. These are great hours for internal medicine. Truly. During the day the teaching is exceptional. Every day there is morning report where different teams on the wards and the unit present interesting cases and we all sit around and generate a differential diagnosis a la "House". It's a great way to learn. Then at noon there is a conference every day where an attending presents an important topic to help with patient care. Oh, and they provide lunch at that conference every day (M-F). Then there is a teaching attending assigned to each ward team who meets with the team for at least 3 hours a week. For us, we present a patient and go through the House-esque routine again. Then we see the patient and all assign each other a topic to look up to help us better understand the case. It's great experience. Once a week we do the same with the head of the department. It's busy, very little down time, and I am pressed to get my progress notes done in a timely fashion, but so worth it.

So, no, it's not the rounding or hours that deters me from internal medicine. It's just the type of patients internal medicine sees. They are so complicated!!! Me, I like to look at a single problem at a time: i.e. baby's coming, I better catch it! Somewhere along those lines. Internal medicine is complex, with each patient having 10 medical issues that are all intertwined and all of which need addressing. These docs are the thinkers. They have to look at it all. It's easy to miss stuff. I told my resident today I don't think I'm smart enough to do what she does. And that's not necessarily what I think, but it's close. I am just at my best when I can know a whole lot about a smaller area. It gives me confidence that I won't miss something huge because I'm so bogged down with the details. I give those docs credit. They are amazing. And I am lucky to have a great team that really is invested in my learning. My resident even told me she thinks it's her job to make sure when I go to the U next month that I look like a rock star. I'm learning so much, but it's taxing and I'm tired - even with this great schedule. The patients can be very sad, lots of end of life issues.

But there's a lot of hope in this field too, so I see why people like it. I actually had a patient who was 98, and when I walked into the room for the first time and saw him lying there, I turned around and walked out because I was sure that was a 60 year old! Nope, 98. "I climbed a lot of mountains in my day." That's his secret. Guess J was right about that afterall.

I only have a week and a half left at St. Joe's. Then I'm back to academic medicine. I'm pretty sure that type of medicine, any field - not just internal - is not for me. I like private practice. I like how nice people are, and I like how they still respect you as a person while acknowledging the fact that there so much more to learn. My experience at the U has been one of a very strict heirarchy. A place where you never forget your "station." It's only 4 weeks. It's only 4 weeks. It's only 4 weeks...

1 comments:

medicine girl said...
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