I'm Not Enjoying my Internal Medicine Rotation

[jerseytrash]

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Good god 100x this. The poor IM residents spend 75% of their time sitting in front of a computer putting in orders, writing up progress notes/H+Ps, phoning back consults or the 100th page from some floor nurse, writing discharge instructions, etc.

Welcome to intern year in pretty much every specialty. I would actually say the gen surg interns probably have it worse at my hospital because they're severely understaffed at night and cover probably twice as many patients and services in the hospital than the IM residents (usually one intern covering around 100-120 as opposed to IM covering gen med teams which is 60-80, and usually split between two interns).

Also worth noting that as you go higher up by PGY ranking in every specialty the scutwork gets a lot less. Our senior residents don't write H&Ps, do notes, do discharge summaries. Most of their work involves doing procedures/coordinating the team, deciding on plans for the patients, talking to patients' families, working with consultants, and teaching medical students. They do occasionally do write notes if covering for the intern who's off, but that's a different story altogether.

Also the nurses paging you depends a lot upon the quality of the nursing staff - you haven't seen really really bad levels of paging until you've worked at a VA.

 

[KnuxNole]

Welcome to intern year in pretty much every specialty. I would actually say the gen surg interns probably have it worse at my hospital because they're severely understaffed at night and cover probably twice as many patients and services in the hospital than the IM residents (usually one intern covering around 100-120 as opposed to IM covering gen med teams which is 60-80, and usually split between two interns).

Also worth noting that as you go higher up by PGY ranking in every specialty the scutwork gets a lot less. Our senior residents don't write H&Ps, do notes, do discharge summaries. Most of their work involves doing procedures/coordinating the team, deciding on plans for the patients, talking to patients' families, working with consultants, and teaching medical students. They do occasionally do write notes if covering for the intern who's off, but that's a different story altogether.

Also the nurses paging you depends a lot upon the quality of the nursing staff - you haven't seen really really bad levels of paging until you've worked at a VA.

H+Ps and discharge summaries are WAY easier if at a place where you can just dictate it. The discharges can be annoying if it's a lengthy stay, but it's easier to dictate it in 5 mins vs. writing it all out like where I did my med school rotations.

 

[jerseytrash]

H+Ps and discharge summaries are WAY easier if at a place where you can just dictate it. The discharges can be annoying if it's a lengthy stay, but it's easier to dictate it in 5 mins vs. writing it all out like where I did my med school rotations.

Yeah we type up our admission stuff and notes and then print them but having dictated discharges is heavenly. I wish everything could be dictatable

 

[KnuxNole]

Yeah we type up our admission stuff and notes and then print them but having dictated discharges is heavenly. I wish everything could be dictatable

Sadly, consult notes aren't dictated at my place. Which is probably the one thing that would be nice to see typed up on a computer. The handwritings of certain docs....let's just say WingDings is easier to decipher.

Of course, regardless, I'd speak to the consultant to discuss the patient, but it's nice to be able to see their thought process and the plan on paper to look back on.

 

[revolution1980]

Med students are funny. You think your clerkships suck? Just wait until you are a resident. As the other posters have already said... residency in medicine, surgery, ...ummm almost every specialty involves..ummm....writing H&Ps...progress notes....and discharge summaries...over and over....and over. and instead of being a med student and writing 2 progress notes a morning, you can write 10. and you can do night float...and answer inane pages all night regarding tylenol, ambien and dilaudid while doing 10 admissions and coding patients. and then if you want to be a hospitalist, you can continue to do this (and get paid a bit more).

you can do IM and spend 75% of your life in the hospital... or you can do surgery and spend....95% of your life in the hospital.

i dont miss residency for a nano second. being in private practice is quite nice thank you.

be smart, do derm, optho or rads. they are insanely overpaid for what they do and work 50X less hours than everyone in IM or surgery and their subspecialties.

 

[jerseytrash]

Sadly, consult notes aren't dictated at my place. Which is probably the one thing that would be nice to see typed up on a computer. The handwritings of certain docs....let's just say WingDings is easier to decipher.

Of course, regardless, I'd speak to the consultant to discuss the patient, but it's nice to be able to see their thought process and the plan on paper to look back on.

Yep absolutely you should always speak to the consultant or if you are the consultant always take a minute or two to face to face talk to the primary team since it improves outcomes and is a good common courtesy

 

[DermViser]

ummmm...what? please explain.....this should be good

as for the other specialties you named.....rads and gas are in a bad way right now in terms of job market and compensation

EM.... have fun seeing 10 drunks, druggies, hypochondriacs, or medication refills for every 1 real case. EM sounds great theoretically but is completely different in practice as long as our healthcare system is set up the way it currently is (no, obamacare isn't really going to change anything)

And yet still much better than Internal Medicine.

 

[DermViser]

i'm going to refrain from trash talking other specialties but realize that the documentation/paperwork isn't unique to IM. For instance in anesthesia, for a straightforward case (which is the vast majority), outside of the first 10 minutes and last 10 minutes of the case you're basically documenting non-stop. At least in IM, much like in peds and FM, you get to know your patients and connect with them on a human level. You also get to delve into the patient's condition. Sure you have to deal with the brunt of the social issues but as someone mentioned earlier each specialty has it's own downsides. When deciding what you want to go into you should weigh all these factors. Also be careful of some rotations that try to shield med students from the boring/difficult/annoying aspects of the specialty ....you need to keep your eyes open and see what the residents and attendings have to deal with to get the real picture.

😆😆😆

 

[PrideNeverDie]

lettuce be reality, IM sucks

people go into it to subspecialize or they are FMGs and it beats living in the 3rd world

 

[evilbooyaa]

And yet still much better than Internal Medicine.

6 month necro just to crap (even more) on IM. Why?

 

[Kahreek]

I've found that the wards are an acquired taste.

 

[Kahreek]

Much like aquarium keeping.

 

[tco]

Much like aquarium keeping.

And drinking gasoline.

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[Kahreek]

You didn't quite get my analogy, because aquarium keeping and general IM are very alike.

 

[mvenus929]

Agree 100%. I was about to write "it's the people not the medicine".

I've found the culture, attitudes and individuals you work with make or break rotations. We develop generalizations about specialties because of the tendency of certain people/personalities to go into those fields (e.g. surgeons, IM docs, Obgyn docs, etc.). Even with that, if an exceptional doc that you click with was working in IM with you, you would probably love it.

I agree that who you work with can color a rotation, but I don't think the people are all there is. I loved my OB residents... They were great to work with, and I still see one of them in the hall from time to time, despite having the rotation a year and a half ago. But I couldn't do OB as a career. Similarly, I had amazing house staff and preceptors on medicine, and did really like inpatient medicine, but I found the lack of variety in patients very boring.

I also had a less than stellar peds rotation, away from my home hospital. And yet, ultimately, I decided the patients were what made the specialty right for me, and that's what I'm going into. Assuming I match next week.

 

[tco]

You didn't quite get my analogy, because aquarium keeping and general IM are very alike.

Im and drinking gasoline are similar, too. After too much of it, you'd rather be dead than in the situation you're in.

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[Kahreek]

Im and drinking gasoline are similar, too. After too much of it, you'd rather be dead than in the situation you're in.

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more in the way that everyday you check the ph, but still everyday one more fish appears to be dead.

 

[Winged Scapula]

more in the way that everyday you check the ph, but still everyday one more fish appears to be dead.

...or growing some weird fungus

 

[Brain Bucket]

I'm disappointed that there isn't a better term for aquarium keeper.

 

[HopefulReapp]

I'm disappointed that there isn't a better term for aquarium keeper.

Aquarist

 

[Brain Bucket]

Aquarist

Haha. Yes!!

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[Gambler 101]

Aside from writing H and Ps, is anyone else just frustrated with the quality of patient care on their rotation? I can't say anything to my residents about it (I know better), but I feel unsettled by the admission counting and leaving people in the ED (because we hit the number of admissions despite there being space upstairs still). If the residents are at sheduled shift end, they will leave the patient without any meds or orders overnight until they put some in the next morning! It's also a battle to get consults to show up, evaluate the patient, and leave a note. At the end of the day, I go home feeling incredibly guilty about the care patients receive and being a part of this system.

 

[jl lin]

Agree 100%. I was about to write "it's the people not the medicine".

I've found the culture, attitudes and individuals you work with make or break rotations. We develop generalizations about specialties because of the tendency of certain people/personalities to go into those fields (e.g. surgeons, IM docs, Obgyn docs, etc.). Even with that, if an exceptional doc that you click with was working in IM with you, you would probably love it.

This^ is so often totally true.

 

[Mad Jack]

Aside from writing H and Ps, is anyone else just frustrated with the quality of patient care on their rotation? I can't say anything to my residents about it (I know better), but I feel unsettled by the admission counting and leaving people in the ED (because we hit the number of admissions despite there being space upstairs still). If the residents are at sheduled shift end, they will leave the patient without any meds or orders overnight until they put some in the next morning! It's also a battle to get consults to show up, evaluate the patient, and leave a note. At the end of the day, I go home feeling incredibly guilty about the care patients receive and being a part of this system.

Sounds like you're in a fairly bad teaching environment. The only reason that a patient ever got left in the ED back where I worked was a lack of beds or no nursing staff to take care of them. And residents tended to be good about overnight orders, because they knew their phone was going to ring nonstop if they didn't straighten them out. Consults though- they're always going to be busy, that's just how it is.

 

[zeppelinpage4]

I can appreciate that a good foundation in medicine is necessary, and I respect the field very much, but I honestly cannot stand IM. I find internal medicine to be very tedious, frustrating, and inefficient. I don't enjoy taking H & P's or writing notes and in many instances internal medicine seems futile. A large number of patients I've seen I can't say really have had a definitive improvement after being in the hospital. I see a lot of sick people leave chronically sick and suffering. The lack of a solution annoys me.

Is it normal to feel this way? I'm a pretty no nonsense person who likes to get things done with a definitive answer, so probably something surgical is more right for me. But I can't help but feeling scared that I'll hate all of my rotations (medicine is my first) and I'll be left doing something I hate for the rest of my life.

IM was my first rotation too, I couldn't stand it for many of the same reasons you stated.
Even though I have no idea what I'm doing, I'm pretty sure it won't be IM. And I enjoyed the patient population in surgery and Peds way more.

Don't worry, you're not alone in your thinking. Lots of us find we don't like IM for the reasons you stated, and that's okay. Surgery was a breath of fresh air for me, generally younger healthier patients, and lots got better in a few days and went home. Hopefully you'll enjoy it a little more.

Also, if you like kids, many Peds pts come in with just one or two acute issues and patients generally get better. A procedural sub specialty of peds may be worth a look also.

Ob/gyn also has opportunities for surgery and a generally healthier population that gets better, or at least feels better and goes home.

Other stuff like IR, rad/onc which we don't get to see, might be a good fit.