Thursday, February 05, 2009

Internal Medicine so far

I'm well into my Internal Medicine rotation. Fortunately, I have been well-warned that internal medicine attendings are notorius for demanding perfection, immense detail, and will respond to any lack of the aforementioned with insults substantial in volume and quantity, so it wasn't too much of a surprise.

Here are a few choice events so far:

  • doing CPR for the second time (second time for real, that is) in a code blue

  • one time feeling like I had learned something about medicine

  • most times feeling like I have not learned anything

  • being schooled by nurses who know critical care medicine much better than I do

  • being asked by my attending doctor, "I was wondering when your brain would turn on" (don't worry, he was joking...I think)

  • developing near-delirium after losing my cell phone in a call room (the first time I have ever lost my phone in about 5 years)

  • smelling fetor hepaticus - the "sweet, feculent odour" on the breath of a patient with end-stage liver failure

I haven't cried yet, so I think that means I'm doing well.


Anonymous said...

So hopefully you have realized that some nurses are actually well educated and competent, no?

I'm amazed reading this, and by your two year old post "geez what a dumb nurse." Firstly I'm amazed that the nurse said what you quoted, considering the patient had BPH. Although, I sort question the context you took it from.

Secondly I'm amazed that you walked away with the assumption that nurses don't receive education about gross anatomy based on one person's blog about exploring body worlds... Come on! That is such a small sample.

I hope you don't feel ashamed as a third year medical student being "schooled" by nurses on critical care floors. They've probably been doing it much longer, and have much more practical experience than you do. In time you'll catch up to them and surpass them in your area.

Med on the Rock said...

I took the same anatomy course as the nurses at my university when I was in undergrad. Now that I am taking anatomy in medical school and compare the depths of what we have to know now compared to that nursing course, there is simply NO comparison. For example: I remember panicking about having to learn how to draw the brachial plexus in undergrad anatomy. Little did I realize that the brachial plexus would be something we were given 5 minutes to learn in medical school, and it followed up with about 5 hours of learning how each branch of the brachial plexus curves around the arm into the forearm and hand, which nerves innervate which muscles, where those muscles originate and attach, vascular supply, lymphatics etc. In addition, we have to be able to go into the anatomy lab and identify all of these structures on cadavers, one at a time, with only 30 timed seconds for each structure. So for all intents and purposes, the anatomy that nurses take is basically non-existant compared to a physician.

DISCLAIMER: I have tremendous respect for nurses and think they do a fantastic job at what they are required to do in the hosptal...but anatomy is just one area where they receive little formal training.

incidental findings said...

"I haven't cried yet, so I think that means I'm doing well."

If I could sum up all of third year, that would be the one line.

comrade said...

Vitum, why are nurses (and/or their roving riot squad) so ridiculously defensive? Mention that a nurse knows more than you and suddenly the "I hope you appreciate nurses, Doc" posts jump out of the woodwork. When you do your psych rotation, perhaps you could proscribe something for their ridiculous insecurity?

Vitum Medicinus said...

I'm amazed that you walked away with the assumption that nurses don't receive education about gross anatomy based on one person's blog about exploring body worlds... Come on! That is such a small sample.

Nice to hear feedback from someone who has clearly been following along over the years...or at least reading older posts - thanks!

Not to worry, I have plenty of very close friends, family members, and now coworkers who are nurses, and I talk to them about issues like this quite regularly. Most of them are all too eager to comment on topics such as the behaviour of some doctors, or the similarities and differences in the scope of our practice and education.

So, just to clarify, my sample size comes from learning about their training from not only talking to them about it during and after their training, but also directly observing their training - I have sat in on an undergraduate anatomy lecture which the nurses at my university took.

As well, most of the nurses I've spoken to said they never did anatomy with a lab component, and if they did, it was based on animal, not human, anatomy.

Anonymous said...

Very interesting Vitum, thanks for getting back to me... That's interesting. Where I did my undergraduate work the anatomy class certainly did have a lab component with human cadavers. I suppose we were lucky.

And Comrade--

I am not a nurse. I obtained by bachelor's in nursing, and my license to practice but am now in my second year of medical school. I do not practice as a nurse. But perhaps I will keep an eye out for both the nurse 'roving riot squad,' and the 'arrogant physician.' I think if you were to take a close look at both groups, you would see that each exists because the other group exists. I think I'm unique because I've seen it from both angles.

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