Blog | Thursday, January 5, 2017

Thankful to have become an internist

In November 1973 I had an epiphany. During my first week on my internal medicine clerkship, I realized that I had found my specialty—internal medicine.

Prior to medical school I had worked with emotionally disturbed children in an inpatient hospital. I really enjoyed the experience, and learned a great deal. During my first two miserable years in medical school (I disliked how they taught the basic sciences and even more how they tested), I had considered pediatrics, psychiatry, and a great blend in adolescent medicine. Parts of medicine fascinated me, but getting out of the classroom was freedom.

I started my third year on surgery, and quickly realized that I was not a surgeon. I loved talking to the patients, examining and studying their test results, but I had no interest in the operating room. One week during those three months I had an ophthalmology rotation that temporarily attracted me (they had great equipment and interesting problems), but that was a short flirtation.

They I started internal medicine and discovered who I was. Why do I love being an internist?

Internal medicine allows me to be a detective. Often on the inpatient service we address diagnostic challenges. Many internists (this writer included) love the diagnostic process. We love talking with patients, listening carefully to the story, asking probing questions, reading the body language. We get excited when a physical exam finding gives us a clue. We pore over the labs and try to understand how they may help explain the patient's current status. We order imaging to help narrow the diagnostic process.

Most internists that I have met love Sherlock Holmes. We all have patients for whom we have played that role successfully. Unfortunately, few of us are that good all the time.

Great internists like patients, and I do mean the great majority. Some patients make developing a positive doctor-patient (or patient-doctor) relationship, but we find them to be unusual.

We like helping patients, providing comfort, decreasing their uncertainty, showing our empathy and often decreasing their distress. Sometimes we make diagnoses and develop a treatment plan that obliterates the disease (most often with infections); sometimes we make diagnoses that lead to lifelong treatment (think type II diabetes, systolic dysfunction, COPD, etc.) and we can often prevent secondary complications or at least delay them.

We offer comfort and dignity when we can no longer treat the disease. We strive to treat every patient like we would want ourselves and our family treated.

Internal medicine provides the ideal balance of our never ending intellectual fascination with medical science and our commitment to comforting our patients. Some classic internal medicine quotes:
“The good physician treats the disease; the great physician treats the patient who has the disease.”
– William Osler

“. . . For the secret of the care of the patient is in caring for the patient.
” – Francis Peabody

“No greater opportunity or obligation can fall the lot of human being than to be a physician . In the care of the suffering he needs technical skills, scientific knowledge, and human understanding, he who uses these with courage, humility, and wisdom will provide a unique service for his fellow man and will build an enduring edifice of character within himself. The physician must should ask of his destiny no more than this, and he should be content with no less.”
– Tinsley R. Harrison

“Time personally spent with the patient is the most essential ingredient of excellence in clinical practice. There are simply no short cuts and no substitutions.”
– Philip Tumulty

So on this wonderful day of Thanksgiving, I am thankful for family, friends, our wonderful country, and the good fortunate I have had in becoming an internist. I have tried to help patients in distress. I have tried to help learners see internal medicine in a positive light, and help them become internists if that fit their aptitude.

Being an internist has always been a great privilege. Every time we help a patient, even in the smallest way, we do something worthwhile. Happy Thanksgiving!

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.