The original poster would do well to observe what it is that medicine interns actually do on the wards.
I'm doing a Transitional Year so I've done Surgery and Medicine.
1. Dictate H&Ps with plans that their second years came up with
I come up with my own plans. Surgery residents dictate H&P's as well.
On my last surgery rotation, the attending told us on the first day he was annoyed with a former resident who said that surgeons don't have to take a "Social History" so he didn't ask patients if they drank or smoked. He stressed that he wanted good H&P's. My experience in medical school was also that Surgery notes aren't "EZ mode", and if you try to take shortcuts you eventually get in trouble. Maybe the assessment and plan section isn't as long compared to Internal Medicine, but that only takes an extra thirty seconds to write.
S- No new complaints
O - Vitals
Gen - Awake, alert, NAD
CV - RRR
Lungs - CTA B
Abd - Soft, tender, decreased BS, inc cdi
Ext - Warm, NT
Labs
A+P 50 yo WF s/p appendectomy POD #1
1) S/P surgery - Continue abx.
2) Pain control - morphine
3) Diet - advance as tolerated
Maybe you can skip heart and lung exam, but a lot of attendings don't like it.
vs.
S - SOB overnight. No other complains
O - Vitals
Gen,
CV,
Lungs,
Abd,
Ext
Labs
A+P 76 yo WM with dementia, COPD, CHF, admitted with recurrent A. Fib.
1) A. Fib - Continue Cardizem drip. Switch to PO. Continue Warfarin
2) COPD - aerosols, steroids, abx.
3) CHF - Lasix
4) Prophylaxis - Warfarin as above. Omeprazole.
What's true is that in Surgery, many of the patients that you get called to see are consults. But new consults still demand an H&P. You can cheat a little bit by copying the primary team's H&P. But even on Internal Medicine, 80% of the patient's that we get are nearing the end of their lives, present frequently, and have old H&P's in the computer which you can cheat off of.
2. Write long daily notes that say essentially the same thing, e.g., "continue after load reduction", "continue DVT/GI prophylaxis", "replete lytes".
My notes on Surgery weren't much different than my notes on Internal Medicine. The time consuming part on both is getting the vitals and the labs. The examination of the patient takes 1 minute on either. Surgery attendings that I've worked with at multiple institutions don't like it if you take shortcuts with the morning progress note. The days of "continue current plan" are over. OTOH, on either rotation you don't need to write out the name of every single medication the patient is on and their use. "Continue home meds." can suffice.
3. Call consults/order labs/follow up on things that their seniors tell them to
I've never personally called a consult. Ordering labs takes seconds on a computer. Surgery residents also order labs.
Surgery has these too.
5. Dictate discharge summaries
Surgery has these too, though perhaps not as many due to many patients being consults. Anyway, from one month of Internal Medicine I usually have about 15-20 discharge summaries (and this is on a busy service) which isn't too bad
What do surgery interns do? The same thing. Except the H&Ps, notes, and discharge summaries aren't inundated with worthless garbage details that no one cares about.
Again, as someone who has done both Surgery H&P's and notes are a little bit shorter, but not that much shorter.
And sometimes they get to do a case or two.
If you don't care about this, it's not much of a bonus.
😴
And they don't sign out their service to the on call person at 2PM.
This is a bad thing?
Hey look on Surgery or Medicine, if people can bail early on a slow day they take it.
Most importantly they learn not to panic.
Not sure about this. The month of surgery that I did, the intern was responsible for new patients at night while the second year night float responded to the floor pages. I would imagine any intern going through this emerges not knowing jack **** about routine patient issues, until they become a second year.
Maybe it's not like this everywhere. But what I do know is that in PM&R which I'm going into, and which takes on a lot of post-surgical patients, the TY and Prelim-Medicine trained people tend to have an easier time on call than the Prelim-Surgery trained people.
A good surgeon stays calm when blood is hitting the ceiling,
No that's when they throw instruments at the scrub tech, and blame the medical student holding the retractor for all their problems in life. I kid, I kid.
and good internist is deeply concerned about a blood pressure of 160/110.
Anyone who gets called at night about hypertension should treat it and will treat, on pain of getting written up by the nurses. On Surgery, if they get the call, that means it's a primary patient for them, otherwise they usually don't get the call. They typically do Metoprolol PRN or something. An IM resident at night might also do Hydralazine 10mg PRN q4h. But on Medicine, they would change it the next day to a more permanent solution. On Surgery, they typically just leave it as PRN IV Metoprolol, until the patient leaves the hospital and presumably gets hypertensive again, which isn't really good patient care.
Don't forget the rounding four times per day for medicine.
100% BS stereotype that I've not witnessed at the academic teaching hospitals, large community hospitals, and small community hospital settings where I've done Internal Medicine so far as a medical student and resident, in a few different cities no less. The typical routine is come in at 7, see a few patients, write some notes, round with the attending from 9/10 until 12. Then go get lunch. Then put in orders, discharge people, and admit folks if you get called.
The painful thing about surgery is that you have to come in at 6 (or sooner), round, see your patients before the senior resident starts his cases at 7 to 7:30. At different points in the day, different surgeons will come and will want to round on their patients. If they're awfully nice, sometimes they'll also see their partners patients. Even then though, sometimes they don't do this until 5 p.m. or later, which keeps you stuck in the hospital. Sometimes your senior resident can insist on rounding a second time before leaving at the end of the day. Overall, I've rounded many more times on Surgery than in Internal Medicine.
There's other advantages to Internal Medicine too, like caps on patients and consults. One day on Surgery I had to see 12 consults, since there's no caps. On Medicine, the most number of patients they'll make you pick up is capped at 5. Our progress notes are capped at 5. On either rotation, I spent an average of about 1 hour working up a new patient.
