Internal Medicine – 今までの話

It seems like in the blink of an eye, 12 weeks has turned into 5. This week was the beginning of the second half of my internal medicine at WHMC and things have unexpectedly shifted gears. Before I explain how, I needs must recap my experience of the first half of IM.

At Wyckoff, IM is split into two modules: service and private. For six weeks, one is part of a service team (mine was the blue team) which consists of one attending, two senior residents, 4-6 interns (first year residents) and 6-8 medical students. The team is responsible for service patients (patients who are admitted to the hospital and assigned to a random team) as well as certain private patients (usually, those who have been admitted by the attending but sometimes, just patients that are under the care of the intern and/or resident). The role of the student varies, depending largely on how willing one’s intern is to take one under his/her wing. A student may be asked to obtain clinical data, ferry samples to the lab, perform physical exams, research topics related to the patient’s condition or to present the patient during attending rounds. Basically, whatever any person on the team asks a student to do, the student must do it. Students are also required to give a 20-30 minute powerpoint case presentation related to one of the service patients for the team*. In addition, every 4 days, the team has short call (from 7 am to 7 pm), during which time, the team admits new patients from the ER. Of course, students are required to attend lectures during the day as well (this is also true for the second module). Residents and interns rotate from team to team every month, so I actually shadowed 2 interns (and thus, had two different experiences) during the service half of my rotation.

My first intern was a friendly but frazzled doctor originally from Egypt. For the first few weeks of the rotation, he was also preparing for Step 3 and so I kind of had to stalk him to get him to notice me. When he did have time, we discussed how to manage certain patients, the kind of labs to order before initiating certain treatments and most importantly, how to optimize “patient flow.” In any major metropolitan hospital, it is important to make sure that the patients aren’t languishing in the hospital for weeks on end. Dr. B was a master at getting patients discharged. I learned quite a bit about discharge planning and also, some clever mnemonics for admissions. Dr. B preferred to handle his own scut work so I wasn’t exposed to much of that but whenever there was an opportunity to examine a patient, he’d send me off to do it first and was always very supportive.

For my last two weeks on service duty, I was paired with Dr. M. I hate to seem disloyal, but I kind of wish I’d been with Dr. M for the entire time. Dr. M is exactly the sort of doctor I’d like to be: knowledgeable, efficient and intelligent, but also kind, polite and caring. He was loved by practically every other staff member in the hospital and always had a kind word and a smile for even the surliest nurses. He was even given an award by the nursing and allied healthcare staff for being so awesome. Another thing about Dr. M with which I really identified was his soft-spokenness. I actually got called out for being soft-spoken by our attending (story of my life) a couple of times and though I know I should be more assertive with my voice, it was remarkably nice to be paired with a doctor who had a similar issue but was not hindered by it.

Whereas Dr. B preferred to review cases together (I’d usually be perched at his shoulder as he browsed information on Meditech), Dr. M always wanted me to gather all the information about a given patient while he did so as well and then discuss it with him – he said it was beneficial to us both for me to synthesize the information first and share it with him so that I could get into the habit of doing that with my medical colleagues in the future. Once we’d discussed the patient’s condition and management, we would go and examine them, sometimes together, or sometimes, he’d divide up the list and assign me a few to check on my own. I’d always get the service patients because during attending rounds, we’d visit only service patients with the team and Dr. M wanted me to be able to present the patient to the attending if I were called upon to do so (this did happen a few times). Dr. M even bought me a hot chocolate once and when I tried to return the favor, he refused. I definitely was lucky to be assigned to him.

Our attending, Dr. H, was pretty cool (despite having scolded me for speaking too softly). When we had the snowstorm that shut down public transportation in the city earlier this month, I called what I thought was his office number (but actually turned out to be his cell phone number) to let him know that I wouldn’t be able to make it into the hospital. I thought he was going to be upset with me for having the audacity to call his personal number but instead, he told the rest of the students who weren’t able to show up that they should’ve done what I did instead of just not showing up, or calling the program director’s office and not letting him know. At the end of attending rounds, Dr. H would always make a little joke about my name (“Is it clear?) and I’d dutifully respond, “Yes, sir, it’s clear.”

As I mentioned before, IM is split into two phases and now that I’m in the second phase, I kinda miss the blue team. I had a wonderful experience being a part of that group and I’m sure the students now assigned to it are learning a lot and having a pretty good time of things. As for how things are going in phase two, that update should be coming soon…

*I actually gave two presentations. No, I’m not a gunner, but I didn’t want to get shown up by the one in our group

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