On mixed findings (or the beginning of Internal Medicine)

This week, I have heard aortic valve stenosis, observed a masterful tobacco cessation counseling session, and asked an avalanche of questions. I’ve also seen a physician stare at his computer and issue clipped, close-ended questions to a frustrated Spanish-speaking patient.

The first week of clinic started slow. A day at a primary care office, seeing a few patients and getting used to the process of history-building and physical examinations again. Two half days and one full at the Lehigh Valley Physician Practice, a resident-run clinic that treats the under- or non-insured of Bethlehem. Another half day at a primary care practice, this one serving the wealthy and upper-class of Allentown. A broad mix of patients from both sides of the socio-economic spectrum.

I’ve seen things that have unsettled me. I’ve witnessed a physician describe a patient as an opiate addict with a vocal inflection that left no doubt about their personal assessment. Then, I saw that same physician casually continue a prescription for an amphetamine salt, for a patient that was more interested in the stimulatory effects than any sort of weight loss protocol. I’ve noticed that in the illicit substance checklist, magic mushrooms are listed under the active chemical compound of psilocybin while cannabis is listed under the street name of marijuana.

So much of medicine will change by the time I retire. A few decades ago, we irradiated children’s faces in order to treat acne, which subsequently led to increased rates of thyroid and other radiation-induced cancers. Within this current generation of physicians, beta-blockers were considered attempted murder of a patient with congestive heart failure, now it is an essential aspect of our medical education and their treatment. It is difficult to remember that much of what we do now will be considered barbaric and primitive in only a few seasons.

I’m looking forward to next week. I’ve learned enough over the past two years that I can ask specific clinical questions and I also know the holes in my knowledge, which might be the more important skill. The expectations from my preceptors are low, as they always are for early third year medical students. I’m hoping to build a solid foundation for the rotations ahead and to avoid picking up practices that don’t sit well with me.

The summer solstice lands on Wednesday and I’m enjoying the powerful sun. The spring brought about change and transition. This summer will be a season of profound growth and challenge.

Bring on the growing pains.


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