My Internal Medicine rotation at SFH was academically challenging. I learned that in Internal Medicine, you see patients with numerous comorbidities and you see an array of different diagnoses (from cardiovascular to neurologic, etc.) It is important to brush up on all diagnoses when practicing as an Internal Medicine physician.

My experience at SFH led me to exploring a new technique in the management of patients with chest pain. The use of Coronary CTA and the reporting of a Calcium Score was novel to me. This testing modality helped clinicians decide whether patients should undergo stress testing or more invasive procedures like cardiac catheterization. I learned a lot about the management of patients in acute heart failure exacerbation (one of the most common diagnoses seen at SFH) particularly about proper diuresis and optimizing patients’ medications to help prevent future exacerbations. Additionally, I learned about how important education regarding the patient’s diagnosis is. For example, educating heart failure patients about sodium restriction, fluid restriction, and medication compliance helps prevent future readmissions.

During this rotation I was challenged in that I was unaware of how to manage certain diagnoses. The Hospitalists with whom I worked helped facilitate my learning by asking thoughtful questions and by encouraging me to read about various diagnoses and the management of them. Situations that were difficult for me included performing CPR (chest compressions) for my first time. This was difficult because it was an emotional experience for me. When performing chest compressions on a “dummy” during training, the student learns the proper technique, but I don’t think they can prepare for the emotion experienced when performing CPR on a person for the first time. Another challenging situation I encountered was an elderly patient that was brought in after cardiac arrest with ROSC achieved at another hospital facility (his care was transferred to SFH). Of note, however, is that the patient was intubated, on high dose pressors, and still “not out of the woods.” When we received the patient, we performed a neurologic exam and the patient had unreactive pupils (“dolls eyes”), no DTRs, and other morbid signs. I was present when the critical care physician and the cardiologist spoke with the three family members about their father’s condition and what his wishes would have been. It was an excellent experience seeing how the clinicians speak with the family under circumstances such as these, but it was also heart-wrenching to see and feel the sadness that enveloped the family.

A “type of patient” I found challenging during this rotation were patients that were seeking opioids (so-called “drug-seekers”). The Hospitalists sometimes care for “frequent flyers” that come in for complaints that warrant pain medication though they try to receive opioids to manage their pain. The Hospitalists have patients that are known to them that attempt to do this and seeing as though they have access to prescription control programs, they can see when patients are abusing prescription opioids. Seeing the Hospitalists work to control the patient’s pain (if indeed they are not feigning) while advising them that prescription opioids are not what they require for pain control (if the complaint can be managed with other modalities) helped to show me how to be patient with your patient’s.

The knowledge I’ve gained during this rotation is widely applicable. As mentioned, academically speaking, there was a lot of learning accomplished during this rotation. One thing I can think of would be in the ER setting, the management of patients in acute heart failure exacerbation would be much more intuitive to me after having this rotation. The knowledge I’ve gained regarding the proper way to interact with your patient’s (in events like “breaking bad news,” or communicating with “drug-seekers”) will certainly carry over to other specialties as well.

One thing I would want the preceptor or other colleagues to notice about my work this rotation was that I actively sought out opportunities to see patients, perform procedures, and even observe surgical cases. I would want them to know that I utilized evidence-based medicine in determining management for my patient’s (for example using CHADS-VASC for Afib patients). I would want for them to see and feel my desire to learn in action.

What I would like to improve upon for the following rotation is trying to know the management for common diagnoses in the rotation. My action plan, seeing as though I’ll be going into OB/GYN next, is to review the common diagnoses and management thereof in an effort to both enhance my knowledge bank and hopefully impress my colleagues.

My internal medicine rotation also brought about a lot of self-reflection. During my experience, I had seen and cared for several critically ill patients and even more terminal patients. One of the things I have always reminded myself of was that in practicing medicine, I want to heal when healing is possible but also just to simply be there for, and care for, those with illnesses that may not be curable. This rotation allowed me to care for patients in this way.

Overall, my experience at SFH was memorable and educational. The healthcare providers with whom I worked (including the Hospitalists, Critical Care PAs, Medicine PAs) were all interested in facilitating my learning. They were eager to be a part of helping to “pass on the torch” while I was eagerly receptive.