Thursday, September 27, 2007


One of the more inscrutable whims of whoever it is that determines the requirements for internal medicine residency this year has been to require a "subspecialty month" in which we see a week of clinic in ENT, Ortho, Ophtho, and Psych. This week has been ENT clinic for me, and it's beeen a leap back in time.

What I mean is, I am basically functioning as a fourth year medical student. I don't know any of the surgery, so I can't really contribute there, and my idea of a clinic visit is at least 30 minutes long, so I'm not fast enough for surgery. These guys have are double and triple booked in twenty minute time slots, and they are rarely behind. On the plus side, I've seen a lot of scopes and procedures that I probably won't ever again, unless I go into general internal medicine, get really fancy in my own practice, and decide a nasopharyngeal scope is a worthwhile investment.

I've survived though and today was actually fun, even for an internist. Just when I was about to slide into the quick, only-the-highlights ENT exam on a patient, I figured out she had something more serious than just hoarseness wrong with her, and we ended up needing a fairly involved thyroid workup. That's something I know how to do. And then one of the later patients needed to be scheduled for surgery, and the ENT doc I was working with wanted to do it tomorrow. He looked at me and said "with this guy's cardiac history, anesthesia is never going to take my word on a physical so seriously that they'll approve surgery on this short notice. Can you do the H&P and write 'internal medicine resident' next to your name? They'll take that, I'm sure." So I did, and I don't think the surgeons minded my 25 minute exam, because it meant one more case on the schedule for tomorrow. It was nice to be recognized for expertise in my field, even if it is considerably premature.


Alice said...

Surgeons do occasionally need internists, after all. :) Anything that gets another patient on the schedule is good. I've finally figured out that my senior residents are least moody when they've had a good number of cases in the OR that day.

Anonymous said...

nicely done!

Matthew said...

Whoa-whoa - YOU'RE doing Psych clinic? Looking forward to that one!

Nathan said...

Alice - actually I got to thinking, the only reason the surgeons can be so cavalier in their assessments is because there are strong primary care docs who have checked the rest of the patient. :)

Matthew - I start Monday. I'll hopefully have some good stories.

Alice said...

Nathan - You are totally right. They just make sure that they have a good cardiologist or critical care doctor they can trust, who understands what's involved in their surgeries, and then they let go. "Plan: Continue routine wound care. Management of cardiac and respiratory issues per consultants."

Looking forward to hearing your take on psych. :)

elrj said...

Well, well, well! Aren't we proud of ourselves!
But I'm sure you're doing a great job. :)
I mean, I love reading your blog, right, so you must be doing well! Ha!