As our friends finish undergrad, apply for jobs, settle down and develop a lifestyle, we are preparing for the next standardized exam, writing that catchy personal statement and requesting another set of recommendation letters on our journey towards residency. Although medicine is not for everyone, for whom it is, it likely is the only choice. After completing three years of medical school, the time finally comes to choose what we will do for the rest of our careers. My decision to enter internal medicine is based on the experiences, diversity and opportunities it provides.
The main reason I chose internal medicine was the experience of developing effective and longitudinal relationships with patients. The irony is that I wrote that same sentence in my personal statement while applying to medical school. Four years later, I actually know what it means. People rarely let others choose their next meal, but in the doctor’s office, we are often guiding patients through invasive treatment options and discussing end-of-life care. Practicing effective internal medicine is rooted in facilitating change through teamwork and communication. Giving a patient the mental wherewithal to improve is arguably as valuable as the medicines and therapies we prescribe.
A common phrase during our medical training is “when you hear hoofbeats, think of horses, not zebras.” Simply put, common things are common. When a patient comes in with ten days of nasal congestion, nasal discharge and facial pain, they have acute bacterial sinusitis, not a raging fungal infection or sinus abscess. Much of our work in the hospitals is treating COPD, congestive heart failure exacerbations, acute coronary syndrome and acute abdominal pain.
However, in just the last few months, I have taken care of patients with rare metastatic cancers, drug-induced lupus and scrofula. Every once in a while, you even get to treat one of those diseases that only exists on board exams. (I’m looking at you, Goodpasture.) The diversity of patient presentations, workups and treatments makes every day on the internal medicine service a bit different.
Similar to the diversity in the patient population, the variety of opportunities a career in internal medicine provides is unparalleled. You have many options to choose from, and most importantly, these choices can evolve as your career matures. You can pick between outpatient and inpatient medicine, or practice both. You can remain a general practitioner or become a specialist through fellowship training. Finally, you can branch out and become involved in academics, administration or research. Although this may change as I continue my training, I see myself as a specialist practicing inpatient and outpatient medicine while devoting time to teaching and training future doctors.
Through my experience, I have learned that we need everyone to be at their best for patient care to succeed. The emergency physician admits the dyspneic pulmonary hypertensive, the pulmonologist provides the acute treatment, the interventionalist performs the cardiac catherization, the cardiothoracic surgeon recommends a permanent solution and the internist manages the team. Time will tell where I fit in the team.
Patients are the true storytellers. They come in with pathology, we interpret physiology and prescribe pharmacology, but their stories are what we remember. They shape our experiences and how we practice medicine.