Sak Pase!!
Happy New Year! 🌚
Y'all I finished twelve lonnnnnnnnggg weeks of internal medicine. I passed the shelf and now I'm in my third rotation.....Obstetrics & Gynecology.
IM was way too long. The first 6 weeks I was at an outpatient clinic. In the clinic I was in, 98 percent of the patients were Haitian and like 80 percent ONLY spoke Creole lol. It wasn't a problem for me because of course, I'm Haitian and well I speak Creole lol. Sooo basically, it was me and 3 other students from AUC. We would go to the front to ask the sweet medical assistants for the next patients on the list. We then went into the lobby and called on our patient, brought them to the back in a room and take their weight, height, and vital signs. We then started a note on their charts in the computer. Basically we did an H&P (history and physical). We asked them what brought them in and did a physical exam. If they're new patients, we would get a full history on them, including past medical history, family history, social history, medications they take etc. I also learned how to do EKGs and a whole lot about medication management and diabetes and hypertension. I also learned how difficult it is for patients to manage their health when they're living in poverty, especially my Haitian people. I can't wait to become an established physician to be able to give back to my community.
The next few weeks I was in inpatient. I did half of that at Jackson Memorial Hospital and the other half at Broward Health. 2 completely different experiences!
At Jackson, I was with two different Attending Physicians. Each week you're with a different attending unless you request to stay with the same one. The first week I doing the night shift lol. It was from 10pm to like 4am if i remember correctly. It honestly wasn't all that bad until my car got towed :) It was me and 4 other students, we basically went to admit patients who came into the ER, we would get a history from them if we could (i say if we could because it's the ER the patients are not able to give histories sometimes)then examine them. Afterwards we would go back to the computers as a group and work on a patient note, the main part of that is the Assessment and Plan portion. Basically list everything that's wrong with the patient one by one and then write supporting details under each complaint and what lab tests, procedures and consults that patient might need for each complaint. The doctor would then go over the note with us, mostly the A&P like I said before.
The other weeks I was in the day shift and I worked with a wonderful Attending. Y'all I loved him!! He was enthusiastic and full of energy. He absolutely loved his patients. We walked into a patient's room who was admitted because of a stroke so he lost control of half of his body so it was difficult for him to eat. Y'all, this doctor walked in to the patient's room and fed the patient himself. Fed him his food and gave him his juice then cleaned his mouth afterwards. He wasn't afraid to touch his patients. He really cared and I loved that. He's also a great teacher. In one day, I learned tons from him. We got there in the mornings and he would give us his patient list and we would divide the patients up among ourselves. We go chart review then go see the patient, do a history and physical exam. After about 2 hours, the attending would meet us on the floor and we would round together and present our patients to him from beginning to end. Then he would spend about an hour or two teaching us on a topic or going over some questions.
Then, I went to Broward. The experience was a lot different. I was exhausted. Exhausted was me. First of all the drive was hella long. At Jackson, the students worked directly with the attendings. At Broward however, we were working under Residents. I mostly saw the attendings when we rounded on our patients. But basically I would get there at 7am sometimes 6:30am depending on when we would round that day. Look up my patients' charts, go talk to their nurse and telemetry about any overnight events then go see the patient and examine them. Afterwards, the med students, the residents and attending would round on the patients. We would present either to the resident or to the attending depending on the day. After rounds, we stayed with the residents. They usually give us a topic to look up and do a presentation on later on. We also do other miscellaneous things like go educate this patient on smoking or alcohol cessation, go explain to this patient how she should take her home meds, go talk to case management about this etc. So unlike Jackson we didn't leave immediately after rounds. So hours would be 6:30/7am-3pm. But every 5 days are call days, meaning our team is on call and whatever patients come into the ER we have to go down and admit them. The hours for call days were 7am-7pm. Those were fun lol (insert sarcasm) but I did learn a whole lot. All in all, it was an exhausting three weeks. I was too tired to study. By the time I got home, I would take a nap and when I wake up i would only have a few hours to study then its back to sleep because I have to be up at 5:30am the next day. I did learn a lot though, I admit. AND Glory to God, I passed my shelf. I used online med ed of course, my faithful buddy Uworld and Dr. High Yield on Youtube. So now I'm done with IM and moving on to ObGyn, woot woot!
I want to end this post with 4 things I learned after my IM rotation....
1) I used to always complain about IM Physicians not spending enough time with their patients. But tbh I realize now that they do a lot of shit. I mean like I have a new appreciation for them. Yes I agree, most of the time spent is not with the patient but that just means that the time they do spend with the patient is very crucial. Most of the time, physicians are in the background, critical thinking and using their knowledge and training to figure out what could be wrong with the patient, what labs and imaging to order and most importantly what meds or treatment options to give the patient NOW while we figure out their mystery. I mean it's amazing. It gave me a whole different outlook on medicine. Like physicians are some smart ass people y'all lmao. I mean you have take the patient's history, their labs and their imaging results and rely on the knowledge that you've gained throughout your training to make sure that another human being doesn't die. That's a lot of pressure man and time is of the essence. The last 6 weeks of IM made me realize how important medicine is, especially hospitalists because people be coming into the ER with some crazy shit y'all lol.
2) Another thing I learned. Imposter syndrome will creep on you now slowly but surely. The last 6 weeks of IM has definitely showed me how much I don't know. I mean it was only my second rotation but still I kept thinking how much I didn't know and how much my peers knew. I kept asking myself wth I was doing in medical school. Who do I think I am? lol. What made it worse was that I was told that I lacked medical knowledge. I mean that shit hurt and I felt like complete shit. But I had some wonderful friends speak life into me. It was only my second rotation, I have room to grow. Even doctors are still learning. I was put here for a reason and i've made it so damn far, that's definitely not by accident. God doesn't make mistakes now does He? I might not be the smartest med student out there but I am def one of the hardest working students out there and I guarantee you, I won't give up now. Gotta lot of work to do but I knew that coming in. Nothing changed.
3) Assessment & Plan is like the most difficult part of a patient note for me. I thought the HPI was the most important so I always worked on perfecting it and i'd like to think that I did (haha right) but working in Inpatient I realize how much of an emphasis the attendings and residents put on the assessment and plan portion and tbh it's the hardest part of the note for me. It requires critical thinking, shit ton of knowledge ad some experience definitely helps. My critical thinking abilities are subpar, my knowledge is lacking I was told and well....I don't have much experience so you can imagine how much I struggle with A&Ps. I explained what it was above. basically its a list of what might be wrong with the patient and what was already wrong with the patient and under each complaint you gotta write a bunch of stuff to support the diagnosis by using labs, symptoms, etc. HARD but one day friends, one day.
4) Finally, residents work a whole lot DAMN IT!!! Like what have I done? What have I signed up for? They only get one day off a week and its like a random day. So I'll be working 6 days a week. I have to say bye bye to weekends and bye to two days off. Y'all might be like duhhhhhh but I legit never knew this until now.
Anyway enjoy this pic of me just existing on my last day of IM lol....
TTYL! 💜
