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Why Outpatient Internal Medicine?

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. Tailor chose the field of Outpatient Internal Medicine and why Outpatient Internal Medicine is a great field for all.

A truly enlightening experience is finding things that you wrote years ago and seeing how your life is reflected in it now. I recently found my personal statement from when I was applying for residency. The things that drew me to internal medicine are exactly what I do today.

“I remember you! I always remember the good ones!” cried Beth when I walked into the room for her three month follow-up. The last time I saw Beth, her asthma was acting up and her blood pressure was high. On top of it all, she was visiting her sister in hospice care two to three times a week, seventy miles away. What a change this follow-up visit brought! Her spirits were high, the asthma better, and the blood pressure well controlled. She had reached a better understanding of her sister's condition. She was excited to see me again. I had only seen Beth once, but when I saw her again, it was like seeing an old friend. It was most rewarding to know that patients like her trusted me. The ability to establish a relationship with a patient, to educate a patient about health, and to coordinate care among providers really appeals to me about internal medicine.

I was attracted to the cerebral nature of internal medicine. Each case is like a puzzle to solve and every clue from the history to the physical exam offers a way to establish the diagnosis. The internist is a puzzle solver, a teacher, and a coordinator. After spending time in an adult outpatient clinic, I knew that I would constantly be challenged and intrigued.

I currently work in an outpatient clinic seeing my own panel of patients. The part that I’ve truly enjoyed is getting to know my patients as an individual. It is my honor to be a part of their health journey. We laugh together, we cry together, and we come to an understanding about what we could do to make ourselves better. Sometimes they share their joy with me, the new grandchild that is coming, or they share their heartbreak, a new diagnosis for a family member or a loss of a friend. These things are important to them, and may help me take care of them too. Maybe that worsening of their reflux, or the sudden headache or hives is stemming from these personal changes.

What drew me to internal medicine was the opportunity to be a puzzle solver. From my discussions, listening to their stories helps me figure out what might be going on. Like the lady who came in with changes to her vision and she was wearing sunglasses during her visit. She described what had been going on, “pain behind the eye” and it had been persistent for 4 months. They had gotten some labs on her but no one had ever gotten an MRI of her head. She said what would that show? I told her about another patient I had who suffered from pain behind the eye which was intermittent, and how from an MRI we diagnosed Multiple Sclerosis. She agreed, and we got an MRI. She had a new diagnosis of multiple sclerosis. That finally gave her an answer and helped her started on treatment to make a difference for her.

Sometimes the questions are part of the screening. The lung cancer screening guidelines changed to a 20 pack year history of smoking in the last year. My patient came in for his physical after a bit of a hiatus due to the pandemic. I clarified with him, have you ever been a smoker. “I was a chain smoker for 12 years with 2 packs a day.” I was surprised, given his religious background. He qualified for lung cancer screening, so I offered the option to him. He agreed. A few weeks later, we found a mass in the upper lobe of his right lung, which was cancerous. He had surgery to remove it, and thankfully it had remained local.

Finally, given COVID-19, I have seen so many patients go through the infection and then suffer from long haul symptoms. One of my patients who got sick with COVID and spent 1 month in the ICU, on the ventilator to help her breathe with her COVID pneumonia. Thankfully, she was able to breathe on her own and eventually came home from the hospital. Since then, her COVID pneumonia has continued to cause her trouble, she now wears oxygen and has trouble with her breathing with activity. We have spent the last few months working on her breathing, and working on improving her strength. She’s been in pulmonary rehab, and we started her on an inhaler to improve her functionality. Her oxygen is being weaned. She was keen on receiving the COVID vaccine when she was able after this experience. During the pandemic, I have shared these stories with the public on the what kind of symptoms patients are having with COVID-19, and their desires to be vaccinated. I hope this has made a difference for the community as we battle this infection.

Being a primary care doctor, there are days the frustration hits hard. It may be the patient emails, the ongoing notes, the prior authorizations or the insurance roadblocks. Those frustrations tend to come and go. The part that sticks with me that I go home every day knowing I’m making a difference for my patients. That’s what keeps me energized. That’s what inspires me. Just like what I wanted in my personal statement for residency, I found what I am passionate about, and I hope you find that too.

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