I'm still doing my internal medicine rotation, and just wanted to check in quickly! I'm not loving the rotation, mostly because I'm pretty frustrated with the lack of care most patients actually receive, and I don't want to rant about it too much in case anyone from my school (or the doctor's office) could happen to find my blog somehow. But, essentially: the office I'm at sees a high volume of patients each day, and that means that the doctor spends about 2-3 minutes with each patient, and really glosses over some things that (in my opinion) should be given more consideration. So! It's up to the students to really talk to the patient and advocate for what they think the patients need, but the doctor can choose to ignore some really glaring things.
I'm honestly pretty disappointed in this rotation. As my preceptor's head nurse said to me today, "This is the rotation where you learn what not to do." My preceptor is a personable guy and pretty friendly, and his patients like him because of this, but they're really not receiving in-depth, quality care. I'm hoping my next rotations in Montana will be different!
Tuesday, January 28, 2014
Monday, January 13, 2014
A great day in IM!
This rotation is great. Not only are the hours incredibly sparse (this whole week, I will only be there for about 23 hours...), but my preceptor is really nice and a great teacher, and the patients are (mostly) nice and come in for relatively easy appointments. I think my favorite part, though, is just taking a few minutes to talk to people and help them beyond just refilling their medications.
Today, for example, we had a new patient come in who hadn't been to a doctor in over six years, because he "never felt bad." So, when I was asking him the typical questions that you ask a new patient, I inquired about his diet and found that it was awful (fast food, highly processed foods, no fruits/vegetables, lots of carbs, sugary drinks all day every day). He thought he was doing pretty well, and told me he never even thinks about eating more healthily. So...kindly and patiently, I suggested adding more fruits and vegetables in, and also suggested drinking something like a V8 Fusion that tastes pretty good but offers some of the benefits of fruits and vegetables. He said he hates fruits/veggies, so that sounded like a good option, and he was definitely excited to try it. Also, he was already trying to quit smoking, so I encouraged him with that and gave him some tips. We also set up a couple of referrals for problems that would require a specialist. It just felt really good to listen to the problems this patient was presenting with and help him to come up with a plan of action that he was really, truly going to follow. I felt good leaving that room because I knew that a person who had previously hated doctors and was only coming in for an acute complaint had been converted and would start getting preventive screenings and care. So, I was pretty proud of myself!
The rest of our patients today were pretty uneventful. This rotation is pretty relaxed, and we get free food a lot. Even though it's not as exciting as, say, the ER or surgery, I could see myself working in an office setting like this!
Today, for example, we had a new patient come in who hadn't been to a doctor in over six years, because he "never felt bad." So, when I was asking him the typical questions that you ask a new patient, I inquired about his diet and found that it was awful (fast food, highly processed foods, no fruits/vegetables, lots of carbs, sugary drinks all day every day). He thought he was doing pretty well, and told me he never even thinks about eating more healthily. So...kindly and patiently, I suggested adding more fruits and vegetables in, and also suggested drinking something like a V8 Fusion that tastes pretty good but offers some of the benefits of fruits and vegetables. He said he hates fruits/veggies, so that sounded like a good option, and he was definitely excited to try it. Also, he was already trying to quit smoking, so I encouraged him with that and gave him some tips. We also set up a couple of referrals for problems that would require a specialist. It just felt really good to listen to the problems this patient was presenting with and help him to come up with a plan of action that he was really, truly going to follow. I felt good leaving that room because I knew that a person who had previously hated doctors and was only coming in for an acute complaint had been converted and would start getting preventive screenings and care. So, I was pretty proud of myself!
The rest of our patients today were pretty uneventful. This rotation is pretty relaxed, and we get free food a lot. Even though it's not as exciting as, say, the ER or surgery, I could see myself working in an office setting like this!
Monday, January 6, 2014
First day of internal medicine!
My first day at this rotation went much better than anticipated! I fell right back into the groove and did totally fine at talking to patients. It definitely helped that my preceptor is incredibly laid-back and funny. He's not pretentious or uptight at all, and he seems to treat students like people and not idiots, which is refreshing (even if I still feel like an idiot at times and still, obviously, have a lot to learn!).
He gives us a lot of autonomy, which is both awesome and terrifying. We (me and the two other students) bring patients back, take their vitals, and see them on our own. Then we jot down a brief SOAP note on the back of their intake sheet, and give it to the doctor (or present it briefly if we have time! He moves fast!). Then, he goes in to see them for about one minute, and basically just chats. Most patients are there for their three-month follow-up visits just for medication refills, but I did do one annual physical today. Then, he uses our opinion and our note to dictate the actual note! Seriously, I heard him doing one of mine and it was essentially exactly what I had written down. Even though it's scary to think that I'm essentially having the last word in terms of how a person is doing, it's also good because it makes you actually assume responsibility for the patients, instead of just relying on the fact that someone with more experience is going to go right in after you and double-check. So, it's closer to real life, and I like that.
Oh, and the content of the visits is very similar to family practice - medication refills and urgent care-type stuff like colds, joint or back pain, etc. Nothing I can't handle. :)
He gives us a lot of autonomy, which is both awesome and terrifying. We (me and the two other students) bring patients back, take their vitals, and see them on our own. Then we jot down a brief SOAP note on the back of their intake sheet, and give it to the doctor (or present it briefly if we have time! He moves fast!). Then, he goes in to see them for about one minute, and basically just chats. Most patients are there for their three-month follow-up visits just for medication refills, but I did do one annual physical today. Then, he uses our opinion and our note to dictate the actual note! Seriously, I heard him doing one of mine and it was essentially exactly what I had written down. Even though it's scary to think that I'm essentially having the last word in terms of how a person is doing, it's also good because it makes you actually assume responsibility for the patients, instead of just relying on the fact that someone with more experience is going to go right in after you and double-check. So, it's closer to real life, and I like that.
Oh, and the content of the visits is very similar to family practice - medication refills and urgent care-type stuff like colds, joint or back pain, etc. Nothing I can't handle. :)
Sunday, January 5, 2014
Back at it!
Well, after an amazing and much-needed winter break at home with family, I am back in Pittsburgh and ready for my sixth rotation - internal medicine. If I'm being honest, my heart's just not in it right now - I'd rather still be hanging out at home for a few more weeks! I'm hoping that getting back in the routine tomorrow will help.
This rotation should be relatively relaxing compared to my last couple rotations - this whole spring semester, in fact, is going to be much more laid back than the fall, just because of which rotations I have coming up. Internal medicine is really just general practice, but specifically for adults. So, it will be a lot of high blood pressure, high cholesterol, and diabetes, and managing all the medications that come with those. Personally, it's not fascinating to me, but my preceptor is supposed to be really nice and relaxed, so at least the rotation itself will be fun.
I'll actually only be at my rotation for the afternoon tomorrow, but I'll try to post an update about the first day anyway! Here's hoping it's either more exciting than I think it will be, or that my attitude changes with a good night's sleep. :)
This rotation should be relatively relaxing compared to my last couple rotations - this whole spring semester, in fact, is going to be much more laid back than the fall, just because of which rotations I have coming up. Internal medicine is really just general practice, but specifically for adults. So, it will be a lot of high blood pressure, high cholesterol, and diabetes, and managing all the medications that come with those. Personally, it's not fascinating to me, but my preceptor is supposed to be really nice and relaxed, so at least the rotation itself will be fun.
I'll actually only be at my rotation for the afternoon tomorrow, but I'll try to post an update about the first day anyway! Here's hoping it's either more exciting than I think it will be, or that my attitude changes with a good night's sleep. :)
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