Internal medicine was my second rotation in third year. What is internal medicine? The most common definition is "adult medicine". That is a crappy definition because it tells you next to nothing. Every specialist, with the exception of pediatrics, practices some adult medicine. I think a better definition is the practice of medicine with regards to major internal organs and systems. Fields like cardiology, respirology, rheumatology, gastroenterology, and, in the past, neurology, are all sub-specialties of internal medicine.
Internists are the "doctor's doctor" because they focus their practice on being up to date with the latest research and understanding the complexities of how multiple systems or concurrent chronic illnesses are interacting with each other. When a hospitalized patient is really sick and their is no single definable cause, the internist is called.
The internal medicine rotation in third year is both loved and hated. It is loved because we are given tremendous responsibility, our work is held to a high standard, and we learn so much during this rotation. It is hated because we are given tremendous responsibility, our work is held to a high standard, and we learn so much during this rotation.
This is the first and only third year rotation where we are given our own patients. That is, a patient is admitted to hospital and the med student is the only member of the physician staff that sees the patient every single day. Of course, these patients are relatively stable and the senior resident and attending staff make sure to review the patients regularly so that their quality of care is ensured., but this is a rotation where we have our own patients. Since we are in charge of our patient's care, we are expected to be up to date with the latest understanding of the pathophysiology, diagnostic criteria, and treatment modalities for our patients' illnesses. We also have numerous educational sessions to teach us how to develop logical diagnostic approaches to different patient presentations, read ECGs, understand pathophysiology, etc.
In internal medicine, we also have to become comfortable with telling patients and their families that it is time to give up medical treatment and prepare for death. Something that is incredibly difficult to do at first, but becomes easier with time. However, regardless of how comfortable you get with the conversation, part of you always feels like you are giving up on the patient...
One thing I truly found remarkable through this rotation was how knowledgable the third year residents were. It blew me away how they could recite differentials, cite the latest clinical trials, and knew how to manage...well, everything. I found this remarkable because they seemed so much more knowledgable than their third year counterparts in surgery, which I will describe further in another post.
So my thoughts on my internal rotation:
1. Learn tons.
2. Actually feel like you can manage most non-complicated patients on your own.
3. Get to be the point person for patient care between for the physician team.
1. Finding time to learn what you need to manage your patients and to pass your exam.
This was a great rotation and I had very few complaints. In the end, I enjoyed every day of it and am now considering internal medicine as a future specialty.