Medicine Sub-I

My medicine rotation went well. I learned what it would be like to be an intern (now I'm scared). I carried more responsibility, developed sharper judgment, and became a primary provider for a patient. I began to make decisions and commit to them which is awfully hard but educational. As a third year student, I had wishy-washy plans for management; "well, if she has a gastrointestinal bleed, we should give her fluids and transfuse. But since she has heart failure, we have to be careful in giving her any fluids." As a sub-i, I had to decide how much, how fast, and how to assess if things were getting better. As a whole, I cared for mostly bread and butter cases, sometimes with psychiatric comorbidities and complex social issues. I learned a lot, but more about time management, logistics of health care delivery, and how to interact with consultants than about disease processes. The learning curve was steep but I think I was prepared to tackle it.

How does this change my thinking about medicine? I feel that hospital medicine is mostly run by house staff (interns and residents). They assess the patients, decide on a plan, and execute it. Attendings merely supervise. And indeed, good attendings don't micromanage. They teach and act as consultants to the team. I'm not sure what to make of it. I won't like intern year regardless because of the grunt work. I would probably enjoy being a resident because there's an intellectual challenge in diagnosis and management decisions. But as an attending? I'm not sure.

I love medicine in theory. I love thinking through complex cases, learning about people, trying to put together that puzzle of diagnosis. I fit in with the people. Medicine interns and residents have been some of the best I have worked with; they are brilliant, inspiring, hard-working, friendly. But as a sub-i, I learned medicine in practice is very different than textbook medicine. Patients will yell at you, decline important procedures, leave the hospital to smoke. Laboratory results will be miscalibrated, equivocal, or missing. Presentations rarely fit classical paradigms and answers can be elusive. There is an emphasis on quantity over quality, on getting work done than doing things perfectly. It is a privilege and a frustration all at the same time. Typing this makes me seem jaded, and I think it's somewhat true; after a year on the wards, I have really learned the limitations of medicine.