IM - feeling useless, dumb, and in the way

[PreMedAdAG]

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So up until now, I suppose everything on rotations has been okay. I didn't exactly like OBGyn and felt dumb most of the time - but it was okay - b/c I did well on the shelf and convinced myself that I was awesome - ha ha - anyway - then came psych - the one I fell in love with - the one I will pursue - everything else seems soooooo boring now! I felt like a master in psych - I navigated the patients well, I knew what to order, I knew what to say - and what to do - but now on medicine I'm like this frieking ***** who doesn't know anything...

Read an EKG you say? Change someone's vent settings? Understand their acid-base disorder - speak in the dialect that internists do???

I'm just soooo blown away by how frieking hard medicine is to grasp on the IM rotation. I just feel like I spend my time spinning wheels.

"Hey you, make sure they do the SBT, if not get him back on A/C with a peep of 5 and TV of 550"

rrrrright - now for the most part I can go around asking a nurse what the hell an SBT is - and then I get the vent settings cool - but where am I going ot read about how to manage someone's airway if not in my Case File book, or my Medicine First Aid - or MKSAP - I'm NOT!

The expectations of medical students is so high, yet the resources and time they give you to learn is so little. I'm no superman when it comes to knowledge- I'll admit - I couldn't remember what you do with someone when their chest X-ray looks infiltratey or wet -

...but I did manage to successfully pass 1st year, 2nd year, and step 1 - so why do I feel like such a bafoon and soooo distantly far from acting and knowing my **** like an intern does?

When does it click?

End rant.. thank you for letting me vent - sorry if sentences don't make sense - I was having a modified free association moment there!

 

[lumbering]

I felt like I could do a decent amount on Medicine. On OB-Gyn, I'm totally worthless.

I don't know what you're talking about with the vent settings. I doubt my attendings knew that. With EKGs, I could pull my weight, and I'm decent with acid base disorders and fancy jargon. I was never expected to function on the level of an intern (though I did crack the case once: laryngospasm as the explanation for treatment resistant asthma).

Hang in there honey. The learning curve is steep. You'll start to feel comfortable with common diseases after a month. Skip out on scut and have deep conversations with your patients.

 

[Anka]

It sounds like you understand what the problem is -- mainly understanding the dialect. Luckly, this will come quickly. When it does, you'll feel like you understand a lot more of what is going on. You've also identified some of the core areas for a clerkship student on medicine -- acid/base, what to do when lungs are wet (LASIX!), etc.

As far as the intricacies of vent management, you don't need to know that yet. You should know what you probably learned in pulm, i.e. that oxygenation and ventilation are two seperate things that you can manage independently with a vent. Management of someone's airway is different -- you should focus on the ACLS algorithm material and some of the hard indications for intubating someone. Knowing what vent settings are good "starter" settings are more an intern level thing, although if you get a sense of that it's great.

EKGs are hard. On the shelf, the EKGs tend to be easy, or the case will be such you can narrow it down to a couple of possible answers just based on the text. That said, try Dubin for a quick drill based intro that will get you as far as you need to get. Other than that, looking at every single EKG that comes your way helps a lot -- even better if you can go over them with your resident. Same goes with chest films and belly films.

Most important thing? Work hard, DON'T skip out on your team, think through things and, when you're really confused, say, "Hold on, you want me to do WHAT???" And don't lose sight of the fact that you are going to get better fast.

Best,
Anka

 

[Blade28]

You won't have to know vent settings until late in your intern year, if not early in your PGY-2 year.

 

[haveaniceday]

I totally agree with you, IM was a lot harder than I anticipated. MUCH harder than surgery (even hours were sometimes worse)...I found my confidence at an all time low during that rotation and, like you, wondered what was up as I had passed 1st, 2nd, step 1, etc. But, now that it is well-over I am astounded at how much I learned and how comfortable I feel in almost every other rotation because of it (I am now 2 rotations out from that beast). Hang in there!

Vent settings are good to know if you find yourself on an ICU rotation, I don't know how your rotations work, but you may even admit some of your IM patients to the ICU on this rotation. In that case, clearly you won't be the one actually managing the vent (leave that to the resp techs and/or pulm/cc fellows), but you will have to report settings as part of the vitals when you present, and understand what you're talking about. You may get pimped on how to adjust, why, so know this. Very intimidating! I was there and it was frustrating, but I really feel good about learning that and now will hopefully be less intimidated as an intern/resident because of it!

 

[plastikosmd]

"You won't have to know vent settings until late in your intern year, if not early in your PGY-2 year"

depends on the program...my first month as intern was CT icu and stepdown, staff by 2 interns and a 3rd year with rotating call (our only Q3 unit..all others were q2). all vents and drips, pacers and tubes day 1. heck i had to figure out how to set up a VDR vent one night my first week, thank god for a sub-i in a unit prior to starting and helpful nurses and resp. techs.

 

[PeeWee137]

i been there dude. i fell in love with psych mid-way thru 3rd year, and then ended my rotations with god-awful medicine. looking back now, there was alot of medicine in my psych rotation, and vice versa. we had medical rounds weekly for the psych inpt's and they would put people on meds for diabetes/metabolic syndrome etc. i didnt pay too much attention then, but when i got to medicine and heard all the names again, i'd remember one of my pts was on that. you will get the hang of it soon enough. you will need to know your medicine even as a psych resident, so keep that in mind. (although i doubt you will ever have to change vent settings). just keep your ears open and you will be surprised at all the knowledge you pick up. and after all this, if you find that you still really hate medicine, try to find the psych in it, cause its everywhere. go chat up the alcoholic or the drug seeker. sit with the cancer pt going thru chemo. try to do an endocrine elective, lots of those conditions present with changes in mentation. you get the drift. you can do iiiiiiiit 👍

 

[premed7]

Does anyone have any suggestions on how to study/read throughout the rotation. Is it better to read up on patient's problems, or better to read a particular organ system at a time. I feel like if I try to read up on patients, I'm looking at numerous problems involving mulitple organ systems and it just gets confusing. But I don't think reading individual chapters in Step-up would be any better. I'm using Step-up, case files, and MKSAP. Any ideas on how to organize my study time?

 

[haveaniceday]

you've got to do what works for you. Step 1 was kind of when to study based on organ system...now you have real patients with all the organ systems and you need to be able to integrate. So, I suggest read based on patient's problems and whenever you come across something you don't understand, look it up. This may divert you from what you originally looked up, but you have to begin to put it all together and this is what worked for me. Pocket Medicine is a great quick reference on the Wards and uptodate is of course great and you can get onto it from any computer in the hospital (i've yet to be at a hospital that does not subscribe).

 

[PreMedAdAG]

Internal Medicine is a slow painful death

what is even more exciting is how my resident goes on and on about how psychiatrists are worthless and it's not an evidence based field - and they know nothing about medicine -awesome - glad that I'm going into psychiatry so I don't have to hang out with arrogant people like that -


this rotations had made me want to quit medical school - seriously - if it weren't for the debt I'd be outta here - it's so not worth it...there are plenty of other ways on this earth to help people out without the pain of medical school.


maybe it's because I'm overly tired, maybe it's because I'm getting sick, maybe it's because I spend more time in the hospital than any other med student I know b/c I'm FORCED to stay by my team... maybe I'm just weak - I don't really know - or care at this point - I just want to be done with this life sucking journey -

ahh.. that felt good

 

[Tired]

what is even more exciting is how my resident goes on and on about how psychiatrists are worthless and it's not an evidence based field - and they know nothing about medicine -awesome - glad that I'm going into psychiatry so I don't have to hang out with arrogant people like that -

I've heard IM called a lot of things (dumping ground, fleas, etc) but never arrogant.

 

[Acherona]

I am so looking forward to the end of IM. No more 14 hour days, no more being shat on and told how much I suck on a daily basis because I haven't memorized my patient's alk phos values since 1956, or I didn't call the immuno lab for the nth time to check up on that ANA which btw is completely useless for the patient's management.

i thought i went into medicine but it looks like i went into some weird combination of politics and menial labor.

 

[PreMedAdAG]

I've heard IM called a lot of things (dumping ground, fleas, etc) but never arrogant.

um................ what fantasy land hospital do you work at?

 

[Old_Mil]

I just want to be done with this life sucking journey.

 

[Blade28]

um................ what fantasy land hospital do you work at?

...because you think the guys from Internal Medicine actually are arrogant? Or are perceived as arrogant? 😕

That's definitely not true at the hospitals here.

 

[xanthines]

Maybe he/she is at JHU? (Yes, I noticed the location said CA, but that's not always accurate; look at mine!)

-X

I've heard IM called a lot of things (dumping ground, fleas, etc) but never arrogant.

 

[Blade28]

Maybe he/she is at JHU? (Yes, I noticed the location said CA, but that's not always accurate; look at mine!)

-X

Shouldn't matter. IM is never perceived as being "arrogant," nor do they think of themselves that way...IMHO.

 

[Tired]

um................ what fantasy land hospital do you work at?

One where every surgical service and the ED dump all the crappy, problem-placement patients on Internal Medicine.

It's hard to be "arrogant" when you're everyone's b!tch.

 

[xanthines]

It was my understanding that JHU IM were, at least they used to be even until very recent times. A quick googling popped this up:

http://www.hopkinsmedicine.org/hmn/F07/annals.cfm

Wasn't it the JHU IM residency prorgram that was put on probation for work hour violations? The guy who outed them totally got screwed, if I remember correctly.

-X

Shouldn't matter. IM is never perceived as being "arrogant," nor do they think of themselves that way...IMHO.

 

[UCLAstudent]

One where every surgical service and the ED dump all the crappy, problem-placement patients on Internal Medicine.

It's hard to be "arrogant" when you're everyone's b!tch.

Agreed. Internists are the ones who keep the hospital running. I've never thought of them as arrogant ... more like work-horses! They end up picking up a lot of slack for many of the other services. Also, at least according to what I've heard from my surgery and Ob/Gyn teams, internists are regarded as some of the smartest people in the hospital.

And no, I'm not going into IM. 🙂

 

[PreMedAdAG]

Bessst motivational poster ever!!!

ha ha ha!!! thank you for posting that!

 

[PreMedAdAG]

Agreed. Internists are the ones who keep the hospital running. I've never thought of them as arrogant ... more like work-horses! They end up picking up a lot of slack for many of the other services. Also, at least according to what I've heard from my surgery and Ob/Gyn teams, internists are regarded as some of the smartest people in the hospital.

And no, I'm not going into IM. 🙂

they're brilliant - they work their arses off - but man - some of the ones I've known - KNOW IT and dump their frustrations on med students...

My phone call today to an ID guy:

"Don't ever call me again - next time either your resident or attending calls me so someone can actually understand my instructions"

I'd classify that as arrogance - and yes he may be far removed from hospitalist type work - but he still trained as an internist.

Most that I've met are nice - I'll give you that - but I've also met some pompous people in this line - it's lame - I feel like saying, "get over yourself..."

 

[Blade28]

Also, at least according to what I've heard from my surgery and Ob/Gyn teams, internists are regarded as some of the smartest people in the hospital.

What? 😕

they're brilliant - they work their arses off - but man - some of the ones I've known - KNOW IT and dump their frustrations on med students...

My phone call today to an ID guy:

"Don't ever call me again - next time either your resident or attending calls me so someone can actually understand my instructions"

We need to clarify again...the subspecialists are completely different from the internists. Cardiologists, oncologists, etc. - yeah, they may have a little more swagger.

But not the internists/hospitalists.

 

[UCLAstudent]

What? 😕

Maybe it's not the same at every hospital? I'm referring to hospitalists/general internists.

 

[smq123]

My phone call today to an ID guy:

"Don't ever call me again - next time either your resident or attending calls me so someone can actually understand my instructions"

You're allowed to talk to consults? I don't know if I'm even allowed to touch the pager on some rotations....

 

[Arctic Char]

Internal Medicine is a slow painful death

what is even more exciting is how my resident goes on and on about how psychiatrists are worthless and it's not an evidence based field - and they know nothing about medicine -awesome - glad that I'm going into psychiatry so I don't have to hang out with arrogant people like that -


this rotations had made me want to quit medical school - seriously - if it weren't for the debt I'd be outta here - it's so not worth it...there are plenty of other ways on this earth to help people out without the pain of medical school.


maybe it's because I'm overly tired, maybe it's because I'm getting sick, maybe it's because I spend more time in the hospital than any other med student I know b/c I'm FORCED to stay by my team... maybe I'm just weak - I don't really know - or care at this point - I just want to be done with this life sucking journey -

ahh.. that felt good

want to elope? 😍

 

[fakin' the funk]

I am so looking forward to the end of IM. No more 14 hour days, no more being shat on and told how much I suck on a daily basis because I haven't memorized my patient's alk phos values since 1956, or I didn't call the immuno lab for the nth time to check up on that ANA which btw is completely useless for the patient's management.

i thought i went into medicine but it looks like i went into some weird combination of politics and menial labor.

your experience rings very true...especially calling the lab AGAIN and AGAIN because, whaddya know, they messed up/lost/tossed your sample for your extremely rare test that's gonna be equivocal/unhelpful anyway 👎

 

[domer621]

Also, at least according to what I've heard from my surgery and Ob/Gyn teams, internists are regarded as some of the smartest people in the hospital.

Agreed... they are the think-tanks.