Internal Medicine

Internal Medicine Rotation Objectives

The first week of internal medicine is a big adjustment for me. Especially coming from geriatrics, where patients were more stable and were admitted for more than a week. The great thing about this rotation is that I get to “tag team” with Evelyn. She overlaps with me for 3 weeks. We have been interviewing patients together and bouncing ideas of each other.  A summary of my first week:

1) Daily rounds: We attend rounds every morning with the CTU team which consists of the senior attending, the junior attending, the senior resident, junior residents and MSIs. I have spent a lot of time looking up things we discuss in rounds because many times I admit I have no idea what they talking about.

2) Alcoholic liver disease: for some reason almost half the patients on the unit were admiited with liver failure secondary to alcoholism. I am learning so much about liver disease and my case presentation will be dealing with the use of corticosteroids in the treatment of acute alcoholic hepatitis.

3) Non-inferiority trials: Evelyn, Sean and I spent 2 hours in his office trying to figure out the statistics behind a non-inferiority trial that Evelyn was doing for her journal club. Although, I am still not as comfortable with them as I am with RCTs. I have a much better understanding of them. Specifically, how a statement about superiority and non-inferiority can be stated and when it cannot.

4) Expectations: This week has been overwhelming for me, not in the sense that I have a lot of patients but in the sense that I realized how much I don’t know. I had a long discussion with Sean about this and we both agreed that I have to come to terms with the fact that I am not going to know everything about all the disease states and treatments that I come across.   I have spoken with colleagues and friends who have done a residency and it’s nice to know they shared similar experiences. This will be an on-going internal battle throughout my residency but my goal is not to let it stress me out too much or to put a damper on what I will learn.

Internal Medicine Week 2 (October 2, 2009)

The first half of my rotation has flown by! I am feeling more comfortable bringing up issues in rounds and the medical students and residents have been coming to ask me questions so it makes me feel useful! I also realized howimportant it is to do a prior medication reconciliation. I found 8 discrepancies in one of my patients today. The doctor always thought Pharmanet was very “accurate” .  I explained to her that it is almost never the case and medications dispensed through BCCA, OTCs, etc are never recorded on pharmanet.

I am adjusting to the different atmosphere (compared to Geriatrics). Patients sometimes are discharged after 1-2 days so it’s hard to fix all their DRPs in such a short time span. I have phoned the family doctor and also the patient’s community pharmacy in some cases to ensure certain issues are dealt with after discharge.

I presented my case presentation on the use of glucocorticoids in the treatment of alcoholic hepatitis this week. It did not go as well as I had hoped. But I received some constructive feedback that will help me make changes to it before I present it in Vancouver. Here  is a copy of my presentation: slides

I am also feeling more comfortable speaking up during rounds and I am finding that the residents are calling me more often to ask questions. There were a few instances where the attending and the senior resident did not agree with me but I don’t regret giving them my opinion!  For instance, there is no evidence that one PPI is clinically more effective than the other and the attending believes esomeprazole is more potent and therefore “more effective” than the other PPIs.

Internal Medicine – Final Week (October 16, 2009)

  On Wednesday, I faciliated a journal club on an article which compared varenicline to transdermal NRT for smoking cessation.  We had VGH teleconference but we were having technical difficulties and unfortuantely the JC did not flow quite as well as I would have liked. They were having trouble hearing our discussion so we ended up repeating comments multiple times.  Here is a copy of my handout: JChandout.