Patellar dislocation is a relatively uncommon injury that is normally seen in athletes and adolescent girls, likely due to different mechanisms of injury. It usually occurs in high impact collisions that involve twisting, but it can happen in any scenario involving contraction of the quadriceps muscle.
Once a dislocation has occurred, the patient's patella is usually displaced towards the outside of the leg and the patient's leg is usually moderately flexed at the knee. The patients are usually in a reasonable amount of pain at this point. The dislocation is reduced, or made normal again, by getting the patient to relax their leg muscles (easier said than done), straightening their leg, and gently slipping the patella back into the right place.
Patellar dislocation can be associated with popliteal artery damage, MCL and ACL tears, and fracture of the patella. A physician must perform a neurovascular exam and x-ray the knee to assess for popliteal artery damage and patellar fracture. With the exception of a very obvious MCL injury, it is unlikely that a physician will be able to assess MCL/ACL damage because the swelling from the dislocation makes it difficult to examine the ligaments. The MCL and ACL can be reassessed when the swelling has reduced, which can take 3-4 weeks.
Patellar dislocation is rarely treated surgically. However, there are multiple conservative options available. This article mentions three different conservative treatments. A plaster cast, a posterior splint, and patellar bandage/brace.
Plaster cast
A plaster cast ensures that the patient's leg does not bend. It will definitely keep the leg straight.
Posterior splint
A posterior splint is a foam or cloth object that patients can wrap around their leg. It has a metal bar running through the material that should be oriented so it runs up and down along the back of the patient's knee. This keeps the leg straight, like the plaster cast. However, it has more give allowing the patient to flex his knee slightly. Also, the patient can take the posterior splint off if he wants to try bending their knee.
Patellar bandage/brace
A patellar bandage is a cloth that wraps around the knee. A patellar brace is similar to a bandage, but may have additional support.
The study found that patients had the best results if they used a posterior splint for 2-3 weeks after their dislocation was reduced. If they used the patellar bandage/brace, they were more likely to have a subsequent knee dislocation later. If they used the plaster cast, they were more likely to have limitations to the range of motion of their knee.
However, there were some serious limitations to this study. First and foremost, this was not a randomized control trial. Physicians would decide which patient received which treatment. This selection process is incredibly prone to bias. For instance, one physician may think that all of the older patients need additional support and decide that they all receive plaster casts. A good study compares oranges to oranges and if you have a significant selection bias, this can't be done. Also, the sample size is too small. A study with only 100 patients is not large enough to draw any large scale conclusions. Especially when there is a disporportionate number of patients in each therapeutic group. For instance, plaster casting alone had 60 patients, while 17 were put in posterior splints and 23 in patellar braces/bandages. Making conclusions about posterior splints based on the results of 17 patients would be a mistake. The reality is that a larger, better designed study needs to be made, conducted, and analyzed before we can conclude how to best treat patellar dislocation.
An orthopedic surgeon told me that, in the end, they try to balance protection of the knee with loss in range of motion (I will explain why the loss in range of motion happens in an other post). So he makes treatment decisions based on the personality and activity level of his patients.
Monday, May 9, 2011
Sunday, April 24, 2011
Psychiatry as a Med Student
My psychiatry experience was well rounded and very different from any of my other clinical rotations. I experienced inpatient, outpatient, early child, and geriatric psychiatry.
In psychiatry, there is no physical exam. I did not need my stethescope. I found this weird.
Since there is no physical exam, history becomes even more important than it usually is. Thus, the history in an average psychiatry note was at least 2 or 3 times longer than an average internal note and 4.6 million times longer than the longest surgery note.
Outpatient psychiatry is the worst. Outpatient psychiatry is basically psychiatric clinics for patients who are sick enough to still need help, but healthy enough to be in their homes doing their day to day activities. Our government does not currently provide funding for patients to see psychologists or counsellors. This means that if a patient cannot afford to see a psychologist/counsellor, but needs someone to talk to and work through problems with, they will go to a psychiatrist, which is covered under our province's health plan. This is a problem because we already have a psychiatrist shortage in this province and their time could be better used managing more acutely ill psychiatric patients rather than providing counselling which can be provided by other mental health providers.
Inpatient psychiatric patients blow my mind. I found patients in acute psychosis to be fascinating. For those of us who are lucky enough to be free of psychosis, our minds are who we are. If we develop cancer, lose an arm, or have a heart attack, we understand that our bodies are failing us, but our mind is still ours. I think that the sense of self which stems from our mind is the basis upon which philosophers created the concept of a soul. When you meet a schizophrenic patient, who was previous healthy like anyone else...and their mind has failed them, it is terrifying. I still do not understand how a once rational person can honestly believe that a microchip has been implanted into his tongue so UFO's can eavesdrop on his conversations. If our minds can become this sick too...then what are we? What is our consciousness? A random set of electrochemical reactions? That doesn't make sense...does it? WTF.
Anyways...
So my thoughts on psychiatry as a med student:
Positives
1. Great lifestyle
2. Interesting potential for research
3. Deal with a unique set of illnesses
Negatives
1. Very little medicine
2. Looked down upon by many other doctors
3. Long, long patient interviews
Psychiatry was interesting and I think I will be better able to deal with psychiatric comorbidities in the future, but I definitely will not become a psychiatrist.
In psychiatry, there is no physical exam. I did not need my stethescope. I found this weird.
Since there is no physical exam, history becomes even more important than it usually is. Thus, the history in an average psychiatry note was at least 2 or 3 times longer than an average internal note and 4.6 million times longer than the longest surgery note.
Outpatient psychiatry is the worst. Outpatient psychiatry is basically psychiatric clinics for patients who are sick enough to still need help, but healthy enough to be in their homes doing their day to day activities. Our government does not currently provide funding for patients to see psychologists or counsellors. This means that if a patient cannot afford to see a psychologist/counsellor, but needs someone to talk to and work through problems with, they will go to a psychiatrist, which is covered under our province's health plan. This is a problem because we already have a psychiatrist shortage in this province and their time could be better used managing more acutely ill psychiatric patients rather than providing counselling which can be provided by other mental health providers.
Inpatient psychiatric patients blow my mind. I found patients in acute psychosis to be fascinating. For those of us who are lucky enough to be free of psychosis, our minds are who we are. If we develop cancer, lose an arm, or have a heart attack, we understand that our bodies are failing us, but our mind is still ours. I think that the sense of self which stems from our mind is the basis upon which philosophers created the concept of a soul. When you meet a schizophrenic patient, who was previous healthy like anyone else...and their mind has failed them, it is terrifying. I still do not understand how a once rational person can honestly believe that a microchip has been implanted into his tongue so UFO's can eavesdrop on his conversations. If our minds can become this sick too...then what are we? What is our consciousness? A random set of electrochemical reactions? That doesn't make sense...does it? WTF.
Anyways...
So my thoughts on psychiatry as a med student:
Positives
1. Great lifestyle
2. Interesting potential for research
3. Deal with a unique set of illnesses
Negatives
1. Very little medicine
2. Looked down upon by many other doctors
3. Long, long patient interviews
Psychiatry was interesting and I think I will be better able to deal with psychiatric comorbidities in the future, but I definitely will not become a psychiatrist.
Friday, April 22, 2011
Surgical education: A problem with resources
Most specialties are either surgical or medical specialties. Surgical specialties include general surgery, neurosurgery, thoracic surgery, etc. Medical specialties are everything else, like internal medicine, psychiatry, dermatology, etc. Some specialties like family medicine and emerg have a mix of both surgery and medicine. Surgical residencies are known as brutal 5-6 year experiences because of the long hours as well as the busy and frequent nights on call. These residencies are intense, in part, because surgery is a challenging skill for residents to develop.
Learning surgery from a book is much more difficult than learning medicine from a book. Both are best learned and remembered in the context of real patients (i.e. I am more likely to remember how to treat sepsis if I learn about it while managing a septic patient rather than only reading about it in a text book), which is the argument for why we need a residency after we complete medical school. However, if context isn't available, it is much easier to learn medicine form a text book. In fact, I think it is almost impossible to truly learn surgery without practicing it on an actual patient under the watchful eye of an attending.
Learning a hands on technical skill is a new challenge for most residents. Excelling in academics from grade school through undergrad and into medical school has made most residents very proficient at learning theory from a book. However, on average, we are much, much slower at picking up practical hands-on work.
Thus, a surgical education is significantly more resource intensive than a medical education. The limiting factor in the training of a future surgeon is most definitely operating room time. There is a surplus of patients that need surgery. There is a surplus of medical students who want to become surgeons. The resource that is scarce is operating time. With limited operating rooms, you can only hire a limited number of surgeons. A surgeon can only really teach one resident how to perform one type of surgery at any given time.
If a hospital has eight surgical residents, but only four operating rooms where surgeries are occurring on a given day. Then only half of the residents will be in the operating room learning how to perform surgery. Since surgery is already difficult to learn, the fact that they are not in the operating room every single day slows their education even more. Thus, they need to work long hours and have frequent overnight call shifts to maximize their opportunities to learn their trade.
Surgical residents would have a much better and more balanced experience if they were able to always be the first assist learning directly from a fully trained surgeon every day. Unfortunately, this is not an economically feasible possibility. This is particularly unfortunate because I think the lifestyle of a surgical resident scares away many talented medical students who may have the potential to become great surgeons.
Of course, in Canada, we currently have a surplus of surgeons graduating every year, so I doubt there is sufficient motivation to address this problem in the near future... Plus, most surgeons wear the challenging lifestyle of their residency as a badge of honour.
Learning surgery from a book is much more difficult than learning medicine from a book. Both are best learned and remembered in the context of real patients (i.e. I am more likely to remember how to treat sepsis if I learn about it while managing a septic patient rather than only reading about it in a text book), which is the argument for why we need a residency after we complete medical school. However, if context isn't available, it is much easier to learn medicine form a text book. In fact, I think it is almost impossible to truly learn surgery without practicing it on an actual patient under the watchful eye of an attending.
Learning a hands on technical skill is a new challenge for most residents. Excelling in academics from grade school through undergrad and into medical school has made most residents very proficient at learning theory from a book. However, on average, we are much, much slower at picking up practical hands-on work.
Thus, a surgical education is significantly more resource intensive than a medical education. The limiting factor in the training of a future surgeon is most definitely operating room time. There is a surplus of patients that need surgery. There is a surplus of medical students who want to become surgeons. The resource that is scarce is operating time. With limited operating rooms, you can only hire a limited number of surgeons. A surgeon can only really teach one resident how to perform one type of surgery at any given time.
If a hospital has eight surgical residents, but only four operating rooms where surgeries are occurring on a given day. Then only half of the residents will be in the operating room learning how to perform surgery. Since surgery is already difficult to learn, the fact that they are not in the operating room every single day slows their education even more. Thus, they need to work long hours and have frequent overnight call shifts to maximize their opportunities to learn their trade.
Surgical residents would have a much better and more balanced experience if they were able to always be the first assist learning directly from a fully trained surgeon every day. Unfortunately, this is not an economically feasible possibility. This is particularly unfortunate because I think the lifestyle of a surgical resident scares away many talented medical students who may have the potential to become great surgeons.
Of course, in Canada, we currently have a surplus of surgeons graduating every year, so I doubt there is sufficient motivation to address this problem in the near future... Plus, most surgeons wear the challenging lifestyle of their residency as a badge of honour.
Monday, April 11, 2011
Political persuasion and your brain
An article in the Globe and Mail discusses a recent study finding that the brains of liberal and conservative people are often structurally different. The study found that liberals have a larger anterior cingulate cortex and conservatives have a larger amygdala. The scientists who performed the study state, according to the article, that the findings suggests liberals are better at dealing with conflicting information and conservatives are better at recognizing threats.
Of course, it is unclear if an individual's political persuasion is formed based on the shape of their brain at birth, or if different influences through an individual's life shapes both the person's brain and their political preferences.
Since our understanding of the brain is still fairly primitive, I would not put too much faith in the hypotheses generated from this study... but it is an interesting finding nonetheless...
Of course, it is unclear if an individual's political persuasion is formed based on the shape of their brain at birth, or if different influences through an individual's life shapes both the person's brain and their political preferences.
Since our understanding of the brain is still fairly primitive, I would not put too much faith in the hypotheses generated from this study... but it is an interesting finding nonetheless...
Wednesday, April 6, 2011
Surgery as a Med Student
Our third year surgery rotation is made out to be one of the most intimidating experiences that we will ever face in medical school. Horror stories abound about 6am rounds, standing in the operating room (OR) for hours pulling back a fat flap so the surgeon can have better access to the tissue, crabby surgery nurses that yell at you for breathing, and attendings who yell at you because you can't do anything right even when you do exactly what they tell you to do.
Needless to say, the horror stories are exaggerations...at least mostly. Depending on which surgical subspecialty I was doing, I would have to be at the hospital some time between 6:15-7am. When I was in the operating room, sometimes I had to retract tissue, sometimes I was the first assistant helping the surgeon, sometimes I closed the surgical incision after the operation was completed, and sometimes I stood. The nurses were nice as long as you were friendly with them and showed them that you were at least competent enough to ask them questions if you had any. Experiences with attendings varied from student to student and attending to attending. No attending ever yelled at me, though, some certainly did ignore me. However, most of the attendings I worked with were actually really friendly, wanted to teach, and tried to convince me to become a surgeon.
My major frustration with my surgery rotation is that there wasn't a lot for me to do as a medical student. In some ways, that should draw a collective sigh of relief from the general public. Do you really want a medical student to be heavily involved in your surgery? However, it was frustrating for me because I had completed my internal medicine rotation and I was accustomed to managing patient care from start to finish. As a surgical med student, I was often given odd tasks here and there when the surgeons and their residents were too busy to do the task themselves. Of course, there are also a set of "med student tasks", such as closing the incision, guiding the camera in a laproscopic surgery, and checking patient labs (in order of excitement).
There is also an interesting type of unity that forms amongst the surgical residents. A surgical residency is tough...actually, brutal. They work from 6am-5pm or later for five days a week and their work is always go, go, go. They also have call 1 in 3 or 4 days, which means they are working every other weekend. They also have a huge patient load and they barely have an opportunity to familiarize themselves with the patient charts. When they get home from work, they have to find SOME time to study. And, oh yeah, they need to find some time to have a life and see their friends and families. However, they are all in the same stressful situation for five years, so there tends to be a really strong bond between them. Uniting against a common enemy, even if that enemy is a residency program, makes working with the residents a lot of fun. They were definitely the most stressed, but most entertaining group I have worked with so far.
So my thoughts on surgery as a med student:
Positives
1. Get to be in the OR (and actually do stuff).
2. Learn how to deal with acute, surgical emergencies.
3. Finally do procedures.
Negatives
1. Lots of standing around feeling useless.
2. Long days.
3. Attendings and residents were often too busy to teach, even if they wanted to.
4. Residents never seemed happy...some were neutral, but most were always stressed.
Surgery was a busy rotation, but being in the OR and seeing surgeons cut people open to fix them was definitely one of the coolest experiences I have had in med school
Needless to say, the horror stories are exaggerations...at least mostly. Depending on which surgical subspecialty I was doing, I would have to be at the hospital some time between 6:15-7am. When I was in the operating room, sometimes I had to retract tissue, sometimes I was the first assistant helping the surgeon, sometimes I closed the surgical incision after the operation was completed, and sometimes I stood. The nurses were nice as long as you were friendly with them and showed them that you were at least competent enough to ask them questions if you had any. Experiences with attendings varied from student to student and attending to attending. No attending ever yelled at me, though, some certainly did ignore me. However, most of the attendings I worked with were actually really friendly, wanted to teach, and tried to convince me to become a surgeon.
My major frustration with my surgery rotation is that there wasn't a lot for me to do as a medical student. In some ways, that should draw a collective sigh of relief from the general public. Do you really want a medical student to be heavily involved in your surgery? However, it was frustrating for me because I had completed my internal medicine rotation and I was accustomed to managing patient care from start to finish. As a surgical med student, I was often given odd tasks here and there when the surgeons and their residents were too busy to do the task themselves. Of course, there are also a set of "med student tasks", such as closing the incision, guiding the camera in a laproscopic surgery, and checking patient labs (in order of excitement).
There is also an interesting type of unity that forms amongst the surgical residents. A surgical residency is tough...actually, brutal. They work from 6am-5pm or later for five days a week and their work is always go, go, go. They also have call 1 in 3 or 4 days, which means they are working every other weekend. They also have a huge patient load and they barely have an opportunity to familiarize themselves with the patient charts. When they get home from work, they have to find SOME time to study. And, oh yeah, they need to find some time to have a life and see their friends and families. However, they are all in the same stressful situation for five years, so there tends to be a really strong bond between them. Uniting against a common enemy, even if that enemy is a residency program, makes working with the residents a lot of fun. They were definitely the most stressed, but most entertaining group I have worked with so far.
So my thoughts on surgery as a med student:
Positives
1. Get to be in the OR (and actually do stuff).
2. Learn how to deal with acute, surgical emergencies.
3. Finally do procedures.
Negatives
1. Lots of standing around feeling useless.
2. Long days.
3. Attendings and residents were often too busy to teach, even if they wanted to.
4. Residents never seemed happy...some were neutral, but most were always stressed.
Surgery was a busy rotation, but being in the OR and seeing surgeons cut people open to fix them was definitely one of the coolest experiences I have had in med school
Monday, February 28, 2011
Time to give up
As I mentioned in an earlier post, sometimes a doctor is required to tell their patients that it is time to give up. The disease is winning and continuing to fight is not worth the burden of the side effects. This is one of the toughest decision any doctor, patient, or family member has to make...
They say you always remember your first. The first patient I lost was in her late 60's, which is young by modern medicine standards. She had been a heavy drinker for years and developed cirrhosis (i.e. liver disease). She came into hospital jaundiced with hepatic encepholopathy. When I first saw her, she was barely conscious and gasping for breath. I wouldn't have been surprised if she died that night. I probably wouldn't have remembered her if she did because, at that time, she wasn't my patient.
A few days later she started looking much better. She was still yellow from jaundice, but level of consciousness improved and she was coherent, chatty even. She constantly complained about pain, but she seemed otherwise well. Since she was out of her "rough patch", my team thought she was stable enough to be followed by a medical student, so she became my patient.
I had a chat with her and her husband and they were both overjoyed that she was doing so much better. They started telling me their life story: how they met, about their kids, about their dog. They mostly told me about their dog. They were both beaming. They were the couple that all hopeless romantics want to replicate when they go through their golden years. We had a nice talk.
Then the hepatologist, or liver doctor, came in to talk with them. He had a doom and gloom expression on his face. I thought he was just stressed out from working too much. He told the couple how the patient's Child-Pugh score, a prognostic indicator, showed that she didn't have very long to live. They were shocked. The husband asked if he should go back to their home, a day's travel away, to get more of their things so he could stay in town for longer. The hepatologist suggested he stay in the hospital; he didn't have time to go back home. Turned out the doom and gloom expression was warranted.
The patient went downhill quickly. She was struggling to breathe, constantly in pain, and often incoherent. The family was begging us to do anything and everything to save her. I understood their motivation, but I kept wondering why they couldn't see that nothing we did was helping... yet, they kept demanding we do more and more.
My attending came in to have a chat with them. He explained that we could no longer save the patient; her disease was progressing faster than our medications could treat it. He told them that we should stop trying to fix her and focus on making her comfortable... preparing her for death.
The way they were demanding more care, I thought the family would be up in arms. Instead, they all looked relieved, almost happy. In fact, they had realized that our medications weren't helping the patient, but they needed a doctor to tell them that it was ok to stop. They didn't want to be the ones to say "it's time for my wife/mom/sister to die"... They needed a doctor to tell them that it was okay to let their family member pass away, peacefully.
On that last day, the husband asked me if I could stay with the patient while he ran an errand. He wanted to make sure that she didn't die alone if he wasn't back in time. Normally, I refuse these types of requests because I have a lot of work to do in the hospital and it is generally unreasonable to ask a doctor (or med student) to sit with a patient while their family runs errands, but something in his expression stopped me from dismissing his request immediately. I asked him what errand he had to run.
"I have to go get our dog... she needs to see him before..."
I waited with her.
Fortunately, she was able to see her dog, in fact, she spent the whole night with him. She died peacefully the next morning surrounded by her friends and family.
They say you always remember your first. The first patient I lost was in her late 60's, which is young by modern medicine standards. She had been a heavy drinker for years and developed cirrhosis (i.e. liver disease). She came into hospital jaundiced with hepatic encepholopathy. When I first saw her, she was barely conscious and gasping for breath. I wouldn't have been surprised if she died that night. I probably wouldn't have remembered her if she did because, at that time, she wasn't my patient.
A few days later she started looking much better. She was still yellow from jaundice, but level of consciousness improved and she was coherent, chatty even. She constantly complained about pain, but she seemed otherwise well. Since she was out of her "rough patch", my team thought she was stable enough to be followed by a medical student, so she became my patient.
I had a chat with her and her husband and they were both overjoyed that she was doing so much better. They started telling me their life story: how they met, about their kids, about their dog. They mostly told me about their dog. They were both beaming. They were the couple that all hopeless romantics want to replicate when they go through their golden years. We had a nice talk.
Then the hepatologist, or liver doctor, came in to talk with them. He had a doom and gloom expression on his face. I thought he was just stressed out from working too much. He told the couple how the patient's Child-Pugh score, a prognostic indicator, showed that she didn't have very long to live. They were shocked. The husband asked if he should go back to their home, a day's travel away, to get more of their things so he could stay in town for longer. The hepatologist suggested he stay in the hospital; he didn't have time to go back home. Turned out the doom and gloom expression was warranted.
The patient went downhill quickly. She was struggling to breathe, constantly in pain, and often incoherent. The family was begging us to do anything and everything to save her. I understood their motivation, but I kept wondering why they couldn't see that nothing we did was helping... yet, they kept demanding we do more and more.
My attending came in to have a chat with them. He explained that we could no longer save the patient; her disease was progressing faster than our medications could treat it. He told them that we should stop trying to fix her and focus on making her comfortable... preparing her for death.
The way they were demanding more care, I thought the family would be up in arms. Instead, they all looked relieved, almost happy. In fact, they had realized that our medications weren't helping the patient, but they needed a doctor to tell them that it was ok to stop. They didn't want to be the ones to say "it's time for my wife/mom/sister to die"... They needed a doctor to tell them that it was okay to let their family member pass away, peacefully.
On that last day, the husband asked me if I could stay with the patient while he ran an errand. He wanted to make sure that she didn't die alone if he wasn't back in time. Normally, I refuse these types of requests because I have a lot of work to do in the hospital and it is generally unreasonable to ask a doctor (or med student) to sit with a patient while their family runs errands, but something in his expression stopped me from dismissing his request immediately. I asked him what errand he had to run.
"I have to go get our dog... she needs to see him before..."
I waited with her.
Fortunately, she was able to see her dog, in fact, she spent the whole night with him. She died peacefully the next morning surrounded by her friends and family.
Sunday, February 27, 2011
Internal Medicine as a Med Student
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:
Positives
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.
Negatives
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.
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:
Positives
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.
Negatives
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.
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