I’ve been hearing forever about hospital rotations, but today I finally started my first one: inpatient medicine.
For the last year I’ve worked in clinic settings learning the ins and outs of outpatient primary care. But for the next two weeks I will be learning about inpatient medicine, the practice of treating patients who are admitted to the hospital. I’m working with a team at Mather VA hospital in Sacramento, California on the TCU and medical/surgical floor. It’s a very clean, modern, tastefully decorated place.
The first order of business was learning the hierarchy of medical professionals on our team. It’s so universally understood that no one explains it to you!
The team is comprised of:
First off, we didn’t walk around the unit as a group of dumb, eager students in over-starched lab coats, clustering around the residents like they always do on TV. Instead, we all sat around the table and talked about the patients. After much discussion, the clinicians fanned out to either 1) see their patients on their own, or 2) sit in front of a computer digesting their patients’ records. It wasn’t sexy or adrenalin-filled. In fact, if there is one word to describe Internal Medicine, that word is chill. So far there are no big, ball-busting blowhards like you see on TV, no one “pimping” the students. From what I hear, that’s way more the style of surgery.
Everyone is very casual, friendly, and all seem to go about their day without much discussion of what is going on – there is plenty that is just picked up through osmosis, I guess. My fellow students who have already done this rotation assure me that within a few days, the routine becomes pretty, well, routine.
As usual, I have to steer well clear of talking about any specific patients, but I can say that the difference between these patients and the ones we see in clinic is that they are much sicker. These days, no one gets admitted to the hospital unless they are 1) very ill, or 2) at risk of becoming very ill or dying. It’s just too expensive. Here are a few characteristics that describe the patients we see:
We started following one patient each today, which doesn’t sound like much, but it’s plenty. For each patient, the electronic medical record system provides an avalanche of data – vitals, labs, imaging studies, previous consults, old records, and much more. You quickly realize that the most challenging part of the work is sifting through the mounds of information to formulate a story about what is going on with the patient, and what to do about it. For example: say the patient had a stroke. How can we determine what type of stroke it was – hemorrhagic, ischemic, or embolic? Knowing the type, what was the likely cause – atrial fibrillation, DVT, a damaged AVM, a carotic plaque that broke off? And finally, what to do about it – anticoagulate, change blood pressure medication regimen, heart surgery?
We each interviewed our patient, did an exam, and read copious amounts of chart information. Tomorrow we will see what has changed and how to proceed. We may formally “present” the patient to the team, which is basically summing up everything that we know and think about them, and seeing what the attending thinks. Down the line we will probably follow more patients each day, along with being familiar with the other patients that our team is caring for.
I’ll let you know when we get the routine down…[subscribe2]