Reflections on Internal Medicine I

Whew! This one’s been a long time in coming, seeing as how I finished this rotation back in…January. The only thing I knew going into this rotation was that:

1. My preceptor did mainly outpatient Internal Medicine. I was pretty overjoyed by this, because then it’d be like Family Medicine! :D!
2. It would probably be more of a shadowing experience vs. lots of hands-on experience. Initially, I was sorta bummed by this, but it turned out okay!

I’ve quoted him a couple times before in my first couple Medical Mondays posts–Preventative Care & the benefits & risks of Exercise), but here’s my summary on my actual rotation with him! This was one of my favorite rotations thus far, due in part to its similarities to Family Medicine, and how well we got along. :]

Reflections on Internal Medicine I

1. Practice what you preach. / Lead by example.
   I’ve long been an avid fan of this principle, and it’s what I want to be able to do when I’m a physician. I’m definitely far from the healthiest eater on the planet, but hell, he ate more healthily than I did. :O I mentioned this in my Preventative Care post, but my preceptor for this rotation was the first one I’d ever had who truly did everything that he asked his patients to do or not do. (Aka not smoking, not drinking soda/pop, exercised via running/weights/golf, followed a balanced + healthy diet.)He’s also brilliant, and aside from owning two private practices, he apparently also has an MBA and a law degree (boarded in California).  I loved that he really took the time to explain to each of his patients the reasoning behind what he asked them to do, and it’s definitely something that I hope to incorporate into my future practice.
2. Having a preceptor that you can joke with and/or relate to is awesome.
   While all the other preceptors I’ve worked with thus far have been really nice, he’s the first one I could really actually relate to (probably because of the similar interests and mutual hope to convince all his patients to lead healthier lives). I made pineapple fried rice to bring in for lunch on my last day, and talked with him and his wife/got semi-grilled about applying to medical school (his daughter’s in the process of doing so right now).
3. Show more initiative.
   I need to work on speaking up. While I did get to see some of my own patients, this was indeed largely a shadowing experience. Although I’m much more of a kinesthetic learner, I actually ended up really benefiting from this because he was so thorough with all his patients. In general though, I do feel that I might need to start asking for more opportunities. I usually don’t because I don’t want to slow them down/step on any toes, etc., but…the worst they can say is no!
4. You reap what you sow. / Treat others how you’d want to be treated.
   On my last day, I happened to be walking by the nurses’ station and one of them told me that I was probably the nicest student that they’d ever worked with. <3 (She’s also the one who talked him into giving me a day off so I could spend the holidays with the people closest to family that I have out here!) They told me to feel free to let them know if I ever needed anything, and that it was great working with me. :D (They’ve apparently had a couple students in the past that they completely could not stand.)
5. Stop it with the self-doubt.
   After taking my shelf exam, I stopped by at the office to see if I could drop off my grading forms and hopefully also ask him for a recommendation letter. One of the nurses asked me if I was in a hurry, because he was in a pretty terrible mood and she advised me it might be better to wait. About 2 hours later, he’d finished with his last patient, so I went to go talk to him. He seemed to be in great spirits and filled me in on what had happened…and went over my grade form with me.Dr. G: How do you think you did?
   F: Um, I have a tendency to be my own worst critic because I always feel like I could do better…
   Dr. G: Let me rephrase that. How do you think you did in medical knowledge?
   F: …I think I could definitely stand to improve a lot there.
   Dr. G: Me too. *marks off a 95% in that category*
   F: …o_oI’ll cut to the chase–he said he’d be happy to write me a recommendation letter! <3 <3 <3!!! I think he was slightly bewildered and amused at my joy over that statement, hahaha.

This is how I knew I’d get along with the office staff. :P

Normally, I’d have a section for “Memorable Cases,” but I think the “Notable Quotes/Conversations” section aptly illustrate a lot of them. :D

Notable Quotes/Conversations

• “I’m gonna teach you something that they don’t teach you in doctor school. The best way to approach life is with PMA–Positive Mental Attitude. I don’t mean macho-ness, but mental toughness. It’s the ability to face adversity. I firmly believe it can take you through anything. That’s why I greet every day with, ‘Good morning, world! Ready or not, here I come!'”
• “Can we wait on the colonoscopy? The love of my life is having surgery done, and I want to make sure she’s okay first.”
• “Oh honey, I don’t mean to stare, but you’re a whole lot prettier than Dr. G.”
  Dr. G: I’m glad I’m not pretty to you.
• “My, can I just say that you look mighty put together? I love those shoes on you; you’re just as cute as can be!”
• “Let’s wait til spring, when the birds are chirping and the sun is shining…”
  F: And your colonoscopy.
  “You just put a dark cloud on my spring.”
• “I’ve had some terrible things done to me because of you–they injected me with something and turned me upside down–that wasn’t the colonoscopy, was it?”
  Dr. G: …No. That sounds like torture.
• “You got a pretty new assistant, you know that?”
  Dr. G: Your wife is sitting right there.
• “Any particular reason why I got this fungus? It just seems so random.”
  Dr. G: Nope. Some people are just more likely to get it. You’re not rolling around with your cats naked or anything, are you?”
  “That’s none of your business!” (joking, we hope)
  Dr. G: You made it my business!
• Dr. G: Your lungs are screaming at me. They’re saying, “Tell her to stop smoking!”

Dr. G-ism’s

• “We’re all gonna die anyway.”
  Dr. G: You’re right. I wouldn’t argue with that, but it’s not the death we’re worried about. It’s the quality of life. You don’t want to live an involent life where you might get a stroke and end up bedfast, with someone else cleaning your poop, if you can do something to prevent it.
• “Exercise will help, but the key is in what you’re eating. I could work out for an hour and burn 500 calories, but suppose I eat a cream-filled donut afterward. That’s 300+ calories in less than 2 minutes.”
• “You can’t do any of those diets forever. What it boils down to is a lifestyle change.“

Resources

• UpToDate
• Boards & Wards (Carlos Ayala, Brad Spellberg)

Read about my other rotations here!