CHAPTER 9: INTERNAL MEDICINE POSTING.
Welcome to the Internal Medicine department, where you learn pretty much everything you need to know for your basic practice in the medical career.
The Internal medicine posting is quite demanding. A good student has to be on his/her toes at all times. Basic knowledge in Physiology, Pathology and Pharmacology is essential.
The specialty has a number of subspecialties like Neurology, Immunology, Cardiology, Nephrology, Rheumatology, Hematology, Gastroenterology, Oncology etc
It was my most intense rotation, but I’m thankful for all I got to learn, which was a lot. To be sincere, I didn’t feel quite prepared or excited when I started.
Here’s an excerpt from my Journal the night before my FIRST day:
I’m starting Internal Medicine Tomorrow. How do I feel?
Sincerely, I don’t feel enthused. But I know I’m not supposed to be moved by how I feel. Joyce Meyer’s message this evening was really encouraging. Knowing is better than feeling.
I know who I am. I know in whom I believe. Through him I can do anything, I can do all things…cos it’s him who gives me strength. Nothing is impossible to him that believes. I know it’s time to overtake…this race is not to the SWIFT nor is this battle to the STRONG. It will be a long ride but at the end of it all, I shall testify. His favor & blessings, his goodness & mercy follow me.
Anyway, I got used to the stress and demands of the department as needed and 12 weeks went by pretty fast. I worked in the Male Medical Unit and occasionally got to see patients on the Female ward.
There were quite a good number of cases, and numerous admissions and discharges. The mortality rate in the department was also the highest all through my clinical rotation which is quite understandable, as some of the presentations were terminal cases.
Here are some of the conditions I saw:
Ø Autoimmune conditions like Systemic Lupus Erythematous (SLE).
Ø Endocrine conditions like Diabetes Mellitus.
Ø Gastrointestinal conditions like Gastritis, Gastroenteritis, Gastroesophageal reflux disease (GERD).
Ø Heart-related conditions like Congestive Cardiac Failure, Atrial Fibrillation, Hypertensive Urgency, Stable Angina, Rheumatic Heart Disease, Myocardial Infarction, Complete Heart Block.
Ø Hematologic conditions like Sickle Cell Disease (SCD).
Ø Kidney conditions like Acute Kidney Disease, Chronic Renal Failure.
Ø Liver conditions like Hepatorenal Syndrome, Liver Cirrhosis, Leptospirosis.
Ø Musculoskeletal conditions like Rheumatoid Arthritis.
Ø Neurology conditions like Headaches, Seizure disorders, Cerebrovascular Accidents (Stroke), Transient Ischemic Attacks, Bell’s Palsy.
Ø Respiratory conditions like Congestive Obstructive Pulmonary Disease (COPD) exacerbation, Exacerbation of Bronchial Asthma, Bronchopneumonia.
Other presentations include: Suicide attempts secondary to poisoning, Delirium Tremens, Major Depressive Disorder, Deep Venous Thrombosis.
Outpatient clinics were for Mondays, Journal club for Wednesday mornings and Continuing Medical Education on Wednesday afternoons.
My Preceptor, the Registrar, Medical officers and Interns I worked with were on point and did their best to show my colleagues and I the ropes.
Here are some typical activities I engaged in during those 12 weeks:
- Ward rounds.
- Bedside drills.
- Patient reviews.
- Case presentations.
- History taking & Physical Examination.
- Writing discharge notes.
- Semi-calls (where I stayed till evening with interns to help admit patients and run errands. I never did an all-night call *smiley*)
- Assisted with Bedside procedures like IV line-setting, blood draw, urinary catheterization, EKG etc.
On the day I completed Internal Medicine, I put up this Facebook post:
I find my Preceptor’s words on how to be a sound medical student very useful:
My Study Recommendations:
· Kochar’s Clinical Medicine for Students (easy-to-read & concise)
· First Aid Q & A
· Case files Internal Medicine
· First Aid for the Internal Medicine Boards
· Harrison’s Principles of Internal medicine
(I used soft copies of all the books, so you can search for and download them online).
And of course, Paul Bolin’s YouTube videos.
Here are some free medical applications you can check out too:
· MEDSCAPE (my BFF)
· Clinical Skills
· Differential Diagnosis
· Clinical Sense
· Figure 1
On the choice of specialty, I’ve noticed that Internal Medicine seems to be the most likely from my interactions with a good number of my colleagues. Personally though, I feel Internal Medicine seems to be a vast world of its own and apart from taking an interest in a particular subspecialty, it would be way too demanding. On that note, I’d rather take on a more streamlined specialty.
That said, a BIG UPS to all the doctors working in the Internal Medicine specialty, they make a good bulk of the medical career and without them there’d be nothing like Medicine.
Thank you for reading!