Friday, September 14, 2012

Internal Medicine...Done

Last week I finished my internal medicine (IM for short) rotation. Twelve.weeks. It was long, varied, intense, but ultimately a really good experience.

The last four weeks were rather blah and mundane in schedule and in content because much of it was devoted to outpatient--a mind-numbing experience for a medical student, or at least the one in the mirror. I mean really, how many hypertension follow-ups can one see before becoming bored! One good thing, however, was my partner and I were the first two medical students in the hospital to use the Electronic Medical Records (EMR) system. Talk about intimidating!!! We were actually  able to log in to a patient's record, edit said record (though not completely), and hash out notes and templates. It was quite the learning experience that we shared with our attending. This was, for me, a rather unique experience because the attending is my teacher, but now we were learning together. In many cases I would be teaching her because I had seen the patient first and fought with the computer for fifteen to twenty minutes attempting to catalog and transcribe a patient's medical history from often-illegible charts. It was quite the challenge!

The rest of the experience was spent being much less hands on than the first eight weeks. Given that the first four weeks (lost yet?) were an intense crash course in writing H&Ps, SOAP notes, formulating your own A/P, and getting use to the intensity of rounding on a dozen patients first thing in the morning, having to write two "measly" H&Ps and present them to a doctor who might care, or might rather discuss her childrens' future medical education (the oldest child being seven...) wasn't much of a challenge. The challenge would come in trying to write down all her pearls of wisdom when she chose to share a week's worth of information in about four minutes. All the while pagers are going off like mad, ICU patients are hacking on their own phlegm in the next room, and bloody annoying nurses and respiratory techs are laughing incredibly loud about God-knows-what in your ear. I did learn about more about the care of ICU patients though. 
I learned how to read and interpret ventilator settings, pull a week's worth of patient history out of a forty-seven page chart and a patient in about ten minutes, and ever-improved my patient presenting skills.

Here are some of the things I saw:

Fecal Occult Blood
Multiple cases of Cocaine and heroin abuse and subsequent withdrawl
Alcoholic Encephalopathy
Pleural effusion
Gallstone Pancreatitis
Alcoholic Hepatitis
Decerebrate Posuturing
Cellulitis (including a particularly nasty bout)
Absence Seizures
Chest Pain
Chronic PUD
Lung Carcinoma
Acute Renal Failure

...and many many others!

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