Internal medicine

Hello readers,

This blog doesn't have any pictures....sorry. I had an afternoon off and spent it with the fam. We had a great afternoon going shopping...I'll tell you about that tomorrow.

Well, today I had my first afternoon off in over two weeks. I have been on an internal medicine rotation at St. Mary's, the bigger hospital in town, and so it's been a long stent of 12 to 18 hour days. Yuck. For one thing, I really don't like internal medicine. I love OB, surgery is great, I like taking care of kids and women's health, I even like the ER. But one cannot like all aspects of medicine...I have learned. Some doctors freak out at the thought of delivering a baby, some wouldn't be caught dead talking to a patient that was under the age of 18, some prefer their patients to be asleep in the operating room...... Well, I have learned that I despise internal medicine. Yes, it seems to be quite a broad topic. I don't mind working in the hospital, I don't mind elderly patients...it's not that. I fianlly realized what I don't like about it: I hate the pathophysiologic state of so many of our "frequent fliers" in the hospital. Otherwise known as "train wrecks," these patients spend more time in the hospital than at home or the nursing home...or wherever they live otherwise. They are usually very overweight, unemployed, and addicted to a barrage of things, namely cigarettes, alcohol, pot, oxycontin, etc. Many of them have acquired either HIV or Hepatitis C. They are hospitalized for a variety of reasons.....alcohol withdrawl, DKA, pneumonia, respiratory distress, etc. But THEN, instead of getting better and going home like most patients, their true colors come out when they're hospitalized. They end up spending a few weeks on the floor, complaining and being rude to everybody, begging for more and more narcotics, and making your day seem a lot longer than it should. By the end of three weeks, sometimes even longer, the attending physician gets fed up with things and discharges them home. They leave, sometimes AMA (against medical advice), and usually come back for another visit in a few weeks.

This is why I don't like internal medicine. People like this, who don't take care of themselves, wind up costing us millions of dollars (yes, one person can ring up a bill of over $1,000,000 in a month, no problem). At least in Minnesota, my tax dollars are funding every penny, except for the stuff medicaid doesn't cover...then the hospital foots the bill. So, after discharging these frequent fliers at the hospital, I go to clinic and manage my hard-working patients over the phone because they can't afford the copays to actually come in and see me. They can't afford to take time off of work, even if there is health insurance there. If only they'd quit working and take the state-funded health care. They'd be able to come to my office every week!

Anyways, sorry I am so glum today. I think it's becasue it's only October 11th, and I know I have most of a whole month left of this internal medicine business. The hospital is kind of like a time vortex. You can spend days and days there, all day, with no daylight exposure, and there is still a ton of work to be done. I really look forward to the day I can go to some rural 25 bed hospital and be their doc. I can transfer the frequent fliers to some other big hospital down the road and not have to deal with it! :)