So this week was my first week of 3rd year and so far I really love almost all aspects of it. I actually started off on outpatient (meaning not in the hospital and more so in a doctor’s office setting) for Internal Medicine so right now I am pulling 9-5p days with my weekends being free. I really have a great attending who really does enjoy his patients and who enjoys teaching students. Everyday he will take time to go through an important topic that I will probably face on this service like hypertension, diabetes, or cancer. He also gives me a fair amount of autonomy; he will go and see a patient in room 2 and give me the chart for room 1, telling me to present the patient to him once I am done seeing the patient. I am really not all that bad at interviewing patients verbally, but when it comes to writing everything down in an organized fashion on the progress note sheet I really had a hard time. But the great thing about 3rd year is that with practice you will eventually get better at it,and by the time this week was over my progress notes were definitely 10x better. I appreciate my attending also because he encourages me to think about the Assessment and Plan of my progress note. As a medical student it is very easy to get complacent and work up the patient via their history and their physical exam, but leaving the diagnosis and management to the attending or resident. What we often forget though is that in 2 years will be looked to for answers on what our patients have and how to treat it. So it makes sense to start the process as soon as possible even if what we write down is completely wrong…at least we are thinking about it.
In my first week as a 3rd year I have really seen how someone could fall in love with primary care. Personally I don’t feel like I am primary care person but certain aspects of it can really reel you in; I really love the fact that your patients consider you to be THEIR doctor in a very personal way. I realized this first hand because my attending is actually leaving soon to do a fellowship in another state and as each one of his patients learned that he was leaving they were expressing how much they would miss him, and exclaiming how it would be so hard to find another doctor as good as him, but how happy they were for him that he was moving on to a higher step in his career. I could also see the slight sadness in my attending who was excited to be advancing his career but who would miss HIS patients tremendously. Having patient-doctor relationships like that can really keep you going from day to day. I have really enjoyed walking into each room, introducing myself, and just sitting down and talking with my patients. Of course I talk about what is going on with them medically, but with some patients (especially the older ones) we talk about their hobbies, their children, funny stories, etc. I really do feel torn at times because my personality equally loves talking with patients and getting to know them, but I also love surgery and the tangible results you get from it…so yeah I’m not set on what I want to do quite yet.
I actually got some nice feedback today from 2 of my patients. I had seen each one and then left the room to present the patient to my attending. Then the attending and I went into the rooms and and he worked each patient up based on what I had discovered and based on what I had forgotten to do. What I like about my attending is that each time he walks into the room with me (after I have examined the patient first) he will greet the patient and then say, “So you have met my student physician, DoctaJay”. And today each patient exclaimed how much they enjoyed talking with me and how nice I was. And then one patient as they were leaving the room once my attending finished with them told my attending, “Keep him around (pointing to me), because he’s good.” I do not at all say this to toot my own horn; these comments from patients are the most gratifying thing I have experienced. You know its like all these years I have worked and studied to get to this point, and the positive affirmation from patients definitely makes it all worthwhile. Now of course some days my patients my not like me as much but I will definitely strive to remember the positive ones more.
One thing that they don’t tell you about 3rd year is that you really have to study almost as much as you did during your 1st year of medical school. Of course you are at the hospital or the clinic for most of the day and afternoon, but at the end of your rotation you have a shelf exam, and you need to be reading and studying every day to prepare for that exam or else you will repeat the rotation. Its been hard this first week to get into the habit of studying when I get home because the type of tired I am is different from tired I was last year. Last year I was tired from sitting in my chair all day and reading the myriads of books and notes. This year though I am tired from being on my feet all day and thinking about my patients; then when I come home, I’m expected to sit in my chair and study for as long as I can. I’m slowly getting a system down but it is still a little challenging. I’m actually very happy that I started off my Internal Medicine rotation in the clinic because I do come home at 5 p.m. My classmates who started off in the hospital for internal medicine only have 4 days off for the whole month which means that they are often at the hospital very early in the morning on weekends. I will be on that type of rotation next month but I am definitely enjoying my relative freedom now. It has been especially hard for my classmates who have kids because most of them just studied at home for the past 2 years. This is the first time that they are going almost 30 hours without seeing their wife or kids and it has been taking a toll on them. Medicine is a sacrifice and for some people, certain specialties just are not worth the time that they are away from their family.
Anyway, life is good; 3rd year is already looking to be like 400x better than 2nd year and I am really looking forward to seeing more patients on Monday.
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