[picapp align=”center” wrap=”false” link=”term=emergency+room&iid=5286372″ src=”6/a/4/9/Hospital_hallway_a0e0.jpg?adImageId=9884053&imageId=5286372″ width=”380″ height=”392″ /] This month I’m “on service” at the hospital. This means, in my group, that I’m the doctor responsible for doing rounds each day and seeing any hospital patients the admitting doctors (usually hospitalists) ask us to see. There are many ways that medical groups split up this responsibility, but we go “on service” for a month at a time. In addition to seeing consults, the doctor assigned to the hospital is also the teaching attending for the month. We usually have two internal medicine residents who are taking the Rheumatology elective for the month. Part of what we do each day is formal teaching about diagnosing and treating common conditions encountered by Rheumatologists.
Perhaps we should digress for a moment and talk about what internal medicine residents do for their 3 years of training. I’m sure you can find many other places online that describe this more in detail, but here’s the quick summary. Internal medicine residency is 3 years and there are certain requirements, like months spent doing “general inpatient medicine” or “ward months” primarily caring for hospitalized patients. Other months that are usually required are ICU, ER, outpatient medicine and then a whole bunch of elective months which a resident can tailor to his or her own interests.
We have internal medicine or preliminary year residents, podiatry residents, sometimes pharmacy interns, sometimes Physician Assistant students and sometimes medical students who spend a month with us. Usually when we get asked to see a patient in consultation the resident gathers the information about the patient’s workup so far, sees the patient for a history and physical exam, then we discuss the patient and go back and see him or her as a team, make our recommendations and, when possible, discuss them with the admitting team. Each patient we are asked to see gives us a chance to talk about “real world” situations as they relate to actual patients. Sometimes there are procedures that need to be done as well. This whole scenario probably looks fairly similar to anyone who has watched “ER,” “Grey’s Anatomy” or “Scrubs,” though in the real world we’re not that attractive, evaluations and treatments move slower and there’s generally much less social drama!
So what kinds of patients do Rheumatologists see in the hospital? Probably the number one reason for consultation is a swollen joint, which could be an infected joint but is usually gout or pseudogout. Often this requires doing an arthrocentesis, which is basically inserting a needle into a joint to draw out fluid for the purpose of diagnosing the condition and also for pain relief as it relieves the pressure. We can also inject steroid into the joint (a “cortisone shot”) at the same time for pain relief and to reduce the inflammation. We also see patients who have a known Rheumatologic condition, like Rheumatoid Arthritis or Lupus, and are in the hospital for some other reason. In this situation, we might need to help manage the patient’s medications. And sometimes we’re asked if a patient might have some type of rare connective tissue disorder. Already this month we’ve been asked to see patients and help decide if they could have such conditions as Wegener’s Granulomatosis, Churg-Strauss and Erythema Nodosum. We also have a monthly journal club, I’ll be giving a noontime lecture to the residents later on in the month and we go to conferences like a radiology conference to review interesting x-rays. I am only “on service” about 3 times a year so I look forward to the change of pace and spending the mornings teaching and discussing cases. In the afternoons we are in the office as usual and the residents come over to our offices and shadow us there. That’s the month in a nutshell. We’re only 3 days in but I have a great resident this month. I actually really like our hospital’s cafeteria food and the break from packing my lunch every day and also we have a Dunkin’ Donuts in the hospital lobby which is convenient for a little pick-me-up! I also get to chat with colleagues whose offices are in the hospital and sometimes there’s a special event, like the “heart expo” they had in the lobby today. I’ll check back in at the end of the month and let you know how it all went.