The Internal Medicine Physician

My father is an internal medicine doctor. It is the physician I have always admired: the kind, humble, soft-spoken doctor in a pressed white coat listening to a patient with a stethoscope, laying hands and making the unexpected diagnosis. His brain is a repository of knowledge, not only of obscure disease states involving every organ, but also of the latest clinical trials, a truly evidence-based practitioner. He is comfortable in every setting, seeing healthy patients in clinic for their annual check-ups and dying patients in the hospital at the end of their life. His patients adore him; his colleagues respect him.

I thought a long time about going into internal medicine; much of it not only appeals to me but also caters to my skill set. But upon seeing the real nature of internal medicine, I knew I could not do it. I've never enjoyed clinic, and in the hospital, internal medicine takes the role of the dumping grounds. If a patient has no home; if his illness is undifferentiated, he is too complex, or no one wants to take ownership, he goes to medicine. Medicine residents spend call nights admitting patients with "failure to thrive," "weakness," and "abnormal lab values." A patient who falls and breaks their hip may not go to orthopedics; they end up on medicine. While some valiant attendings try to recreate the bedside diagnostician of yore, internal medicine, as I have seen it, has been relegated to the care of older patients with many comorbidities, none of which can be cured. They try to patch what they can to get these patients out of the hospital knowing that in a few days, weeks, or months, those patients will return. It can be a depressing job.

When I was an ICU fellow, the medical ICU was the internal medicine equivalent for critically ill patients. There were so many situations of a patient with a surgical illness who was simply too sick to survive surgery, and because of that, they came to my medical ward. Even trauma patients with some complicating arrhythmia made the surgical intensivists too scared; they came to me. I was by default the accepting ICU fellow for any patient who was intubated, needed pressors, or was too altered to remain on the floor. There was a burden associated with this role.

Although I love taking care of patients, it's hard to be the "default." For this, I respect my internal medicine colleagues so much more, for having a role I could not fill. I wear the hat for critical care patients, and I actually enjoy it, but it has taken me a long time to understand what it means to be the one who has to step in when everyone else steps back.