Follow-Up On My Sub-Internship
The rumors of my demise have been greatly exaggerated, even though my first night of call as a sub-intern was incredibly, incredibly painful. It’s scary to actually admit it, but I… kind of enjoyed my Internal Medicine sub-internship. Yes, I know, this is crazy talk, especially having found my prior medicine months a bit slow, but the constant hypervigilance required to make sure all your patients’ labs get drawn and studies get done is, in a small, small way, similar to the constant nature of the ED.
I enjoyed it so much, and felt so comfortable managing the patients there that I even wondered for a few minutes, “Am I going into the wrong field?” Of course all my medicine colleagues asked me the same thing, and always had their own opinions about Emergency Medicine (I’m used to getting ragged on by pretty much every service by now, so it’s fine).
Calls went incredibly smoothly–probably another reason I enjoyed the month so much. We only capped (received the full number of patients we’re allowed to have) twice in the entire month, once on our first day, and the other we’d capped by 11am, since most of our patients came in overnight and were already tucked in by a fantastic night float resident (thank you, Cheryl!). Taking a note from the ED playbook, I was king of dispo, able to discharge half of my patients by post-call time! (Which often makes you wonder if they needed to be admitted in the first place.)
I definitely learned a ton, and feel comfortable writing diet and DVT prophylaxis orders now. Overall, a really great month.
I think the deal-breaker, however, is summed up today in clinic. I was reading the latest ACEP Newsletter. In the Tricks of the Trade session (written by an awesome mentor of mine, Dr. Michelle Lin!), she mentions unique uses for wall vacuum suction, including how to remove a foreign rectal vegetable using vacuum tubing and bulb suction. What other specialty talks about that in their monthly newsletter?
Do you mean “the constant hypervigilance required to make sure all your patients’ labs get drawn and studies get done” or “the constant hypervigilance required to make sure [I order] all [of my] patients’ labs and studies, [which an RN must then collect and send independently.]“
The former, Shawn, not the latter–I had frequent problems with labs and studies being correctly ordered, but not being drawn. This was a problem when you’re asking for q8 hour troponins to rule out an MI.
you can have the best of both worlds – consider a combined internal medicine/emergency medicine residency. i’m a happy resident in my final year of such a program. i had a similar med school experience: thought i was going to do ER but really liked medicine once i rotated on it. the rest is history….
http://combined.imem.uic.edu
(ps: i’m a bit envious of you – i spent a year at stanford doing health econ research in between undergrad and med school, while living up in the city. i look back on it with very fond memories.)
Graham, we’ll miss not having you in internal medicine. You’d make an awesome medicine doc!