Residents: Are you enjoying internal medicine?

[lost777]

When you get an admit, do you find it fun to do the H&P, and putting together a differential and ordering tests to rule in/out?

Do you fun physical exams to gauge improvement/worsening to be interesting?

Do you find your level of interest in what you're doing is high?

My answer to the above would be no, not really...I cannot tell if its just normal residency woes, or if I dont belong in IM.

How would you respond?

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[DoubleBogey]

When you get an admit, do you find it fun to do the H&P, and putting together a differential and ordering tests to rule in/out?

Do you fun physical exams to gauge improvement/worsening to be interesting?

Do you find your level of interest in what you're doing is high?

My answer to the above would be no, not really...I cannot tell if its just normal residency woes, or if I dont belong in IM.

How would you respond?

I’ve completed residency, but would say this is a common feeling at this point in your training - unfortunately, it gets worse around Jan to April it really starts to suck.

I didn’t feel “excited” to do workups until mid 2nd year - too busy as an intern with paperwork, initial 2nd year you’re dealing with a brand new intern. So, mid second year you have a competent intern and you feel more comfortable in your supervisory role to take a step back and look at the big picture.

Keep your head up - it does get better

 

[Crayola227]

lol, who said life and work is about fun?

 

[DoubleBogey]

I have a lot of fun at work - even working half days (12hr). I wouldn’t do it if it wasn’t fun, but certainly the paperwork/EMR/poor scheduling make the job less appealing

 

[Crayola227]

enjoyment is such a strong word

 

[wamcp]

When you get an admit, do you find it fun to do the H&P, and putting together a differential and ordering tests to rule in/out?

Do you fun physical exams to gauge improvement/worsening to be interesting?

Do you find your level of interest in what you're doing is high?

My answer to the above would be no, not really...I cannot tell if its just normal residency woes, or if I dont belong in IM.

How would you respond?

Let me tell you, as a hospitalist, "fun" and "interesting patients" are not what I'm looking for..I want the easy peasy bread and butter patient I can admit in 10 minutes so I can get through the day, make my decent coin and GTFO the hospital

 

[DNM]

I posted something similar recently. I'm only an intern. Internal medicine has been ok -- better now that I finished some of my most challenging months. Definitely not loving every second, but I think most of it is due to the bs that comes with being an intern (navigating new system, pointless pages, etc). I agree with wamcp -- as a medical student teams would always give you 'the interesting one' which was cool. Now, I want nothing more than a bread and butter admit where I can bang out the note very quickly and move on.

I anticipate a lot of this will get worse before it gets better (i.e. late this winter), but there are definitely many other interns who feel similarly to you, myself included.

 

[rokshana]

I posted something similar recently. I'm only an intern. Internal medicine has been ok -- better now that I finished some of my most challenging months. Definitely not loving every second, but I think most of it is due to the bs that comes with being an intern (navigating new system, pointless pages, etc). I agree with wamcp -- as a medical student teams would always give you 'the interesting one' which was cool. Now, I want nothing more than a bread and butter admit where I can bang out the note very quickly and move on.

I anticipate a lot of this will get worse before it gets better (i.e. late this winter), but there are definitely many other interns who feel similarly to you, myself included.

it is one thing for the hospitalist to want the quick and easy...in the real world time is money and the hospitalist easily has 18-25 pts on their census. As an intern, nothing is bread and butter or quick and easy...frankly you, in your 3 months as a baby doctor, don't have enough knowledge or training to think anything is simple and easy....you are in training...this is your only time when it is ok that you don't know what you are doing and have seniors and attendings to teach you and more importantly make sure you don't kill anyone.

you don't know what you don't know and to be overconfident with a few months of training that you do have, you are a dangerous intern.

 

[DNM]

it is one thing for the hospitalist to want the quick and easy...in the real world time is money and the hospitalist easily has 18-25 pts on their census. As an intern, nothing is bread and butter or quick and easy...frankly you, in your 3 months as a baby doctor, don't have enough knowledge or training to think anything is simple and easy....you are in training...this is your only time when it is ok that you don't know what you are doing and have seniors and attendings to teach you and more importantly make sure you don't kill anyone.

you don't know what you don't know and to be overconfident with a few months of training that you do have, you are a dangerous intern.

I ask for help from my seniors frequently and there is a ton that I don't know. My seniors and attendings have not had concerns with my thought process or asking for help when I need it which I do frequently. If you think we do not occasionally get simple admits from time to time, I'd disagree (i.e. social placement, PT eval and back to SNF tomorrow). I definitely don't think you can accurately comment on my day to day confidence based on a single internet post made in jest.

 

[rokshana]

I ask for help from my seniors frequently and there is a ton that I don't know. My seniors and attendings have not had concerns with my thought process or asking for help when I need it which I do frequently. If you think we do not occasionally get simple admits from time to time, I'd disagree (i.e. social placement, PT eval and back to SNF tomorrow). I definitely don't think you can accurately comment on my day to day confidence based on a single internet post made in jest.

after a few of those admits, there is little to no education in them...frankly they are the ones that should go to the hospitalist service, not the teaching service (sure the teaching service will take some of them because sometimes it can't be helped.
the fact that you want them at this early stage says something...

and eh...there is always someone like you that posts here about how "great" they are and that they "know" just as much as their seniors or even their attending...you are not that special a case.

 

[DNM]

after a few of those admits, there is little to no education in them...frankly they are the ones that should go to the hospitalist service, not the teaching service (sure the teaching service will take some of them because sometimes it can't be helped.
the fact that you want them at this early stage says something...

and eh...there is always someone like you that posts here about how "great" they are and that they "know" just as much as their seniors or even their attending...you are not that special a case.

Where in my post did I say that I think I know even a fraction of what my seniors or attendings do? I said that I frequently need help and go to them often for it.

 

[epicandprivate]

after a few of those admits, there is little to no education in them...frankly they are the ones that should go to the hospitalist service, not the teaching service (sure the teaching service will take some of them because sometimes it can't be helped.
the fact that you want them at this early stage says something...

and eh...there is always someone like you that posts here about how "great" they are and that they "know" just as much as their seniors or even their attending...you are not that special a case.

 

[deleted392989]

I find internal medicine to be fun and thought-provoking at times, but not frequently enough. Bread and butter cases like CHF or COPD exacerbations, CAP, endocarditis, DVT/PE are important to master during residency because it is a big chunk of what you will practice for the rest of your career. Fortunately in our program, the ED saves interesting cases for us like the 22 year old male presenting with sepsis and right neck swelling -> right IJ thrombus on CT. Recent hx of strep throat 1 week ago. No family or personal hx of hypercoagulable states. Spontaneous thrombus or Lemierre's? We get cases like this at least 1-2x a week and it really keeps you on your toes!

 

[wamcp]

it is one thing for the hospitalist to want the quick and easy...in the real world time is money and the hospitalist easily has 18-25 pts on their census. As an intern, nothing is bread and butter or quick and easy...frankly you, in your 3 months as a baby doctor, don't have enough knowledge or training to think anything is simple and easy....you are in training...this is your only time when it is ok that you don't know what you are doing and have seniors and attendings to teach you and more importantly make sure you don't kill anyone.

you don't know what you don't know and to be overconfident with a few months of training that you do have, you are a dangerous intern.

How common is it to have a census that high? I'm working my first job out of residency and I rarely see more than 12 total encounters per day shift. Usually it's 10 encounters...(as in typically start the day with 8, maybe admit 1 or 2, discharge 1 or 2).
I'm usually sitting on my ass for 3 to 4 hours doing nothing but browsing the internet in a call room.
I can't fathom having 18+...

 

[rokshana]

How common is it to have a census that high? I'm working my first job out of residency and I rarely see more than 12 total encounters per day shift. Usually it's 10 encounters...(as in typically start the day with 8, maybe admit 1 or 2, discharge 1 or 2).
I'm usually sitting on my ass for 3 to 4 hours doing nothing but browsing the internet in a call room.
I can't fathom having 18+...

25 is high, but during the winter at a high volume hospital, not uncommon...18 is easily what i've seen at different hospitals.

10-12...wow that's impressive that your place has enough hospitalists on that you are only seeing 10-12 pts...you should keep that job!

 

[CatFactorial]

Where in my post did I say that I think I know even a fraction of what my seniors or attendings do? I said that I frequently need help and go to them often for it.

A point of order Dr. Osler! Literally you have to know a fraction of what your seniors and attendings do. Otherwise you’d know nothing.
#mathamirite?!

 

[CatFactorial]

When you get an admit, do you find it fun to do the H&P, and putting together a differential and ordering tests to rule in/out?

Do you fun physical exams to gauge improvement/worsening to be interesting?

Do you find your level of interest in what you're doing is high?

My answer to the above would be no, not really...I cannot tell if its just normal residency woes, or if I dont belong in IM.

How would you respond?

1. No.

2. Sprechen sie englisch?

3. Yes.

 

[Stedari]

I am a PGY3 in internal medicine taking an academic hospitalist job next year. I really enjoy the process of working through an undifferentiated patient. I find less fulfillment in managing slarps, but I enjoy teaching and working with med students. Often times, if a case is boring, the patient or their family is not. If I don't know something, I know where to find the answer or have access to the consultant who does; however, it's fun to improve my knowledge base and become better. All this being said, I don't think I could find happiness/fulfillment as a community hospitalist seeing 25 patients a day for the rest of my career.

 

[MyTachyBradyHeart]

When you get an admit, do you find it fun to do the H&P, and putting together a differential and ordering tests to rule in/out?

Do you fun physical exams to gauge improvement/worsening to be interesting?

Do you find your level of interest in what you're doing is high?

My answer to the above would be no, not really...I cannot tell if its just normal residency woes, or if I dont belong in IM.

How would you respond?

Few interns/residents enjoy writing notes and putting in orders. Talking to all the consulting services is the worst. Depending on the workflow and level of support from upper levels, intern year can range from awful with service>>education to much more balanced experience. The winter months are also extra difficult because on busy rotations, you don't see the light of the day. Seasonal affective disorder is real. Therapy dogs in the hospital helps.

With that being said, a few good questions to ask yourself would be:
1. Do you enjoy the morning reports and conferences (that you have time to go to)? Do you enjoying learning something new at those conferences?
2. Do you enjoy working and hanging out with your co-interns/co-residents? Do you see yourself fitting in with the type of people you work with?
3. If you see a case of arrhythmogenic RV dysplasia or lymphangioleiomyomatosis or May-Turner syndrome or atypical hemolytic uremic syndrome, do you think that's cool?
4. If a pt in the hospital or in your primary care clinic thanks you for doing a good job, do you feel more energized about work?
5. Do you enjoy teaching medical students/interns about pathophysiology of diseases and how to approach a chief complaint?
6. If you've successfully diagnosed a condition (can be common or rare) and successfully treated it and a pt gets better, do you feel satisfied?

If you answer no to all of those questions, then IM is probably not the right field for you.

Personally, I switched from surgery to medicine in July of my 4th year of medical school because I enjoyed thinking about a complicated patient and coming up with a broad differential. And as much as it slows the work flow down, I make sure that I (and my interns) always go to conferences, even if I need to help out with notes/calling consultants later on in the day.

 

[deleted547339]

I find internal medicine to be fun and thought-provoking at times, but not frequently enough. Bread and butter cases like CHF or COPD exacerbations, CAP, endocarditis, DVT/PE are important to master during residency because it is a big chunk of what you will practice for the rest of your career. Fortunately in our program, the ED saves interesting cases for us like the 22 year old male presenting with sepsis and right neck swelling -> right IJ thrombus on CT. Recent hx of strep throat 1 week ago. No family or personal hx of hypercoagulable states. Spontaneous thrombus or Lemierre's? We get cases like this at least 1-2x a week and it really keeps you on your toes!

Dude, where do you work that you admit endocarditis in similar numbers to chf and copd....sounds terrible.

 

[deleted547339]

Few interns/residents enjoy writing notes and putting in orders. Talking to all the consulting services is the worst. Depending on the workflow and level of support from upper levels, intern year can range from awful with service>>education to much more balanced experience. The winter months are also extra difficult because on busy rotations, you don't see the light of the day. Seasonal affective disorder is real. Therapy dogs in the hospital helps.

With that being said, a few good questions to ask yourself would be:
1. Do you enjoy the morning reports and conferences (that you have time to go to)? Do you enjoying learning something new at those conferences?
2. Do you enjoy working and hanging out with your co-interns/co-residents? Do you see yourself fitting in with the type of people you work with?
3. If you see a case of arrhythmogenic RV dysplasia or lymphangioleiomyomatosis or May-Turner syndrome or atypical hemolytic uremic syndrome, do you think that's cool?
4. If a pt in the hospital or in your primary care clinic thanks you for doing a good job, do you feel more energized about work?
5. Do you enjoy teaching medical students/interns about pathophysiology of diseases and how to approach a chief complaint?
6. If you've successfully diagnosed a condition (can be common or rare) and successfully treated it and a pt gets better, do you feel satisfied?

If you answer no to all of those questions, then IM is probably not the right field for you.

Personally, I switched from surgery to medicine in July of my 4th year of medical school because I enjoyed thinking about a complicated patient and coming up with a broad differential. And as much as it slows the work flow down, I make sure that I (and my interns) always go to conferences, even if I need to help out with notes/calling consultants later on in the day.

No part of me thinks May-Thurner is interesting - maybe that’s why I picked EM, lol.

 

[gutonc]

No part of me thinks May-Thurner is interesting - maybe that’s why I picked EM, lol.

I'm Hem/Onc and I don't find it interesting.

 

[deleted392989]

Dude, where do you work that you admit endocarditis in similar numbers to chf and copd....sounds terrible.

The south. And we get a bunch of transfers from other hospitals in the boondocks that are located several hours away.

 

[cbrons]

Dude, where do you work that you admit endocarditis in similar numbers to chf and copd....sounds terrible.

Oh yeah our university hospital sees a ton of endocarditis. There is usually at least 1 patient with it on each teaching team on the general medical floor at all times. The VA where we also do wards does not have nearly as many however, and is admittedly 75% acute decompensated heart failure or COPD exacerbations.

 

[jhamaican]

What medications do you take?
Not sure, read the computer doctor

Do you do any drugs?
All of them

Where is your pain located sir?
AHhhhh, It hurts please give pain medications

Do you have any friends/family/emergency contacts?
no

Can you elaborate on the characteristics of your pain? When did it start?
no. I don't know. total body dolor.

What brought you to the hospital?
I am in pain


literally the conversation with every other patient admitted. Can't wait for fellowship

 

[Psai]

No part of me thinks May-Thurner is interesting - maybe that’s why I picked EM, lol.

daf is maythurner

 

[Siggy]

daf is maythurner

LMGTFY

On a more important note, LMGTFY now supports other search engines?

 

[xoggyux]

I do enjoy my residency very much. My program is relatively new so there was so much enthusiasm from administration to develop an attractive program. The schedule is reasonable (60h/w+ on average but I rarely hit 70+).
Most of my attendings are young (<40) and energetic and welcome challenge and discussion.
Despite being in a community hospital, the patient population is fairly varied. To this day I have never had more than 2 patients on my rounding list simultaneously with the same major problem (unless you count ICU respiratory failure, but even then usually they are due to different underlying pathology and not just the same Dx).

 

[leviathan]

Few interns/residents enjoy writing notes and putting in orders. Talking to all the consulting services is the worst. Depending on the workflow and level of support from upper levels, intern year can range from awful with service>>education to much more balanced experience. The winter months are also extra difficult because on busy rotations, you don't see the light of the day. Seasonal affective disorder is real. Therapy dogs in the hospital helps.

With that being said, a few good questions to ask yourself would be:
1. Do you enjoy the morning reports and conferences (that you have time to go to)? Do you enjoying learning something new at those conferences?
2. Do you enjoy working and hanging out with your co-interns/co-residents? Do you see yourself fitting in with the type of people you work with?
3. If you see a case of arrhythmogenic RV dysplasia or lymphangioleiomyomatosis or May-Turner syndrome or atypical hemolytic uremic syndrome, do you think that's cool?
4. If a pt in the hospital or in your primary care clinic thanks you for doing a good job, do you feel more energized about work?
5. Do you enjoy teaching medical students/interns about pathophysiology of diseases and how to approach a chief complaint?
6. If you've successfully diagnosed a condition (can be common or rare) and successfully treated it and a pt gets better, do you feel satisfied?

If you answer no to all of those questions, then IM is probably not the right field for you.

Personally, I switched from surgery to medicine in July of my 4th year of medical school because I enjoyed thinking about a complicated patient and coming up with a broad differential. And as much as it slows the work flow down, I make sure that I (and my interns) always go to conferences, even if I need to help out with notes/calling consultants later on in the day.

Those are good questions to ask. Sometimes I feel burned out, but when I read those questions for perspective, I still think IM is definitely a good fit for me!