1) I really don't like inpatient medicine
I've said it before and I'll repeat myself here. Inpatient medicine, at least at the academic hospitals I've worked at so far, depresses me. The people I've worked with are generally quite nice, supportive, and capable, while the medicine is deep and interesting, but there are so many system-level problems that it makes the whole thing unbearable for me. Patients, doctors, learners and other healthcare workers all seem to get a pretty raw deal. Some of these system-level issues will get addressed or even solved in the coming years, but a lot of them won't. Large academic centres are huge beasts with so many competing priorities and parties with different objectives that solutions come slowly or with unwelcome side-effects. Hard for me to see me spending my life dealing with those challenges.
2) I really, really don't like inpatient consult medicine.
If there's one part of inpatient medicine that exemplifies my dislike for it, it's in the use of consulting services. Consulting services are basically experts in a particular field who are brought in to help with particularly challenging patients with established or potential diagnoses in that expert's area of study. That sounds great in theory and it works reasonably well in outpatient medicine, but for inpatients it's crippled by one major issue - the consults are caring for the patient at the same time and communication between all parties involved is horrible. It's like cooking a meal with 4 chefs all trying to make a good meal, but all attempting to make a different meal and only occasionally telling the other chefs their plans, ideas, or intentions. Not a good system.
For the record, patients see this terrible communication system and they don't like it at all. However, as I did before I started this rotation, they blame individual physicians. That's not entirely false, some physicians are terrible communicators too, but the more fundamental problem is our system is not set up for effective or efficient transmission of information. Even the most well-intentioned, capable physicians will not coordinate care nearly as well as is necessary, it's just not routinely feasible with the processes currently in place.
For the record, patients see this terrible communication system and they don't like it at all. However, as I did before I started this rotation, they blame individual physicians. That's not entirely false, some physicians are terrible communicators too, but the more fundamental problem is our system is not set up for effective or efficient transmission of information. Even the most well-intentioned, capable physicians will not coordinate care nearly as well as is necessary, it's just not routinely feasible with the processes currently in place.
3) Lots of independence - and lots of learning
Internal is amazing for reinforcing the basics of medicine. A reasonably high emphasis on teaching is a big part of that, but the main element is independence. When you're responsible for your own work - and you get quite a bit of it - you have to learn to survive. Plus, since it's all contextual knowledge, it sticks in your brain pretty well. It's like studying without the pain of studying!
4) Lots of independence - maybe too much
The downside of independence is that it can be given too quickly, putting students and other learners in a position where they have more responsibility than they can handle, or have to complete tasks beyond their training or experience. This has happened... frequently. It's awkward for trainees, difficult to address for instructors (who generally have to put the trainees in that situation or go to extremes to avoid it), and potentially hazardous for patients. Yet, it's how much of medical education seems to operate - sink or swim, even if it means dragging patients down with you.
5) Be Nice to the Nurses
When someone comes into hospital, they're not there for the doctors, they're there for the nurses. Doctors can't do that much more in hospital for patients than they can out of hospital, but nurses are essential to maintaining health while the reason for coming into hospital is investigated and managed. The further along I got in the rotation, the more I learned to lean on nurses for their perspective and expertise. I've got more than a few than a few stories of suggesting a treatment plan that came directly from a nurses' mouth that had a positive impact on patient care (I always tried to give the nurses credit, though that positive feedback never gets back to them as often as it should).
5) Be Nice to the Nurses
When someone comes into hospital, they're not there for the doctors, they're there for the nurses. Doctors can't do that much more in hospital for patients than they can out of hospital, but nurses are essential to maintaining health while the reason for coming into hospital is investigated and managed. The further along I got in the rotation, the more I learned to lean on nurses for their perspective and expertise. I've got more than a few than a few stories of suggesting a treatment plan that came directly from a nurses' mouth that had a positive impact on patient care (I always tried to give the nurses credit, though that positive feedback never gets back to them as often as it should).
6) The Happiness Test
I hate to say it, but at least when it comes to people on the clinical teaching unit, the answer is no. They put on a brave face, but most are more than willing to admit that they do not like their time on the CTU. It actually causes a bit of a vicious cycle, where residents try to take vacation during their CTU blocks to spend less time there, thereby increasing how much work there is for everyone else to do and making CTU that much less enjoyable. While interest in General Internal Medicine has grown, most people in Internal seem to merely tolerate general medicine itself until they can sub-specialize into what they actually want to do. The result is a number of not-so-happy people on rotation. Considering my own level of happiness on the rotation, I don't blame them.
I hate to say it, but at least when it comes to people on the clinical teaching unit, the answer is no. They put on a brave face, but most are more than willing to admit that they do not like their time on the CTU. It actually causes a bit of a vicious cycle, where residents try to take vacation during their CTU blocks to spend less time there, thereby increasing how much work there is for everyone else to do and making CTU that much less enjoyable. While interest in General Internal Medicine has grown, most people in Internal seem to merely tolerate general medicine itself until they can sub-specialize into what they actually want to do. The result is a number of not-so-happy people on rotation. Considering my own level of happiness on the rotation, I don't blame them.
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