Medicine: Hit the Ground Running!
>> Wednesday, July 20, 2011
Time flies when you hit the ground running, and oh boy did I hit the ground running! I began my medicine rotation at the beginning of this month right after July 4th. I'm currently finishing up my first rotation site at the end of the next week.
Right now I'm still on the hospitalist team. This experience has been amazing in so many ways. First, the "amenities": at this rotation site, my day begins at around 8am and finishes whenever I complete my work (usually between 3pm and 5pm). We admit patients to our service everyday and so there is no call - which is amazing. But the best part of this site is working with the hospitalist one-on-one and his/her physician's assistant (PA).
The hospitalists give med students a ton of responsibility and independence starting on day 1, which is exactly what I wanted and needed (and secretly feared, haha). On day 1, I remember I had to take a full history and physical (H&P) on a patient who was newly admitted, all by myself. And then I had to present the case to the hospitalist, come up with a differential diagnosis, and a treatment plan. On day 2, I checked up on my patient (pre-rounded) before the hospitalist did, presented my updates to the hospitalist, and wrote a medical note. By the end of the first week, I had done many of the things that interns in residency would be doing - examining the patient (doing the H&P), writing notes, coming up with an assessment and plan for the patient, writing orders (these had to be signed by the hospitalist, of course), and calling consults if the patient's problem was too complex for our team alone. And I did all of this mostly by myself. For the first time in med school I felt like I was really doing what I would be doing for most of the rest of my career.
And I had some great patients from whom I learned a lot of medicine. My first patient came in with congestive heart failure, my second with Crohn's disease, and my third with a UTI that lead to SIRS and subsequently sepsis. And by the middle of the second week, I had call consults from plastic surgery, gastroenterology, cardiology, and neurology services to come see our patients and advise us. Again, all of this pretty much by myself and at my discretion (of course I had to make sure the hospitalist, who's overseeing me and my patient, agrees). I loved feeling like I was actually contributing to my patients' care and helping them get better.
I honestly couldn't have asked for a better experience. Yes, it was intimidating at times, especially when my hospitalist basically says to me, "We have a newly admitted patient. Please go see him/her, start doing what you think should be done, and tell me what you think." And yes, it can be difficult answering the hospitalist's questions since I'm still trying to figure out what is the most important info to know, clinically.
The hospitalists change every 2 weeks or so, and by the end of my first 2 weeks, the first hospitalist I had been working with complimented me on my improvement from day 1 to when she went off service. I had started as a freshly minted M3 student, fumbling around and almost scared of making mistakes. And in less than two weeks, I had become more confident and comfortable around patients, working with them, and doing what I thought was necessary to help them. She was so happy by my progress that she offered to write me a letter of recommendation for residency, when the time came. That is, quite honestly, one of the highest compliments an attending physician can give to a med student - and I felt quite honored.
I hope that I can keep up this momentum and continue to improve over the course of this academic year, to learn from all of my patients and to help them. This is, truly, why I decided to do medicine.
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