Friday, August 31, 2007


It's ten weeks into internship, and I feel surprisingly down, bored, and unmotivated. I can barely get through my long days, which consist of pre-rounding on a bunch of patients whose exams and complaints don’t change from one day to the next, ordering a handful of tests on the computer, rounding for at least an hour, trying to track down all those test results, and then dealing with the pleasure of figuring out my patients’ social situations and dispositions since half of them have nowhere to return to upon discharge – except the street, of course. My day is capped off by going home and having no energy to do anything -- read, socialize, or enjoy previous hobbies -- but sleep.

I am depressed that I don’t get to do anything hands-on for any of these patients to help them get well (unlike the surgeons and emergency room doctors who do lots of procedures), and I am completely uninterested in dealing with all the patients’ medical problems (as opposed to just the one acute issue bringing them to the hospital).

I hate spending hours on rounds. I want more doing and less discussing. I don’t care anymore about patients’ social issues. I actually don’t care much for patients anymore either. I don’t want to be shat on by other services. And most of all, I can’t stand to be around the few of my co-interns who are “having a blast” this year.

Although I hope not, I wonder if this entire "journey" is a mistake. Hopefully this is simply the plight of the intern, and not me having chosen the wrong specialty (internal medicine) ... or, the wrong field entirely (medicine).

Saturday, August 18, 2007

I Should Have Gone Into Surgery

Title says it all. But in case you want additional details, here are a few:

They focus on just one problem
While medicine doctors focus on the acute problem during patient hospitalizations and clinic visits, they also have to address ALL other problems (hypertension, diabetes, lower back pain, anemia, etc.) Surgeons, on the other hand, address only their body part of expertise and that’s it. No more optimizing a cardiac patient's complex problems ... and then having to deal with their random bowel incontinence they get once a year.

Their history and physical are focused.
This is the best part. Based on your specialty, you can focus your questions and exam to just that one organ system. Examining the body head to toe gets to be quite tedious and rarely do you uncover a hidden physical finding that changes your management plan. I would love to just examine the abdomen and then be done.

If not altogether unnecessary.
Given how dependent the medical field has become on imaging these days, who cares what the patient complains about. You don’t care as much about chest pain when the echo shows aortic stenosis, and you definitely don’t care if a patient can’t move their arm when an x-ray shows a huge spiral fracture.

They know how long their patients will be hospitalized.
OK, THIS is the best part. Surgical patients fall into one of three categories: pre-op, intra-op, or post-op, and each period usually lasts several days. This is great for morale -- the physician’s morale, that is -- and patient turnover. No more rocks on your service!

They wear scrubs everyday.
I am not as passionate about this reason, but if I could bring my dressing time in the mornings from 15 minutes down to 1, that would be great. Although, I do look pretty good in shirt and tie ... .

Their notes are brief.
No, THIS is the best part, and it's a by-product of the “they focus on just one problem” reason. I would love not to be bogged down by writing notes, which often takes close to an hour with a full load of patients. Surgeon notes are often overly terse, but they convey their message well; on the other hand, medicine notes document every piece of information ever tied to the patient, whether they’re lab values, antibiotic histories, or elementary school grades.

I know some of this might be overly simplified, but it does capture the essence of how I presently see things.

Saturday, August 04, 2007

No Longer a Medical Student

While I know that I'm now an intern, I often forget it. In other words I sometimes forget I am no longer a medical student. I am no longer just a tag-along member of the team that needs to feign non-stop enthusiasm and over-eagerness. I am now the intern, and so I'm one of the "real" team members. I can now behave how I want instead of the way that I think will earn me good evaluations.

As a med student, I would only speak when spoken to, cling to the team like glue during rounds, and make sure not to do anything that wasn't directly related to patient care. Now, I speak whenever I want, I walk away from the team at any time during rounds, and say I receive a text message during rounds ... that's right, I whip out my phone right there and reply back.

I realize I probably sound unprofessional -- and perhaps even assholic -- but whatever, I have earned my new position, I am working hard, and so I enjoy taking these little liberties. It's all I have to get me through the day.