IM boring?

[Fei]

Hi everyone,

I know I'm gonna get crucified for the topic subject above but I must ask for everyone's opinions. I've been on IM rotation for a week now and everyday I come in I just feel that a lot of energy and time is wasted on the floors. The way my hospital works is that med students and interns round on their own, then present it to attendings and seniors and ask for their opinion/permission on how to treat the condition. After that the interns go write orders, round on the patient and report to the senior/attendings. This cycle goes on throughout the day and much precious time is spent waiting for attendings and seniors with not much being done in the mean time. I know that I may only feel this way because I'm still a student and don't have any real responsibilities yet but I see my intern works and I can't ever imagine myself doing that. Don't get me wrong, I love the teaching aspect of medicine, every topics is so interesting in their own rights but rounds and the work type is sooo inefficient and I feel that lot's of time can be save from the frivolous stuff that some internists do. Am I destined to be a surgeon or EM guy just because I want things done more quickly and efficiently. I really thought I wanted to be an internist but after this experience, I can't ever imagine myself doing these things. Please tell me what everyone thinks of IM...

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[Darth Vader]

Unless you become an attending for a teaching hospital, you will not need to "round" with other physicians, rounding will only consist of you seeing your in-patients and doing whatever needs to be done. But if you really don't like IM management (inpt and outpt), and prefer the rush of the ER or like to be the OR, I'd recc that you do that or whatever you like.

 

[chicamedica]

Originally posted by Fei
Hi everyone,

The way my hospital works is that med students and interns round on their own, then present it to attendings and seniors and ask for their opinion/permission on how to treat the condition. After that the interns go write orders, round on the patient and report to the senior/attendings. This cycle goes on throughout the day and much precious time is spent waiting for attendings and seniors with not much being done in the mean time. I know that I may only feel this way because I'm still a student and don't have any real responsibilities yet but I see my intern works and I can't ever imagine myself doing that.

I am an MS-3 who recently finished my 2 mos of IM on the floors (each month at a different hospital), and I can tell you my hospitals did not work that way at all. The whole team (with the attending present 1x per wk) usually rounds together in the AM (around 7:30am), where each member presents his/her pts to the resident or attending. Then we go off to do all that needs to be done for our pts (med students either take charge of writing the orders for their patients, or work with the presiding intern to do orders, depending on how your resident wants to do things)

Depending on whether the team is hospitalist or non=hospitalist, there would be another rounding session with the attending daily in the late AM or early afternoon, which would be sit-down (meaning just discussing each case, and maybe have informal presentations about pertinent topics). I can see how your hospital would seem really inefficient, with so much redundancy.

I should let you know though that IM can be pretty inefficient at times regardless of this, in that many times there is a lot of scut to be done, and by that I mean phone calls to set up CT scans and MRIs for your pts, phone calls to fix a lab order that got botched by the ward secretary, bugging the nurses to get things done, making sure pt got meds that you ordered, and more phone calls. That this kind of scut needs to be done is quite sad, and suggests an incompetent nursing/administrative staff that jeopardizes pts lives and because of their carelessness costs the medical system a lot more money. I don't consider doing procedures like taking vital signs, doing phlebotomy, IV lines, getting X-rays, etc to be scut. In fact I treasure the opportunity to do those things. It's the former that is the real, awful kind of scut that I despise. The nursing recruitment/training really need to be majorly revamped. My apologies to the select few good-hearted, hard-working excellently trained nurses out there. My words are obviously not directed at them, in fact they have my eternal gratefulness.

 

[Da Vinci2]

I don't think IM is boring. I did two months of IM rotation as a third year, and a month of AI. Both turned out to be one of the most interesting months in medical school. Granted there are "scutwork" like mentioned (which got me frustrated plenty of times), but that exists in every field. If you go into surgery, you have to do consents and the likes. And if go into ER, there will be plenty of addicts/homeless who came into the ER wanting a chest pain workup, along with a place to stay for the night with warm meals. Just find out what drives you; I don't think there is field that is perfect in everyway.

 

[oldandtired]

"I don't consider doing procedures like taking vital signs, doing phlebotomy, IV lines, getting X-rays, etc to be scut. In fact I treasure the opportunity to do those things"

Gosh, if I could be young and naive again. In four years when this medical student is a jaded resident, he will wonder what the hell he was thinking

 

[MD'05]

... it's an opportunity for me to sit on my big, fat a*s and give my feet a rest or go on a great adventure trying to find the pharmacy in the catacombs of the hospital ...

 

[RADRULES]

Thank god for the fleas, and the future generation of fleas. Good luck.

 

[powermd]

I'm an M4 now and found most of my third-year clerkships boring as hell, mostly because of the lack of real responsibility, nebulous expectations, life as a perpetual transient, and, of course, shelf exams. The clerkships I most enjoyed were those that gave me direct patient responsibility- IM, surgery, emergency, and OB/GYN when I would go on ER consults by myself.

The quality of an IM rotation is very much team and attending-dependant. I was fortunate enough to work (mostly) with attendings who cared about efficiency and wanted to keep rounds as short as possible so the interns could get their work done. One liked doing the whole 5-hour walking rounds thing.. ridiculous. But alas, this young, attractive, and brilliant attending was quite easy on the eyes if you know what I mean, so it was more than tolerable.

I recently did my medicine sub-internship and the experience was outstanding. I had all the responsibility of an intern, with the exception of needing co-signs on my orders and notes (which were treated as a mere formality). It was amazing what a difference real responsibility made in how much more I cared about my patients, and my job (doing thorough exams, asking the right questions, ordering appropriate labs and treatments, and keeping in contact with both service and private attendings and consultants- and the stupid scutwork like SW consults, requests for old medical records, etc.). My advice to anyone considering IM is to do your subinternship early on in the fourth year so you can really feel what IM residency is like.

Incidentally, I am going into anesthesiology. But I still love IM and respect those who choose it!

 

[chicamedica]

Originally posted by oldandtired
[B
Gosh, if I could be young and naive again. In four years when this medical student is a jaded resident, he will wonder what the hell he was thinking [/B]

excuse me, I'm a SHE. there are female med students around nowadays. . .

 

[Fei]

I totally agree with PowerMd for this one. Third year clerkships are boring as hell. What's the point of doing a thorough exam and writing up an awesome note if no one cares about it and it really is not worth anything because someone else is going to do all that crap over anyway. It's really discouraging when you have no real responsibility and all your clinicial decision are second guessed and scrutinized. I know I still don't know anything yet as an M3 but give me a chance to at least guess on the management strategies of these patients. I'm speaking for all the 3rd year rotations. I feel like I'm just there for frivolous multiple rounding sessions and horrible pimping episodes to satify seniors and attending's sadomasochistic urges. I hope this will change as the rotation goes on because right now I feel like I'm just a tech or assistant doing repetitive scut works that a train monkey could do. Attendings and seniors should know that we can handle more than this. Come on we've spent 7 years in school already for this stuff...

 

[ckent]

Originally posted by Fei
I totally agree with PowerMd for this one. Third year clerkships are boring as hell. What's the point of doing a thorough exam and writing up an awesome note if no one cares about it and it really is not worth anything because someone else is going to do all that crap over anyway. It's really discouraging when you have no real responsibility and all your clinicial decision are second guessed and scrutinized. I know I still don't know anything yet as an M3 but give me a chance to at least guess on the management strategies of these patients. I'm speaking for all the 3rd year rotations. I feel like I'm just there for frivolous multiple rounding sessions and horrible pimping episodes to satify seniors and attending's sadomasochistic urges. I hope this will change as the rotation goes on because right now I feel like I'm just a tech or assistant doing repetitive scut works that a train monkey could do. Attendings and seniors should know that we can handle more than this. Come on we've spent 7 years in school already for this stuff...

I'd just advise you to be patient, and speak up about asking for more responsibility. As a third year, people expect you to know nothing and that's oftentimes the case with many students. I wouldn't be too upset about those pimping episodes either, you shouldn't think of them as "masochistic urges" but rather opportunites to prove to your senior and attending that you know your stuff and opportunities for you to learn. Also, if you were a patient, wouldn't you want all of the third year medical students decisions "second guessed"? Your time for complete patient care responsibilty will come soon enough, for now, just try to learn as much as you can.

 

[Fei]

thanks superman. I'm a human information sponge this year. But yet I still wish for at least something to do to pass the time and incredible boredome...