How to Survive your General Internal Medicine Ward Months

By Ruben N. Sanchez, M.D.

Ophthalmology Resident, Doheny Eye Institute, University of Southern California

WHAT TO EXPECT

Welcome to General Internal Medicine Wards! With 24 days left before I begin my ophthalmology residency, I must say that this past year has been one of the most rewarding and yet frustrating times of my life. First, take a deep breath: the hardest part about July 1 will be figuring out the hospital's computer system, where the restrooms are and how to order a CT scan. Apart from this, the best piece of advice I can give is to work very hard and try to keep the whole year in perspective by recognizing your role in the hospital.

Your number one responsibility is to be an efficient, hard worker who admits patients to the hospital and more importantly DISCHARGES them quickly. The quicker you learn how to write tight insulin sliding scales and PRN orders for Tylenol, Pepcid and insomnia medications, the less frequently your pager goes off.

Become very good friends with radiology, they will be your best friends and read CT Scans for you at 4:00 AM . Also, try to behave appropriately. It is always better not to yell at nurses no matter how dumb you think their questions to you are at 2:00 AM . It just makes you look foolish and you will feel pretty bad about it afterwards. Remember, nurses have the patient’s best interest at heart and so should you.

WHAT YOU NEED TO CARRY WITH YOU

You should always carry a penlight, stethoscope, and most important, your hospital meal card. The following pocket books are very helpful and are available in PDA format.

1. Medicine, 2005 Edition by Paul D. Chan, M.D. This is a little maroon book filled with admission orders for all sorts of internal medicine problems.

2. Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine (Pocket Notebook) by Marc S. Sabatine.

3. Of course, every IM house officer would be lost without Pharmacopia (or some PDA equivalent)

4. Up-To-Date is a fantastic resource if you need to know more detailed info than the above resources provide.

HOW TO HANDLE YOURSELF IN A CODE

If you are fortunate enough to be the first M.D. on the scene of a code in July of your intern year, just go back to your ABC's. No one will ever fault you for that. By the time you are assessing the patient's airway and breathing, someone with more experience will be on the scene. I have never been alone during a code. Remember, ACLS is just an algorithm. Don't let the class stress you out, once you do it a few times in real clinical situations, it becomes routine.

USMLE STEP 3

Just get it over with! Have a few months of medicine wards under your belt and take it! I used Crush and QBank , studied for 2 weeks and did fine.

WHEN THE GOING GETS TOUGH

Smile! You are going into ophthalmology and won’t be pre-rounding, “running the list” and admitting patients to the hospital at all hours of the day and night for the rest of your life.