One of my more popular entries on here is about choosing a medical specialty. I've decided to write some on each specialty that I've had a rotation on, the good and bad parts.
Internal Medicine
The backbone of medicine for adults, the core of the hospital.
Who should consider internal medicine?
This is a field for those who enjoy thinking, differential diagnoses, adjusting doses, and primary care. Among the things you will see the most as in- and outpatient are:
- Hypertension
- Dyslipidaemia
- Diabetes
- Acute-on-chronic events like COPD exacerbations, CHF exacerbations
- New-onset events like heart failure
- Liver disease
- Viral illnesses
- Fatigue
Procedures:
Minimal. I met someone who actually said they hate procedures, so take that into consideration. You'll have the basic physical exam down, and then probably administer injections, take an arterial blood gas in the hospital (but respiratory care has the best skill), but not much else.
Pros:
You'll be able to manage very sick patients, and be the first person many people go to see first.
You take care of the whole patient instead of specializing on one aspect.
Less physically demanding than surgery, without cases that span across the night.
You're a focal point in the hospital, and if you're a very good internist you won't have to consult many services and you can handle much of the cases on your own.
Cons:
The flip side of one of the pros: many patients come in with multiple problems: heart conditions atop COPD, combined with renal problems and poor physical reserve, and so on. It can be frustrating.
You never truly cure anyone unless it is a bacterial infection.
Outpatient results depend heavily on patient adherence, and ability to pay for medications.
It's hard to find an end-point with some hospitalizations. Some patients are so sick they could stay in the hospital until they pass away. Many very ill patients must go to hospice.
The paperwork is extensive and frustrating. Being the pointman/primary care provider means you have to know absolutely everything about your patient all the time and constantly juggle.
hi,
ReplyDeletei love the blog :)
im a first year medical student in england and personally internal medicine is my main aim, as i feel you can build some sort of friendship with the patient.
how do you feel on other medical specialities
thanks
Sonia x
1st year medical student.
Scrubbing Up - Students of Medicine & Surgery
http://www.scrubbingup.com
Hey there, thanks for your readership and great compliments.
ReplyDeleteThe last thing I wanted to in my life before starting medical school was surgery, I thought everyday would have an intense atmosphere and that I just wouldn't enjoy it.
I ended up enjoying it, and find the OR to be a small place of sanctuary where you can work and change a life. However, I'm not very interested in other surgical specialties like OB/GYN, orthopaedics, or urology. I think I could be happy as a general surgeon, or focusing on a field under it.
For me, the medicine rotation was taxing because there are so many things to manage in such sick patients, in both the short and long term. It's enjoyable to see the same patient every now and then when they're as serious about their health as you are, and many patients are thankful.
Bear in mind surgery has less relationship building in it not because of the personality of a surgeon, but because most problems can be solved in the OR. Usually there'll be a clinic visit, inpatient time after surgery, and a follow-up visit in the clinic.
In surgery I think you see more new patients, and it's a chance to touch more lives, but that's just me!