So I finished Internal Medicine almost three weeks ago. I had to give it some time before I could bring myself to write about my IM rotation at Riverside Hospital though... because it was not the most pleasant 4 weeks of my life. Let me start out by saying that Riverside is a fantastic hospital. It's a tertiary care center and one of the biggest hospitals in Columbus. It's located about 10 min north of downtown and is known among medical students as "the magic hospital" because you actually see people get better, and more importantly, you see patients who want to take care of themselves and get better. I carried a map of the hospital and used it religiously for the first week so I could get around. For those who've ever been at a teaching hospital or seen on TV the posse of white coats that come into your room and talk to you and about you on rounds...yeah I was a part of one of those posse's(teams). At Riverside there is red, white and blue team with each being assigned up to 20 patients. I was on the white team. Each team consisted of an Attending doctor(MD or DO), a 2nd year Internal Medicine resident, two Interns(in their 1st year after med school), and three 3rd or 4th year medical students. As you can see, medical students are at the very bottom of this "food chain." On a typical day, I would arrive at 6:30 am to look up lab values of the patients I was assigned to(medical students usually got 2-3, and interns had 5-6). At 7:15 am we had a morning lecture. Between 8 and 9:30 am I had two or three patients that I gathered a history and completed a physical on and wrote progress notes on. It was my responsibility to know EVERYTHING about these patients...anything and everything in their past medical history, social history, family history, the medications they were taking(some had over 20), their allergies, surgical history, all their recent imaging results and lab values, all the reasons they were currently at the hospital, the specifics about their diseases, the recommended treatment plans...just everything. Then between 9:30 and noon, the team would round on each patient. For my patients, I would present to the attending Dr all the important information before we entered the room and then tell him what I thought the diagnoses were and what I wanted to do to treat. We would all go in and see the patient and afterwards he would tell me whether he agreed. I must admit, it was pretty intimidating at times presenting in front of all your other collegues and friends when you yourself are trying to figure everything out...especially since they are evaluating you for your ever important grade. And because their is so much information on these chronically ill patients with 6 or 7 diseases, it becomes quite an art form to know what is important enough to say and what is not. Rounds also became a great time for the attending or resident to"pick on you" by asking all the obscure questions about the disease and make you feel like you know nothing. Such a great way to build confidence in future physicians don't you think? On the bright side, once you've been "pimped" about a disease and been made fun of for not knowing everything about it, you'll likely not forget about that disease the next time someone asks you a question about it. After rounds, we attended a daily noon lecture and then spent the afternoon checking on our patients, filling out the paperwork to get the patients discharged from the hospital that were ready to go, helping with admissions from the ER and of course studying. I usually left the hospital by 5 pm but occasionally stayed til 6 or 7 when it was really busy. I also spent two nights sleeping at the hospital on-call...but those weren't too bad at all because I never got a page after 10 pm. Here are my impressions of Internal Medicine:
1. I'm pretty sure it's not for me. I enjoyed learning about the many vast array of diseases and seeing all sorts of interesting cases, but I just don't think I want my life to rotate around rounding at the hospital everyday. Perhaps i'll like it more in a few years when I feel like I know more about medicine...and now that I have the structure down perhaps it will be a little easier next time also.
2. It's hard being a generalist. Quite the responsibility to know everything about every disease. Perhaps specializing is the way to go for me. I'll find out next semester when I do more specialty rotations.
3. General Internists have difficult lives and lifestyles. My uncle Bruce may be the exception. He has a great practice, is in a perfect situation at Tanner Clinic and from my perspective has has a great lifestyle. I respect him an very much. But the Internists here took call one week a month , rounded on Saturday and Sunday, also kept private practices and always seemed tired.
4. Internal Medicine is Adult medicine. Almost every adult in this day and age that they take care of is obese, has high blood pressure, diabetes and kidney failure. Most are on 20 medications. Most have other issues as well. So most patients are quite complex in a nutshell.
5. Elderly people can be great to work with but they can be cranky too! My favorite was the retired dentist who came to the hospital with an infection in his blood and pneumonia. He was so pleasant and nice to me. It was day 2 and he was feeling better. I felt like he should stay at least another day or two. He did not want to because he was feeling better. So after a discussion with my attending, we decided to let him go against our medical advice. He came back in the ambulance later that night because he was having trouble breathing. After another day in the hospital, he again was feeling better and wanted to go home. We were more adamant that he stay this time based on what happened last time. This man threw the biggest fit I had ever seen! It was childlike! We finally convinced him to stay one more day. He left the next day against our advice. And it turns out the guy had an undiagnosed colon cancer and will probably be back shortly. But it taught me one thing...the hospital is not a prison. No one will force you to stay against your will.
6. The funniest patient I had was an African American lady who had left her dentures at home because she was brought in by an ambulance. Her mental status was a bit altered also. I'm sure the nurses got a kick out of listening to me trying to communicate with her...i've never said what so many times in my life, and for me that is saying something!
