Medicine – on the differential

Since second year when I shadowed Dr. P at DHMC, I have liked the idea of hospital medicine. You get to romp around the hospital, changing orders, negotiate with specialists, communicate plans, counsel and even break bad news to patients. Its more continuity than the ER but not the agonizing length and commitment of outpatient medicine which I think I simply do not have the patience for as important as it is. Add to that the versatility of seeing both routine “social visit” patients and very complex acute care patients and hospital medicine seems like a good choice.

The patient I am seeing now is a case in point. This guy is a noncompliant 65 yo patient with full blown AIDS and a CD4 count of 18 and a viral load of 176k who is here with 12lb weight loss, fever and chills likely due to an opportunistic infection exacerbating some possible hypogonadism (fancy word for your endocrine system not working well anymore and causing your metabolism to be out of whack). I like stabilizing the patient and then taking symptoms, tests and thinking and looking up literature about what could be causing this guy’s problems then going back, discussing it and coming up with a diagnosis or plan that is not only the state of art care for the patient but is also the result of my creative and diligent researching. I like explaining these things to my patients, educating them, treating them and then discharging them when they get better.

I guess the only drawback is the acuity of care, there is still a difference between surgical and medical patients in the sense that surgery is really still the last line of defense when medical options have failed and carries with it the gravity (and also the rewards) of being responsible for the life or death of a patient. I wrote to Dr. B at the end of my trauma experience thanking him for teaching me how to save lives. As cliche as that might sound, I really meant it because the satisfaction of seeing my kickboxer patient who was literally dead weeks before sitting up in bed and talking to him knowing that myself and my team played an important role in saving his life was probably one of the most meaningful experiences in my life.