Sunday, August 7, 2011

Internal Medicine: One Week Down

Downtown BangorThird year clinical rotations are great opportunities to discover what you don't know. For instance, I thought, like many other well-intentioned medical students, that "internal medicine" was concerned with illness conditions too severe for the family practitioner to manage. You referred to an internist when the waters were swirling and you didn't want your patient going under a third time. Oops, there goes another of my misconceptions. Internal medicine means simply the practice of adult medicine. Family docs treat families, pediatricians are all about kids, OB/GYN's manage women and babies, and psychiatrists -- well, they try to keep everything on an even keel, how's that? Except family docs treat adults and pediatricians may treat young adults, so that throws simplicity out the window.

Once upon a time, internal medicine would have been my first rotation, but as it stands, I've spent time in a rural family practice (loved it), pediatrics (really loved that), and psychiatry ("you make me feel like dancing, I wanna dance the night away" ~ Leo Sayer). I've also done a stint in osteopathic manipulative medicine (a wonderful experience) which, for us DO types, ties pretty much everything together. I guess I've come back to where I might have started.

So, what kinds of things can you encounter in IM? The same ones you do in kids, the kids are just bigger, is all. And there are some you don't as much. Heart disease is more common in adults, hypertension and the effects of lifestyle -- alcohol, drugs, overwork. Cancer, clearly something the world would be far better off without, is there, too. Adults have responsibilities and being sick means being under stress, which only complicates the healing process. Internal medicine (and pediatrics and family medicine and...) is one part physical and two parts psychological and spiritual. People who are sick need hope. Come to think of it, so do the rest of us.

Where do I see my assigned patients? Since this is a hospital-based rotation, the inpatient unit, ICU, and rehab. If one of them is undergoing a procedure, I'll follow along to observe and learn and provide moral support. You see, students possess in relative abundance, something the residents and attending physicians have in short supply, i.e. time. We also have some measure of freedom about how we choose to use it. Talking to patients, forming a relationship, is one of the best uses of our time. If you've never been a patient yourself, or even if, like me, you have, this is a chance to find out what it's like for them to be in their shoes. Moral support may seem small in comparison to writing treatment orders, but from the patient's perspective, it's huge.

It's also important to spend some of that "abundance" talking to nurses and not simply about the patients you have in common. Nurses know things, things you want (and need) to know, too. When you're trying your heart out to do well, to develop some measure of competence, and to avoid doing anything that should never be done in the first place, having staff members who watch your back is priceless. Besides, it makes life more pleasant and we can all use some of that.

I mentioned in a previous post how I wanted to learn more psychiatry in the course of learning internal medicine. One week down, I think it's impossible not to. Osteopathic physicians are intent upon finding the person in the midst of their illness. Patients aren't problems to be solved, though their condition may pose many, nor are they incidental to what we do like a spot on an X-Ray that turns out to be a clasp on a hospital gown. They're the why for all of medicine and any occasion to work them teaches something about why they tick the way they do. I suppose you could say I'm learning how to keep them ticking as healthily and hopefully, as long as they can, before the clock strikes twelve.

(Public Domain image of Downtown Bangor, ME via Wikipedia)
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