Internal Med: the Nitty-Gritty

Want more details about my time on Internal Medicine? (If not, skip to my other post about this rotation: http://beckymacd.blogspot.com/2010/11/internal-struggles.html)
If you want to know more, here's a day in the life...

Each team consisted of one attending (a "real," fully-trained doctor who oversaw everything and was ultimately responsible for the team), one senior resident (a doctor in the 2nd or 3rd year of the 3-year Internal Medicine residency, who essentially ran the team, divvying up responsibilities and doing a lot of teaching), two interns (doctors in their first year of residency, who had finished medical school and gotten their MDs about 5 minutes ago), and 1-3 medical students.

A team was assigned up to 20 patients on its service at a time, and during morning rounds, we visited each of them. Outside the patient's room, the intern responsible for the patient would present the case (patient's age, pertinent medical history, current condition(s) being treated, today's vitals and physical exam findings, and treatment plan) and the whole team would go into the patient's room and talk to/examine him or her and the attending would decide whether the team’s plan was a good plan or an entirely stupid one, possibly quizzing medical students and/or teaching us something along the way. If we were lucky.

The day really started long before rounds, though, with interns and medical students pre-rounding on patients. Students started at 7am (interns at 6am), and visited each of the patients we were following, inevitably waking them up to question them about any new symptoms and poke and prod them, then going and checking the results of their morning labs and any other new tests and writing all of this down in a progress note. All of this needed to be done by 8:30 (or 8, if you were on a team that had social workers assigned to it, in which case you met with them from 8-8:30), when medical students and residents went to Morning Report. This was a teaching conference for the residents, each day based on a different interesting/tricky patient case. Then we went back to the floor for rounds, which could last anywhere from 3-6 hours, depending on the patient load, complexity of patient problems, and speed and rounding of the attending. After rounds, the interns, residents, and students go to work, carrying out the day’s plan for each patient (ordering tests or medications, following up on the results of labs or tests, doing discharge paperwork, talking to patients and their families) and going down to the emergency department to admit any new patients assigned to our team.

I stayed each day until someone sent me home. (Guess how much I loved that lack of power over my own time.) Then I went home, ate dinner, tried to study a little bit, occasionally made it to the gym, visited with/complained to Tay, and went to bed. And got up to do it all over again.