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Jan 6, 2011

Second Best

I started a new rotation with the new month and new year and, I really hate to say this, but I’m already kind of done with it. It’s an elective rotation in infectious disease, which I picked because I never feel comfortable with antibiotics so I thought immersing myself in them for a month might force me to deal with that. I expected to see patients who had some sort of infection, maybe one or two a day, have plenty of time to read up and figure out what was going on and what to do about it, and be home in time for an afternoon walk with the pups. Honest in intention and pure of heart, that’s me.

Unfortunately, there are a few problems with my plan.

First, there are the patients. I guess that most people already know what to do with the normal infections, the ones I wanted to learn about like pneumonia, and so they only call the infectious disease team when there is something really crazy going down. Also, there are a metric ton of these kinds of patients, which means that not only do I not know the first thing about what is going on or what to do, but I don’t have time to figure it out because there are three more people that still need to be seen and (not) figured out before rounds in twenty minutes. We’re there all day and all evening trying to get things going for these people who have mystery fevers, bizarre little bugs growing from their blood, and symptoms that don’t go away when we tell them to. There go all my goals.

Second, things that I thought were incredibly bizarre and crazy are really just shunted to the specialty teams. My very first patient was one with HIV and disseminated histoplasmosis. Holy cats! I didn’t think that even happened anymore since, like, ever or something. Wow, this is a case of a lifetime! Except that the girl I am with on the service has a patient who also has HIV and disseminated histo, and then, two days later, we were consulted on a newly diagnosed HIV patient who was found to have – you guessed it – disseminated histo. Throw that “rare” thing out the window.

And third, and this is much more petty, but the other student that I’m with this month is going into internal medicine, and might in fact specialize in infectious disease. As in, for her career. She loves this stuff and is excited every minute we are at work. She goes home excited to read about her patients and comes in the next day saying things like, "I was thinking about this last night and I came up with a new idea." Me? Little ol’ me over here? I’m just an OB hopeful who’d like to know how to treat urinary tract infections and the occasional pneumonia. If I ever get any of these patients, know what I'll do? I'll call the infectious disease doctors. What I’m saying is that I am WAY out of my league and it shows. I'm just here to learn, but it's like I skipped the 101 class and went straight to grad level.

If I’m being honest, I think that is what I dislike the most about this rotation. It is certainly not the patients, and it isn’t the work. It isn’t even the hours, though I would be happy with fewer of them. It’s that I’m not the best, not by a long shot.

Let’s be clear. I have never been the top score on any exam, maybe ever. (With the notable exception of my first organic chemistry quiz – top score. It was a total fluke that has never been repeated.) But I usually do very well when it comes to clinical interactions with both patients and other medical people because I like to talk to the patients, which makes it easy to get all the information. I pride myself on getting a complete history and being able to answer the most obscure of questions about a patient and their medical background. I like talking to other medical personnel, so it makes rounds fun, a social and entertaining time, instead of the dull time-suck that many perceive rounds to be.

Something is just not clicking on this one, though. The other girl is rocking it out, nailing recommendations and making herself invaluable to the patient’s care, just like you are supposed to. I just can’t seem to get it together. Instead, I feel like I’m floundering through my presentations, in the dark about important things, and like a total jerk. Worst of all, I don’t know how to fix it.

I know part of it is motivation. She’s excited by these problems where I am intimidated. She has experience with these drugs and infections, where I am clueless. It’s an inherent difference, and I need to deal with that.

But the rest of it is totally fixable. I need to find time to read more, be faster with my interactions with patients so I have more time to look up their problems and medications. I need to think like a medicine doctor and, as the popular medical saying goes, broaden my differential. I can totally make these things happen. I just need to find the motivation to do it.

And that motivation needs to be something other than petty competitiveness.  

2 Readers rock!:

Go Long! Go Green! said...

believe me ... ID is one of the hardest areas to treat. the ID pharmacy rotation is a killer too!! there are so many ATB ... hard to remember which treat what ... and the resistance issues these days! hang in there ... how many days left?? :)

barrie said...

1. Watch more House? ;-)

2. Jellybean had high liver enzymes on a routine blood work thing last week done before a scheduled spay which we didn't do because of the liver enzymes but my vet started in on "differential diagnosis blah blah blah..." ala House.

3. When they were trying to figure out what was wrong with me I had to go to an ID doc and that is NOT a waiting room in which ones feels comfortable!!!!