Family Medicine - Acting Internship

Yes, Meredith, but it is good to be happy every once in a while. And today was a very good day for happiness. Today I had a case where everything went right (although it helped that it was a bread 'n butter General Surgery case!). I had plenty of time to read about the condition before I saw him, I was able to do a leisurely admit, the resident and attending physicians told me I had a "great" presentation and plan, and then the patient himself told my superiors that I was going to be a great doctor. It doesn't get much better than that. I told my patient that I would slip him a check for saying nice things about me...

There's nothing more satisfying than when an entire encounter goes well. Obviously, this is not the norm, but it is wonderful when everything clicks.

So, this month I am in "Block 0." It is a four week rotation before the beginning of the medical calendar year. Everything starts on July 1 in medicine. The new interns arrive at the hospital, the residents become a year older, and the chiefs graduate and become fellows/attending physicians. Third year med students hit the wards, eager and scared shitless (I certainly was - "Today I was called doctor and that was scary..."). After a year off, I really wanted to do a Block 0 clerkship before starting on a surgical service at UNC. Family Medicine in Asheville was a perfect choice. I could re-train in internal medicine, pediatrics, OB/GYN, and admit surgical cases. Family Medicine is the specialty with the broadest spectrum (which in my mind, makes it the most difficult to practice well), and I certainly still need a lot of work relearning the knowledge that I've lost. There are quite a few axons that need to be rewired.

The schedule isn't too bad. Each morning we meet on the 7th floor to check out with the night float resident. We hear about any complaints or calls that the resident had to field the night before, and any new admissions. Typically, our service runs about 10-15 patients, although today we had six. Last Friday we had 25. After sign out, we divvy up who to see, and then we round on all our "peeps." Depending on the census, I see between two and five patients. I get a history of the nights events, perform a focused physical, then write up the encounter with an assessment and plan. Then it's off to rounds, where we discuss each patient individually as a team. I present my patients, but a resident and attending have generally already seen them as well. Finally, I spend the rest of the day helping to manage the issues on the floor and admitting new patients to the service.

Then I'm off in time for dinner. Rinse and repeat.

That is my schedule during the week. On the weekends, I just have two nights of call during the month. This is when I'm at the hospital with the night float resident. Sometimes the call schedule will be every third or fourth night ("Q3" or "Q4"), so having a Q14 call schedule here is not bad at all! I expect to take call Q3 on Peds Surgery next month, and some preceptors have even suggested I try to take Q2 call so I can impress my attendings.

Being back in Asheville is also wonderful. I have already been to White Duck Taco twice, and the Bywater once for a (very brief) happy hour. Rebekah and I have a dinner scheduled for Sunday night at the Admiral, thanks to Mom and Dad. At Christmas, they realized how much I missed NC and I received a lovely gift basket of Carolina stuffings, gift certs included. So we will cash-in this weekend with some beef tartare.

It's going to be an intense month. I am also trying to spend some time in the OR to get comfortable again, and I will have to re-learn how to tie knots. But it is indeed exciting (I don't know if you could tell).