Medicine, Neuro, Psych
Roshini Selladurai Jan 23, 2016
Obviously MS3 has been pretty busy–less exams, but a lot more scheduled time. Each rotation is different, each team is different, each attending has different expectations. I’ve been really blessed to have great teams. I think that truly does make all the difference…it’s the whole “you can hate your job, but if you love the people you work with, the day isn’t so bad.” I started that statement thinking it’s a common saying, but now I’m thinking maybe I just made that up…haha. But it’s true. Even the worst rotation/job can be fun if you’re around the right people. And vice versa–a rotation/job you thought you’d love can be horrible if you’re around the wrong people.
I’ll give a quick recap of the first block in this post and recap block 2 in a separate post. I started out with my Medicine block–meaning I did Internal Med, Neuro, and Psych. I’m currently in the end of the second block on my VACATION month…which is why I’m trying to catch up on this blog :)
Internal Med–the schedule is pretty intense. And there’s a lot to know. I intentionally chose to have this rotation first because I felt it would best prepare me for the rest of the year. Everyone’s experience is a bit different, but I can tell you about mine. I had an awesome resident who sat down with us day 1 and walked us through how to present a patient on morning rounds. I’ve used her structure for every presentation since then and that was a huge blessing that made presentations pretty stress-free for me.
So basically the way life works on Medicine is you’re assigned patients (usually start with 1 and work your way up to 3-4 by the end of the rotation) and it’s your job to know what’s happening with them and “present” them to the team each morning. You’re basically catching up the team on anything that happened overnight and laying out a “problem list” along with a plan for each problem…ex. “Problem #1–Anemia…patient’s Hgb is 6. Let’s give him 1 unit of packed red blood cells today and continue to monitor.”
You start the day at 7am, pre-round on your patients (go see them, talk to the nurses, check on their charts, get the important lab values) by yourself, then the team rounds together with the attending, resident, interns, pharmacist, med students, etc. Rounds can be quick or long, depending on the attending. Some attendings like to table round…meaning you stay in the team room and talk through each patient and the plan. Others like discovery rounds, meaning you don’t need to pre-round–you all go into each patient’s room and “discover” any new info the patient may give you together. There’s also patient/family-centered rounds where you present the patient to the team in the patient’s room. That takes some tact because you need to be mindful that the patient and/or their family is listening to all the medical jargon…this type of rounding is pretty common during the peds rotation. On Medicine, we mostly presented the patient outside their room, discussed the plan, then went in and talked to the patient and went over the plan with them. After rounding, you go back to the team room and write SOAP (Subjective, Objective, Assessment, Plan) notes on each patient. The afternoon is spent working on notes, visiting your patients again, potentially getting a new patient, and helping the residents/interns.
In order to like Internal Med, you’ve got to enjoy dealing with multiple problems at once. You can’t just address one problem…there’s almost always multiple problems (COPD, Hypertension, Diabetes, etc.)…and you’ve got to be thinking about all those problems when addressing one problem.
As an MS3, the advantage of Medicine is that it makes you FEEL like a doctor…you’ve got “your” patients and you get to know them and earn their trust and form a special bond. You tend to have more time than anyone else on the team to spend with them, so they really start trusting you. It’s pretty special to walk in the room with a huge team of important people and the patient is focused on what you have to say because you’re the one they trust. The patient encounters from Medicine will definitely stick out to you. I’ll hopefully share some of those stories in future posts.
I’d say the downside of Medicine is the days can be long (start at 7am, end whenever the resident lets you leave…this can be as early as 2pm (I had an awesome resident!!), or as late as 7 if you take longer to write notes on your patient or are given extra work), you work 6 days a week, sometimes you end up working 2 weeks straight depending on the call schedule, the call schedule can be draining (“call” means you stay till 10pm at the latest), your experience is VERY dependent on your team (this was a good thing for me, because I had an awesome team the whole time, but it can be bad if you don’t like your team), and the rotation is long. It’s definitely an intense schedule.
Neuro–one of my favorite rotations thus far. The neurologists are phenomenal. They’re fun to work with, they enjoy teaching students, and they make the day fun. The schedule was also awesome compared to Internal Med (and the rotation is half the length of IM). I did 4 weeks of outpatient–2 weeks of adult, 2 weeks of child. So my schedule was 9-4pm (some days got out even earlier!!). The patients are very kind and the pathophysiology is interesting to learn too. It’s one thing to read about Parkinson’s disease and another thing to see a patient who has Parkinson’s disease. I LOVED Peds Neuro. It was just so much fun to walk into a room and see a child. The whole experience of interviewing and doing the physical exam is so much more fun and creative with a kid!
Psych–I thought I’d love this rotation but it was actually pretty depressing for me. I chose to do Child Psych because I had an interest in peds + psych…so it seemed like the perfect combo. I was assigned to Larue Carter. The hours were great (9-3ish), the attending and fellow were very kind, but I dreaded going to work each day…very different from how I’d felt during Neuro. It just felt like a very hopeless atmosphere in many ways. I was so saddened by the trauma that many of the children had undergone…they’d gone through so much, they didn’t even seem like children anymore. I’ve heard that Larue is a unique atmosphere and not all that indicative of what Child Psych is like. The kids live there, go to school there, and basically rarely leave the building. Obviously different from outpatient child psych. However, I do think it was a good rotation for me to do. MS3 is all about figuring out where you do and don’t fit in. I thought I’d fit in with the psych world, but I realized I didn’t really…at least, inpatient child psych just wasn’t my thing. And that’s okay. It’s good to learn that. Thankfully I know my perspective wasn’t tainted by working with a bad team or something…the team was great. I just didn’t feel like Psych is necessarily what I see myself doing in the future. I’ve been encouraged to do another psych elective since it was a speciality I’d had some interest in (I was a psych major in college). We’ll see if I end up doing that…
Summary of what I learned / my advice for this block:
BE CONFIDENT. Seriously, that was the biggest advice I gave to everyone after I finished Medicine. No one expects you to know everything…some people don’t expect you to know anything. Take advantage of that fact and get comfortable with being wrong. Just don’t melt into the background. And don’t let people intimidate you. I did pretty well clinically and I think that was largely due to the fact that I wasn’t afraid to be confident or to be wrong. Each attending is a bit different…there’s definitely a necessity to read them and figure out what they want. But most attendings want confident students. Keep in mind there’s a difference between arrogance and confidence. Be willing to admit when you make a mistake, take the time to learn more about that topic, and be ready to make more mistakes. Thankfully, your mistakes will not affect the patient because you are never the sole decision maker as an MS3. That’s a beautiful learning opportunity!
BE NICE. Take everything you learned in kindergarten and apply it here. Share your resources with others. Smile. Be friendly. Don’t be mean. Take an interest in others. Be a team player. Learn from your teachers–nurses, pharmacists, attendings, interns, residents, etc. Don’t freak out if things don’t go your way. Be flexible. Don’t take yourself too seriously. Get to know your patients–spend time with them, listen to them–really listen to them, let them talk about stuff besides their medical condition, get to know their family, be willing to help. Just be a nice person–it will get you far in life and in this rotation.
BE YOU. Don’t forget that you’re a person, not just a medical student. Take time to enjoy life outside of medicine–exercise, play outside, go see a movie, have fun. And while you’re at work, it’s easy to feel like you have to conform into this “perfect med student” mold. Don’t. Be yourself. You have something unique to offer to the team and that’s awesome. If you’re funny, be funny. If you’re serious, be serious. Don’t try to be someone else. Let the gunners be gunners, let the chill be chill. Anyone want to guess which category I fell into? Haha. Don’t forget to hang out with your friends and talk to your family. Hopefully you’ll have people in your life who understand your schedule and go out of their way to visit you and see you on your days off. You may also have people who get frustrated with your schedule because it makes life inconvenient. That sucks. Be patient and try not to get discouraged. This too shall pass. You’ll quickly discover the people in your life who see you as a priority…cherish those people because they are worth their weight in gold. Also, don’t become entitled or feel like your life is so much harder than everyone else’s. Easy fix to this common problem: just keep in mind that you are the med student and not the patient. That will change your perspective and humble you and make you grateful pretty quickly.