This week’s rotation: internal medicine

As a third-year podiatry student at DMU, we get the opportunity to observe an internal medicine doctor for a week. At first, I didn’t know what was to come and so felt indifferent until I met the doctor I was shadowing.

Day one was the hardest for me to adjust to. Since the hospital I was at has completely transitioned to electronic medical records (EMR), the majority of time spent with the patient is fumbling with the computer. If the computer was slow, then it was a bad day and appointments were backed up. EMR is very useful and helps organize a patient encounter at every visit. However, I am concerned about how patients are perceiving their visits when the doctor is bound to their computers. This was the hardest part for me to understand, how time spent on the computer requires the patient sitting in the room silently while the doctor types away.

What I appreciated the most during this rotation was observing the interaction with the doctor and the patient. Although there is an incredible amount of time devoted to EMR, the doctor was very compassionate about the patient’s list of concerns. There is also a strong sense of trust making it the visits productive and easy to manage. It seemed to me the doctor tried to decrease the amount of medicines patients are on at every follow-up if the lab results are normal. (I would say on average, for the patient population over the age of 45, patients take at least 6-15 different drugs daily multiple times a day.) I think this is a very nice goal to have and to discuss with the patient but we realize now that the effort is a two-way stream. For example, for every newly diagnosed diabetic patient, there is a greater increase for high blood pressure, high cholesterol and, sometimes, depression. All of these diseases are intertwined but could be managed with weight and diet control.  It is important to realize that the doctor is on the patient’s side and will provide necessary medicines to manage the health problems. Unfortunately, there is no medicine to “cure” the problems since many of these chronic diseases stem from poor lifestyle behaviors. From these patient encounters, I realize that the patient should meet the doctor halfway and work together to reach health goals such as losing weight and improving lifestyle behaviors, like smoking cessation or modifying food intake.

The biggest lesson I learned in internal medicine this week is that change is difficult but it is possible. A good day for me was hearing that a patient was ready to consider cutting out smoking. Even though doing so may seem like climbing a huge mountain, the best way to do it is to take the first step.

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