Hello boys and girls! Well. It's been a few months. One hell of a few months, to be exact. I moved to Miami! It's insane. More on that another time. I just finished my internal medicine rotation, as in, took the exam today (Don't worry, I only cried ONCE afterwards). For those of you keeping score, thats 3 months of surgery and 3 months of internal medicine under my belt. So, basically, I'm a doctor now, right? Wrong! I had a very mixed experience in IM and some of that included time in the ER where I had quite a bit of autonomy - to diagnose, treat, and sew people's faces! I loved it. I actually understood the patient poaching on Grey's Anatomy. (Read, one patient comes in with head laceration - four medical students want to sew that head - must guard that head). I'm not kidding, I went with my patient to their CT scan and sat outside and then marched right back with them. I was GOING to sew that head. (Don't worry, I did!)
Anyways, ER side note aside, it's been intense. Learning how to work with different attending physicians every week, with very different teaching styles, learning that patients' really hate being woken up at 5 a.m by the med student, learning it's best not to wake patients up by leaning over their bed and whispering "Good Morning Mr. Smith". Apparently, that's "unsettling". Just kidding! I didn't do that! It was Mrs. Smith! Hahaha, hohoho... so funny. ANYWAY! Let's get to the topic of this post - Medicine is 100% fake it until you make it.
Let me explain - if you're wearing a white coat and speak with authority, people will believe you know what you're doing. Something else no one mentions, patients don't know the proper physical exam technique or question sequence sooo when you mess up, if you just pretend you didn't, no one knows! (Man, I use A LOT of commas). This worked very well when I was trying to find my patient's kidneys a feeeww inches too low and just readjusted. Yup, totally had to check your bladder, sir. He had no idea. I know, I'm sly. In all seriousness, this really helps you develop your clinical reasoning and skills. A big part of medicine is controlling the room when you're taking an interview or doing a physical exam and a big part of controlling the room is having self-confidence and being authoritative. There's no room for nerves or self doubt when you're interacting with a patient, what patient is going to tell you their life story, including all the private little details doctors need to know, if you're sitting there playing with your hair and mumbling. You gotta fake it until that fake confidence becomes real, I'm convinced it's the key to being a successful medical student.
All of that being said, I think the most important thing I've gained from this rotation was confidence. I feel comfortable working through a differential diagnosis, asking questions and doing a physical exam to narrow down what's going on. I even think things like "Hm, I wonder what the creatinine came back as this morning... that would make this diagnosis more likely". I KNOW! Before you think I'm incredibly smooth and talented, you should know that I also still do things like:
-ask the wrong patient, who is not on dialysis, when they go to dialysis
-get hopelessly lost because why does one hospital need 19 buildings and 213823984 elevator bays?
-Try to find coupons to support my starbucks habit
-get my toes run over by gurneys
-have absolutely no idea what I'm doing and just ask a patient a WHOLE bunch of random questions hoping one willl give me an idea but often I just walk away knowing their great great uncle died in a train accident
So, don't worry, I'm still humble and awkward and embarrassing. It's been a blast, I've got pediatrics up next and, unfortunately, it's during flu season. Everyone please hold for the sniffles featuring yours truly.