Blog | Monday, March 6, 2017

The joy of being a teaching and learning internist


Since Dec. 1, I have made attending rounds all but 10 days. As usual, this stretch has invigorated me.

As an internist (I am eschewing the phrase general internist because I believe that the adjective general is redundant), my teams care for a wide variety of patients. Some patients have given us diagnostic challenges, while others management challenges. Many patients need the right side of our brain, while others need the left side. The best internists have balanced brains!

As a teacher, I love inducing excitement in the learners. When we figure out the diagnosis, we feel like Sherlock Holmes.

As a learner, I love a diagnostic challenge. I spent several hours yesterday trying to better understand tachycardic cardiomyopathy and to diagnose a patient with intermittent left bundle branch block. Sitting there, reading articles to see if they shed light on our confusion gives me great pleasure.

As a physician, my greatest pleasure occurs when we connect with the patient. I recently cared for a patient who was angry with his health care team. We understand his anger, and refocused he and his family to a more patient-centered plan. He left the hospital satisfied and his family felt that we had addressed the important issues. We made no diagnostic coups. We focused on symptom control. But most important we let him know that we wanted to make him feel better.

Atul Gawande, in his recent article ”The Heroism of Incremental Care“, wrote this: “Success, therefore, is not about the episodic, momentary victories, though they do play a role. It is about the longer view of incremental steps that produce sustained progress. That, such clinicians argue, is what making a difference really looks like. In fact, it is what making a difference looks like in a range of endeavors.”

While he wrote particularly about primary care, I would state that these words and concepts often apply to hospital medicine. We provide care for patients who need a bit more intensity, but as internists we rarely provide heroic medicine. We help patients through their exacerbations of their chronic illness, or diagnose a new illness, or help improve the management. We act as conductors, hopefully getting the inpatient symphony of consults to play their solos without discordance. We bridge between primary care visits, tweaking things that need tweaking.

We try to role model one of Osler's famous sayings, ”The good physician treats the disease; the great physician treats the patient who has the disease.”

We owe our patients that. We revel after our successes when we actually help another person.

I love it. I love helping patients. I love helping students and residents grow. I love the intellectual challenge and always having more to learn.

Forty-four years after falling in love with internal medicine, I still am amazed at how much I love the field.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.