Dec 9, 2012

Goodbye Internal Medicine

It seems totally unfair not to dedicate a post wrapping up the end of intern year Internal Medicine before moving forward to the holiday season which I will spend in 3 honeymoon rotations. However, my recalls of Internal Medicine got really messy toward the end - I guess I will leave that for some other time. Nevertheless I'm glad it was over and thankful for all our residents, nurses, and teachers during the past quarter.
I guess all rotations has its strengths and irregularities, and our hospital's Internal Medicine is no different. Their strength lies in a strong network of support afforded by friendly residents, nurse practitioners, and attendings. Over the past 3 months, they became more than colleagues for us. And I recall a few nights when the on-call resident patiently troubleshoots a problem with me at 3 am, and follows up the patient with me the following morning. True to the saying - you actually learn more during call nights - I met some of the most interesting cases during call nights. I had patients with classical presentations of hepatic hydrothorax, peritoneal dialysis-associated peritonitis, painless jaundice diagnosed as pancreatic cancer, progressive limb weakness diagnosed as a brain metastasis, fulminant hepatitis etc. Seems strange how interesting patients only arrive during call shift.
Starting calls in Internal Medicine is tough as a majority of calls are patients' complaints (aside from missing orders, new patients, meal orders etc). Learning to triage will make one's life easier but depending on the working culture of each ward, more often one has to attend more to nurse's qualms rather than the patient's. However, once you masterminded the game things will get better. Some smart nurses will even settle the problem before calling you ("thanks sweetheart, love you to bits!").

Daytime workload in internal medicine is surprisingly light (because most patients arrive at night!) I enjoyed working with our residents and nurse practitioners who more often than not will spend time discussing one's patient despite their overflowing workload. All procedures are under strict supervision, which is very much appreciated. Most attendings are open-minded enough to listen to and accept one's evidenced opinions if you do have one, which makes rounds and conferences more interactive.
We heard about interning at other hospitals which is less exhausting with guaranteed sleep hours and a lower patient cap, but the hospital kept replying us by quoting more exhausting examples and reminding us to be thankful for what we have.
I personally think learning quality is inversely proportional to the exhaustion you're experiencing. To find the right balance between both is hard but why not give interns the benefit of the doubt? It's also a good way of keeping internal medicine attractive, at least from the vantage point of interns. Privately among ourselves, we talked about liberalizing internship to all 4 hospitals under the Tzu Chi umbrella - an open market, free competition - that would definitely make things more transparent and competitive.
3 months in internal medicine is no easy feat, especially when you're simultaneously preparing for a major exam. I'm only glad it's over but thankful for all that I've learned. Also a blessing meeting visiting Professor Chang (again), and a brief encounter with Prof. Hsu. The hospital spent a lot of money invested in interns but yields remain low with a rigid hospital policy and poor paramedical support. Things are improving, but not in the direction or speed we'd like it to be.