I did, after all, come into this rotation excited about the possibility because I have thought about doing med/peds. You know, in case looking into ears all day would be too boring. Also, the idea of being able to follow a patient throughout their life, rather than booting them out the door at 18, is intriguing, especially if you consider the possibility of subspecializing within med peds (for example, a friend of mine wants to do a med/peds cardiology fellowship so that she can treat congenital heart diseases in babies, and then follow her patients through adulthood too). So what's it been like, hanging out on the wards, the front lines of adult medicine? The most I can say, really, is that it's a mixed bag. Perhaps it's too soon to tell.
The Good: As with most general specialties, I enjoy the thought process. Looking at the patient's history, vitals, labs, imaging, developing the differential, figuring out what might be wrong and how you could test for it and treat it. It's a fascinating mystery that unfolds before your eyes.
The Bad: In medicine, once you've figured out the diagnosis and treatment plan, you often end up sitting around babysitting the patient with nothing else to do, either waiting for nursing home placement or consults or confirmatory tests or imaging to come back. I have a patient right now who has been with me for weeks while we try to figure out why he has diarrhea. For the past several days, we have done nothing but order some tests and wait for the results. We're helping him, yes, but not actively so, and that's frustrating.
The Good: You see some really interesting cases. On our call day on Wednesday, we took on a new patient with an incredibly rare type of cancer, one with a rare form of nephrotic syndrome that we're still teasing out the cause of, one with new-onset congestive heart failure, and one with (possibly) a very strange and dangerous form of pancreatitis.
The Bad: You also see some really not interesting patients. Our service is typically filled with patients who are either being treated for a COPD (emphysema) exacerbation, or who have cancer and are just waiting to get their chemo. Not that these diseases are not important, but they don't require a lot of work or thought, much like the original "looking in ears" problem. Also, even some of the interesting patients are, to put it frankly, gross. I have a patient with a chronic bone infection that smells AWFUL. Like, you know what room this person is in because you can smell it from down the hall. In kids, you can look past these things because they're kids and it's cute and you feel sad that they have this gross thing, but with adults, it's just kind of...gross.
The Good: Sometimes, your patients are very kind and thankful and wonderful. I had a patient last week with cellulitis who was effusively gracious about my help in getting him out of the hospital so quickly, and it was moving to have him feel so grateful. It felt good to feel needed and useful.
The Bad: Sometimes, the patients suck. My diarrhea patient (see above) is a cranky, nasty person who frequently tells me what an idiot I am because I ask questions that he has already answered--to someone else. We had another patient on the team whose family screamed at us en masse because we suggested that his confusion might be a result of alcohol withdrawal. I'm sure this is true of many medical specialties, but it's frustrating when you get yelled at for trying to help people.
So yeah. Medicine is interesting, and it's kind of hard to narrow down exactly how I feel about it. I'll have to see how my subspecialty parts of the rotation go. After next week, I spend a week on palliative care service, three weeks on infectious disease (which I'm really excited about), and two weeks on another subspecialty (likely endocrine). If I'm still on the fence, I'm considering doing a week long career exploration elective in the spring in one of the med-peds outpatient clinics to get a clearer picture of what "real life" practice is like. So we'll see.
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