My experience at QHC’s internal medicine floor was very different than the patient populations that I previously worked with. Most of my previous rotations dealt with more outpatient settings in which the majority of patients were in relatively good health and were not bedbound. Internal medicine also operates differently as there are multiple rounds of rounds and there is more paperwork to be done in terms of discharge summaries and making sure that patients had follow up appointments scheduled for them. Rounds were somewhat longer than I expected but I was able to learn a lot during rounds since we would review the patient’s history, why they were admitted, and follow up with how they were doing overnight. I enjoyed being able to present on at least one patient per day as opposed to following many patients per day since I was able to spend more time with my patients and really get to know them during the length of their stay. I was also able to follow results from blood work or imaging and discuss any significant information with the residents or interns on my team.

Prior to this rotation, I have not had much experience drawing blood or doing procedures on inpatient patients. I was surprised at how challenging it was to draw blood! During this rotation, I saw both nurses and medical students draw blood from the tiniest veins (like metacarpal veins) since there were no other options. It was challenging for me at first but I was able to learn from their advice and techniques, such as using hot packs and leaving the tourniquet on for a few minutes to allow the blood to collect. I underestimated how slowly blood would flow, which would make sense since the patients are in a horizontal position and are ill or dehydrated, making it hard to collect full tubes of blood. I also learned how to perform procedures like paracentesis and how to insert PICC lines, which were really interesting because I had no previous experience with such procedures.

Another important skill I learned was more ways to break bad news. In internal medicine, the providers there are often the first ones to tell patients about possible malignancy after imaging or other studies were done. I was able to observe how my attending physician spoke to the patients and pick up skills that he used in doing so. Although it was generally not my role to be the first person to break bad news, I often followed up with the patients and spoke to their family members. Overall, my experience in internal medicine was more intimate than my previous rotations since I was able to follow up with patients from the time they were admitted to the time they were discharged. Seeing the gratitude in my patients and their families really made rotating in internal medicine nothing less than rewarding.

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