Why so many dislike IM?

[LGMD]

Reading various posts in these forums, I see a great number of people who dislike IM greatly. What is the reason for this and how come so many students not like IM and yet a lot of students go to IM? For those of you who liked IM, can you provide an insight at you enjoy in IM?

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[QuinnB]

I think there are a lot of reasons. Commonly, people talk about the "eternal rounding" and of course there is some truth to this. I honestly have rounded for 5 hours before, but the reality is that on average, for a full census, we rounded for typically 2 to 2.5 hours. Some attendings were much better than others. This is not at all different from surgery at my school, where they may round for 1 hour in the morning, but also tended to round for another hour+ in the evening. The main difference was that the attendings never rounded with us on surgery, which was a major light at the end of the tunnel for many people who just couldn't bear it.

Another thing people talk about is the very esoteric, sometimes archaic, discussions on IM rounds. I've found that if you know your stuff, you can always control the pace of the conversation (that is if you are being spoken to). This is especially true with electrolyte abnormalities like hyponatremia.

Some don't like how in many fields of medicine you don't physically intervene to correct a patient's problems - you often rely on pharmaceuticals, fluids, etc...

Others get bored with the paperwork.

The big difference I've noticed with attendings in surgery vs IM is that IM attendings really don't have much going on after rounds. I like this prospect a lot. I've always wondered what they do all afternoon (clearly read articles, work on research/grants, see patients in clinic, etc...). I'm sure some of them are out there mountain biking, surfing, etc...though.

 

[domer621]

A lot of people just don't like dealing with the older patient population.

 

[superoxide]

With adults you are dealing with mostly chronic problems (diabetes, hypertension, chronic renal failure etc etc). With such patients there is no real cure, you are just managing the patients symptoms. The other thing that is annoying is that adults are not the most compliant patients. From my experience on IM, I have heard all the excuses. Patients don't want to take their meds because they don't like the taste, or don't check their daily glucose because they don't like the needle sticks. The next thing you know they're having their foot amputated.

That's why I'm going for peds. Not only do I love dealing with kids, but also because most of their conditions are acute and curable. Also, when you tell the parent that the kids needs to take such and such med, or the kid has to do this or that, the parent will make sure that it gets done!

 

[Sean2tall]

When most people say they didn't like IM, I figure that they are referring either to the 3rd year IM rotation or the prospect of doing an IM residency, either of which consists mostly of floor work, which, in turn, consists of occasional problem solving interspersed with frequent managing of minimally important numbers and determining how we can get Mrs. X back to nursing home Y, from which she was "dumped."

Now, that shouldn't reflect too much on actually finishing and IM residency, which means that you are either going to do a subspecialty fellowship, which will add many more things to your daily routine, or go into general practice, which will seeing many patients in your office much more quickly, and making hospital rounds only one of many things that you will be doing, a new one of which will be concerning money and its obtain-ment (is that a word?).

Oooh, edit: Or you could be a hospitalist, which I am actually not seeing how that is different from residency.

 

[deleted87716]

That's why I'm going for peds. Not only do I love dealing with kids, but also because most of their conditions are acute and curable. Also, when you tell the parent that the kids needs to take such and such med, or the kid has to do this or that, the parent will make sure that it gets done!

Sorry...I couldn't help myself. 😉

 

[Hard24Get]

I think there are a lot of reasons. Commonly, people talk about the "eternal rounding" and of course there is some truth to this. I honestly have rounded for 5 hours before, but the reality is that on average, for a full census, we rounded for typically 2 to 2.5 hours. Some attendings were much better than others. This is not at all different from surgery at my school, where they may round for 1 hour in the morning, but also tended to round for another hour+ in the evening. The main difference was that the attendings never rounded with us on surgery, which was a major light at the end of the tunnel for many people who just couldn't bear it.

Another thing people talk about is the very esoteric, sometimes archaic, discussions on IM rounds. I've found that if you know your stuff, you can always control the pace of the conversation (that is if you are being spoken to). This is especially true with electrolyte abnormalities like hyponatremia.

Some don't like how in many fields of medicine you don't physically intervene to correct a patient's problems - you often rely on pharmaceuticals, fluids, etc...

Others get bored with the paperwork.

The big difference I've noticed with attendings in surgery vs IM is that IM attendings really don't have much going on after rounds. I like this prospect a lot. I've always wondered what they do all afternoon (clearly read articles, work on research/grants, see patients in clinic, etc...). I'm sure some of them are out there mountain biking, surfing, etc...though.

I agree with above!

- I hate rounding for so long only because it is usually for stupid reasons (watching the attending ask the patient about his/her bowel movements). In the ICU, we rounded longer, but it was all great and necessary discussion that led to a world of learning. Similarly, in surgery we are inspecting/culturing a wound or changing a complicated dressing or something that we NEED to do.
- Too many people in IM don't like procedures to their patient's detriment, and hesitate to put in lines and tubes for too long - this is dangerous!
- The paperwork sucks but what is worse is when people have to stay in the hospital for social reasons, then get nosocomial infections. Too frustrating.
- I've watched the attendings ambling around co-signing notes and seeing patients in clinics and that life is not for me.
- While there is the reward of being someone's doctor, general medicine is often routine, then when it gets interesting someone else rushes in to do the thinking. Seems better to go into Family or Emergency Medicine if you want something so general, as these fields have more variety.
-Many people end up in IM because they fell in love with an organ system. I have had residents tell me they HATE IM but are doing it to be a Cardiologist, etc.
- In fact, if Emergency medicine didn't exist , I would end up doing IM so I could practice Pulmonary/Critical Care medicine (though that 10+ year surgery training would be a close second). I would hate it, but I would do it. Perhaps this explains the disconnect you see.

 

[ChildNeuro]

With adults you are dealing with mostly chronic problems (diabetes, hypertension, chronic renal failure etc etc). With such patients there is no real cure, you are just managing the patients symptoms. The other thing that is annoying is that adults are not the most compliant patients.

I think that it is a misconception that nothing is cured in adult medicine. I have done the medicine rotation, before everybody jumps on me. There are alot of diseases that are self-limited, and fully ~85% of ICU patients will be well enough to leave the hospital at some point. Also, if you do a good job it could add like 15 years or more to a patient's life if you can help them become more "compliant." I have noticed that more and more internists don't advise their patients to lose weight or stop smoking, perhaps because there is the pre-conception that adult medicine patients won't stop smoking or won't try to lose weight. It is too bad there is this idea that adult patients don't get well.

 

[kat82]

i LOVED internal medicine! but only the inpatient part. i must say, IM clinic is probably the worst form of torture ever invented and made me hate clinic in general and made me hate primary care in general
so, while i think IM has lots of cool things (cool cardiology stuff, cool gi stuff, interesting heme/onc, etc) the boring PCP clinic stuff is a huge turnoff (hypertension, diabetes, high cholesterol, etc)

if im going to see a patient with diabetes, i'd rather see a cool case of DKA or HHNC!

 

[silas2642]

Reason I don't want to go into IM-- Because it's gomer city, baby-- that's why.

 

[JayneCobb]

What is the reason for this and how come so many students not like IM

because they do not actually like using what they learned the first two years in medical school (j/k)

 

[8o8o8o8]

I and many in my class, found the rotation to drag. There is A LOT of clerical work and often an endless stream of assignments (ie presentations, write-ups)...rounding itself is pretty good, you learn a lot & see pts, but the afternoon of being on hold and getting records is not all that fun...things get old quickly when you are Q4

 

[ChildNeuro]

I bet IM as a resident is *really* good, I really loved my medicine rotation, but what would make it a sweat deal would be:

1. All electronic charts and vitals sheet that could be accessed anywhere in the hospital, as a third a couple of hours are spent a day wasted on finding charts.

2. Efficient and reliable inpatient phlebotomy team.

3. Work with efficient attendings, and preferably sit-down rounds, with walk rounds only to see patients, not to stand on feet for hours outside patient's doors which is painful.

4. Daily noon conferences with food that are pre-prepared power-points, NOT attendings talking off the cuff aimlessly about patients without having a good prepared presentation or good teaching points.

5. Good sign-off rounds procedures, more importantly good oral info from team coming off, a printed list would be good, but I wouldn't want to be a slave to minor details while missing the big picture of what is going on with the patient.

6. Nice attendings.

If somebody gave me this I would be snug as a bug in a rug.

 

[nutcancer]

I bet IM as a resident is *really* good, I really loved my medicine rotation, but what would make it a sweat deal would be:

1. All electronic charts and vitals sheet that could be accessed anywhere in the hospital, as a third a couple of hours are spent a day wasted on finding charts.

2. Efficient and reliable inpatient phlebotomy team.

3. Work with efficient attendings, and preferably sit-down rounds, with walk rounds only to see patients, not to stand on feet for hours outside patient's doors which is painful.

4. Daily noon conferences with food that are pre-prepared power-points, NOT attendings talking off the cuff aimlessly about patients without having a good prepared presentation or good teaching points.

5. Good sign-off rounds procedures, more importantly good oral info from team coming off, a printed list would be good, but I wouldn't want to be a slave to minor details while missing the big picture of what is going on with the patient.

6. Nice attendings.

If somebody gave me this I would be snug as a bug in a rug.

Wow great points childneuro. I would only add computerized notes (everything including progress notes, consult notes, PT notes, etc.). I spend way too mch time trying to figure handwritings out. If everything was computerized, the day could fly by in IM. Afterall, nothing really happens to these patients and most of the day is spent in paperwork.

 

[hyperbaric]

I bet IM as a resident is *really* good, I really loved my medicine rotation, but what would make it a sweat deal would be:

1. All electronic charts and vitals sheet that could be accessed anywhere in the hospital, as a third a couple of hours are spent a day wasted on finding charts.

2. Efficient and reliable inpatient phlebotomy team.

3. Work with efficient attendings, and preferably sit-down rounds, with walk rounds only to see patients, not to stand on feet for hours outside patient's doors which is painful.

4. Daily noon conferences with food that are pre-prepared power-points, NOT attendings talking off the cuff aimlessly about patients without having a good prepared presentation or good teaching points.

5. Good sign-off rounds procedures, more importantly good oral info from team coming off, a printed list would be good, but I wouldn't want to be a slave to minor details while missing the big picture of what is going on with the patient.

6. Nice attendings.

If somebody gave me this I would be snug as a bug in a rug.

I'm on IM right now and actually enjoy it as a result of the reasons you just listed. The weakest point at my place being #5. It has been a pleasant surprise, but I still have no interest in doing IM as a specialty.

 

[ChildNeuro]

Wow great points childneuro. I would only add computerized notes (everything including progress notes, consult notes, PT notes, etc.). I spend way too mch time trying to figure handwritings out. If everything was computerized, the day could fly by in IM. Afterall, nothing really happens to these patients and most of the day is spent in paperwork.

Yeah, way too much time is spent trying to decipher handwriting. . . some attendings spend several minutes trying to read the scrawl of their colleagues. The residency application website actually lists which residencies use electronic charts, I believe that the whole chart is electronic, I haven't experienced this but it must be great! In a decade a significantly higher percentage of hospitals will use all electronic charts as more and more young attendings can type and use a computer. It is such a game trying to get a chart and hold it long enough to read stuff, I always feel imposing, electronic charts where more than one person can see the chart would make medicine more efficient and safe. Some hospitals have like 6 different workrooms where nurses and nurse's aides can be and you literally have to a huge search just to find one single vitals book or chart, ridiculous if you ask me. I love little hospitals because the floors are so small and you can look around you and see the chart or vitals. I love ICU patients, partly because you can find the chart and vitals are in the chart, and you can spend time actually thinking about medicine.

 

[nutcancer]

Yeah, way too much time is spent trying to decipher handwriting. . . some attendings spend several minutes trying to read the scrawl of their colleagues. The residency application website actually lists which residencies use electronic charts, I believe that the whole chart is electronic, I haven't experienced this but it must be great! In a decade a significantly higher percentage of hospitals will use all electronic charts as more and more young attendings can type and use a computer. It is such a game trying to get a chart and hold it long enough to read stuff, I always feel imposing, electronic charts where more than one person can see the chart would make medicine more efficient and safe. Some hospitals have like 6 different workrooms where nurses and nurse's aides can be and you literally have to a huge search just to find one single vitals book or chart, ridiculous if you ask me. I love little hospitals because the floors are so small and you can look around you and see the chart or vitals. I love ICU patients, partly because you can find the chart and vitals are in the chart, and you can spend time actually thinking about medicine.

oh god how i hate those separate vitals books!

 

[ChildNeuro]

Reading various posts in these forums, I see a great number of people who dislike IM greatly. What is the reason for this and how come so many students not like IM and yet a lot of students go to IM? For those of you who liked IM, can you provide an insight at you enjoy in IM?

Maybe alot of residents went into IM because they didn't know what they wanted to do and are sort of floating around, alot switch out IM too because they don't like it, I've seen ALOT of unsatisfied IM doctors i.e. medicine attendings who are so upset/acidic that it is obvious they don't like the job. There is huge variability, some residents are great to work with, really into IM, others treat it like a pain in the booty and want to get out of the hospital as soon as possible.

 

[iatrosB]

I'm on IM right now and actually enjoy it as a result of the reasons you just listed. The weakest point at my place being #5. It has been a pleasant surprise, but I still have no interest in doing IM as a specialty.

Easy now, don't turn on me. Stay with us, don't go toward the light.

 

[BMW19]

When most people say they didn't like IM, I figure that they are referring either to the 3rd year IM rotation or the prospect of doing an IM residency, either of which consists mostly of floor work, which, in turn, consists of occasional problem solving interspersed with frequent managing of minimally important numbers and determining how we can get Mrs. X back to nursing home Y, from which she was "dumped."

Now, that shouldn't reflect too much on actually finishing and IM residency, which means that you are either going to do a subspecialty fellowship, which will add many more things to your daily routine, or go into general practice, which will seeing many patients in your office much more quickly, and making hospital rounds only one of many things that you will be doing, a new one of which will be concerning money and its obtain-ment (is that a word?).

Oooh, edit: Or you could be a hospitalist, which I am actually not seeing how that is different from residency.

About $120,000 a year is the major difference I see!!!