Internal Medicine Clinical Rotation

POP QUIZ: What is the only lipid-lowering medication class not contraindicated in pregnancy?

     For Internal Medicine, our program has two, four-week rotations. While it's ideal that we do both rotations at the same clinic, that's not always an option. I was at a Cardiology clinic for my 1st rotation, and I was at an out-patient primary care clinic for my 2nd rotation! I did not think I would enjoy primary care as much as I did, but I saw something new/interesting every day!

     As a provider at an out-patient internal medicine clinic, you are the patient's go-to for healthcare and also the "middle-man" between the patient's various doctors. If a patient has numerous medical conditions (i.e. congestive heart failure, chronic obstructive pulmonary disease, osteoarthritis), you are to ensure they are being referred to/seen and treated by their Cardiologist, Pulmonologist, Orthopedist, and so on. You also see the patient for annual physicals, acute illnesses, chronic medical problems, lab work, medication adjustments and so much more! 

     As a primary care provider, it's important to build a positive rapport with your patients. I noticed very quickly how much my physician's patients meant to him, and how well-respected he was by patients. He cared for each patient as an individual, helping them with medical problems as well as life in general. He has gone on mission trips with his patients, long-distance bike marathons with others, and even attended events/parties when his patients asked him to join. As a medical provider it's important to always remember that you are treating people; people with emotions, feelings, concerns, stressors, and anything else you can think of. Compassion is the best way to develop a positive rapport with patients. Studies actually show that patient overall health and disease outcomes are linked to a better patient-provider relationship.

     We had a couple of very interesting patients that came into the clinic...

• Female that was born with esophageal atresia and developed a fistula. For treatment, they took a portion of her jejunum and made a new esophagus that ran on top of her sternum. Looked WILD.
• Male patient with hypokalemia that says he drinks 2-3..... POTS of coffee each day. Does anyone else drink that much coffee!?
• Male that has debilitating headaches with orgasm, recent-onset.

     We have assignments that we do for the class portion of rotations, and one of those assignments is to type up a SOAP (subjective, objective, assessment, plan) note on a patient that we saw in clinic. For those interested in the male patient that has headaches with orgasm or if you want to see how a provider's clinic note is typically typed up, CLICK HERE (*please note: all HIPAA standards have been followed)

     Our program uses PAEA Exams, and they post a topic list and blueprint for each exam. Below are those categories if you want to see what we are responsible for (the IM topic list is a unreal):

• IM Topic List
• IM Exam Blueprint

 Books that helped me ROCK this exam include (the latter two are books for all PANCE topics, not just IM):

• Washington Manual Internal Medicine
• The Green Book
• PANCE Prep Pearls

POP QUIZ ANSWER: Bile Acid Sequestrants (cholestyramine, colestipol, and colesevelam)
- Be sure to monitor fat-soluble vitamin levels as these drugs may impede their absorption

Regret

QUESTION: What is your biggest regret?

     I hear so many people say, "I regret not doing this" or "I regret not doing that." How many people do you know regret something they they have done? I hear that so few times that I'd be lying if I said I could count on two hands. I'm personally of the mind set to trying everything. You want to try out for the local baseball team? Train, and try out. You want to become a doctor? Study, and apply to med school. You want to date that person you think is out of your league!? Ask, they just might feel the same way... Try everything! And even though you might not succeed initially, you CAN do it and you WILL do it if it's what you truly want to do.

• Bottom Line: Try Everything - Shakira

     There was a video I saw on YouTube where they had a giant chalkboard, and at the top "Write your Biggest Regret..." People began populating the wall with things their regrets; not pursuing their dream, not asking that girl/boy out, not taking that extra step to reach their goal, not applying to their dream school, not ______, you can fill in the blank. Not a single person wrote something on that wall that they regretted actually doing.

     My grandfather shared a quote with me... While humorous, it hits the nail on the head. "It's better to reach for the stars and land on the moon than to reach for the top of the haystack and land in the dirt." Pursue your dreams! You will regret it more if you don't try.

My Biggest Regret: The mental stress I placed on my family growing up. Love you guys!