Anyone likes internal medicine but not MICU?

[salmonella]

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This is an MS4 here...I love outpatient and ward medicine but did not like my MICU rotation at all, so now I'm thinking about internal medicine may not be right for me. Do you guys ever feel this way?

 

[sacrament]

This is an MS4 here...I love outpatient and ward medicine but did not like my MICU rotation at all, so now I'm thinking about internal medicine may not be right for me. Do you guys ever feel this way?

Regardless of what specialty you enter, there are going to be aspects of the training that you don't enjoy. Some radiologists hate reading brain MRIs, some general surgeons dread their ortho rotations, etc. This is not a problem you're going to escape.

 

[gwen]

you may not like it now. i also wasn't too thrilled with my brief MICU rotation as a student - it did not stop me from pursuing IM. then i did two micu rotations as an intern, 1 as a second year and 2 as a third year resident. i totally LOVED it. its a controlled environment, you don't really have to run around the hospital (unless there's a code, of course), the nurses are usually the best trained nurses in the hospital, when you ask for something - it happens right away. yes, people are sick, really, really sick...but its the best pathophysiology lesson you could ever ask for. i don't know...think about it...

what is it that you don't like about it right now? busy? don't understand things? people too mean?

 

[salmonella]

I actually really enjoy the medical science aspect of MICU: ventilator management, fascinating pathophysiology, real-time monitoring systems, the fast pace, relative lack of insurance issues. The only thing I don't like is, having to coordinate patient care with so many different subspecialists. Most patients get nephrology and ID consults, neuro for altered mental status, hem/onc for cancer management, palliative care for end of life issues..... I find it very stressful chasing down these consults all day and having the primary responsibility to coordinate things with everyone. Can anyone comment on this?

 

[Mumpu]

You only have to do a few months of MICU as a resident, then you don't have to see it ever again if you don't want to. There are plenty of P/CC hotshots out there.

 

[clueless1]

I personally HATE the MICU (and all units, frankly) with a passion... It might be interesting, but the amount of work/stress that goes into it just overwhelms any intellectual stimulation one might garner from it. Even if you're interested in the medicine aspect of it, what's to like about working 32 out of every 48 hours, being constantly tired, having no life, no nightlife, and never being able to string 2-3 days off in a row to actually do something/travel/rest adequately? It befuddles me whenever I meet people that like the unit...In addition, I hate doing lines, and pretty much all procedures for that matter. They are time-consuming and require a level of OCD I just can't handle.

I guess I just never feel comfortable in the units, always feeling like all the patients are on the edge of disaster (and they usually are), and you go through a whole month of feeling nervous and anxious. Some people can relax in that environment, but I just can't. To me, it's just 1 long month of feeling really tired and really anxious/scared the entire time I'm there. Not my idea of a good time...of course, I think it's all about how your personality jives/doesn't jive w/ the unit.

Not a dig at the units or anyone that likes them...I'm happy there are P/CC whizzes that want to do that stuff - they're usually really sharp and some of the best residents. Just my non-CC-inclined opinion of the units, and evidence that you can hate the units but still be fine in the world of medicine. At least, I think I'm fine...

 

[coogmed]

I personally love the unit - give me the deathly ill over the worried well any day - but I don't think it's prohibitive for IM at all - either as primary or as a specialty for you to have to love the unit (i feel dirty just saying that 😀 ) . Allergy and Rheum are 2 in particular. Other subspec. will have to grace the halls of the MICU (ID) but can spend a decent amount of time outside of it.

Like prev. posts, I think the real issue at hand is finding what you don't like about it and zeroing in on that- it will more likely bring you closer to your answer. Is it death and dying issues? The hours? Going home with the sound of respirator alarms dancing in your head?

 

[BigBadBix]

The only thing I don't like is, having to coordinate patient care with so many different subspecialists. Most patients get nephrology and ID consults, neuro for altered mental status, hem/onc for cancer management, palliative care for end of life issues..... I find it very stressful chasing down these consults all day and having the primary responsibility to coordinate things with everyone. Can anyone comment on this?

I would imagine that this depends in large part on where you are practicing. In the MICU at my current institution this was definitely not an issue. We really didn't get that many consults, and certainly not any more than we got on the medicine ward patients. Also, for whatever reason, it felt like I spent *less* time tracking down consults and coordinating care in the MICU than on the floor. The specialty services recognized when issues were urgent and would give us a quick call if they had time-sensitive suggestions. Otherwise, I would just get around to looking at their notes when I had a chance - it wasn't something I spent a lot of time stressing about because I was so busy with everything else.

Of course, I'm biased because I love the MICU, but I really don't think the consult thing is a universal issue. And I agree with coogmed that disliking MICU shouldn't prevent you from pursuing IM. I'm on geriatrics now (basically covering a nursing home) and I HATE it. My attending, on the other hand, openly abhors critical care and has found a job where she gets to completely avoid it. I think it's pretty unusual that someone would like every part of IM given that it's so diverse. As long as you can put up with the MICU for a few months of residency I think you'll be fine. (Plus, you never know, it might grow on you!). 🙂

-BBB

 

[Benzo4every1]

love the micu. one of the reasons i went into internal medicine. more than likely will pursue a fellowship in pulm/cc. who knows? LOL. my goal: survive internship 🙂