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Why (Inpatient) Internal Medicine? - PCP on the Wards

Updated: Feb 21, 2019

Trying to figure out what kind of doctor you should become? Wondering what specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Partha chose the field of Internal Medicine and why Internal Medicine is a great field for women (and men).

Why Internal Medicine SheMD Why Specialty

Three and a half years ago, I returned to the world of academic medicine after years of practicing as a primary care internist in our community.  I missed the collegiality and the intellectual stimulation of the teaching environment and was thrilled to join the university environment. I also had been discouraged by the dwindling numbers of residents going into primary care internal medicine, and honestly, I wanted to be part of the change I hoped to see. When my division chief told me that one of my responsibilities would be to attend on the inpatient service, however, I felt more than a moment of panic.  I hadn’t been on wards service in more than a decade. Like many women, I thought I should “know it all” before I went and tried to teach something. What could a PCP, albeit a seasoned one, teach internal medicine residents and medical students on the inpatient side? The answer? Quite a lot.

My lessons from the time I like to call “when outpatient meets inpatient.”

The art of writing a note.  In this EMR age, there is a lot of temptation to cut and paste the note.  A progress note often begins to look like a discharge summary as one or two lines are simply added each successive day.  It is vital that information is updated and deleted. Does your assessment and plan accurately reflect what you have assessed and planned?

Know how to confidently have a goal of therapy discussion.  If you’re lucky, your patient has a thorough PCP who has already had and documented said discussion.  This is not a “do you want your chest compressed if your heart stops?” conversation. There is often a long and sickly road between now and cardiac arrest.  The information that is needed is, “What are you willing to go through to achieve what end?”

Internal medicine is all in the details.  Yes, the antibiotics are a lot more potent than when I was a resident.  Yes, you all know more acronyms than I did (HFrEF, anyone?). But medicine is medicine.  If you don’t ask, you won’t know. If you don’t know, go find out.

Be an advocate.  You may be taking care of your patient for just 2 days of their lives, but it is your job to speak on their behalf.  Stand up for your colleagues who are being mistreated or need help. Remember, though, the focus isn’t really on being right.  It should be on making it right.

Believe your patients.  If they say it, at least initially start by accepting that what they are telling is the truth.  Your journey through medicine will be a much happier one if you try to keep cynicism at bay. It is very important to remember that the balance of power will always lie in your favor.  No matter how bad a day you’re having, remember that you’re not the one lying vulnerable in a hospital bed.

Review to improve. I have numerous office visits to “make things right” with my patients in clinic.  On the inpatient side, we don’t have the luxury of time. Make sure to reflect on patients’ adverse events in a timely manner to talk about what went well and what should have been done differently.

We can’t solve a lifetime of problems in a three-day admission. That’s when we rely on the PCP to take over the reins of care upon discharge.  Put a solid outpatient plan in place and try to set up your patient for success when they leave the hospital and your care.

Don’t underestimate the healing power of a touch. Did you shake hands with your patient today?  Did your stethoscope make contact with skin?

And truthfully, I think the best part about being on the wards was teaching the housestaff how important it is to be a great internist first and foremost.  There has been an increasing push and trend to apply for fellowship after IM residency. I like to share with my residents and students the reasons behind “Why GIM?”  Going into general internal medicine is an active choice. It is not a default career for someone who said no to fellowship. Rather, it is a career for someone who said yes to being involved in all aspects of their patient’s care, helping them live a healthy life and die a peaceful death. I wouldn't trade the relationships I have, or the breadth of illness that I treat, for another field.  They call us “primary” for a reason.

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