Sunday, June 2, 2013

PGY-2 almost done

I know that it has been some time since I wrote but I have been up to my head in residency. There are so many things that need to get done, that sometimes I even forget that I have a blog and there are people who are waiting for me to write.

I am at the tail end of my second year of my residency. I have learned a great deal and learned what I really do not know and need to work on. But I have also learned about my strengths. PGY2 is a lot different that the intern year. You are considered a senior resident and there are many more expectations from you than before. For starters, you are the leader of your team. When I am on the general medical floors of hospital, I have 2 interns that report to me directly. It is my responsibility to not only make sure that they write all of their notes but that the patient is being properly taken care of. That the attending physicians have been communicated with and the interns come to me for advice on what should be done next. In addition, I am also responsible to teach the interns. It gets even more complicated when there are medical students as well.

If there is a 3rd year medical student, they typically report to the intern. However, this has been changed and now they report to the resident, me. I need to ensure that they see 2-3 patients, review their notes, cosign the notes and write the orders. In addition, they have to do only 4 admissions per call and I have to go over that entire history and physical with them. Not to mention that medicolegally they cannot write the assessment and plan but I have to do it. Finally teach them. If there is a 4th year medical student, they are considered a sub-intern and have always reported to the resident. These students, being senior medical students have a little more knowledge than the 3rd year but they are still students. I need to give them a larger patient load which means that I have more work to do.

Now most of the time this is not a problem. The issue comes in July when the new interns start. Because these are fresh interns right out of medical school or international medical graduates that are not familiar with how US medicine is run. On top of that being the senior resident all of the discharge dictations have to be done by me. But first I have to review the discharge instructions to make sure that the new interns did not miss anything. Luckily this coming July, I do not have that responsibility.

I have been doing a lot of admissions since I have been the admitting doctor at night and during the day. I have been reading all of the consults and the test results on the patients I have admitted to see if I was correct in my assessments. I have been doing a pretty decent job lately. But it is always a learning process. I am very lucky to be where I am as I get to see many pathologies that I may not have seen anywhere else.

For instance, I was able to see a gentleman with early stage Huntington's Chorea (a virtual death sentence if this is diagnosed), late stage multiple myeloma that is non secretory (very rare), and several incidental findings of renal cancer.

Currently I am preparing to apply to fellowship in critical care medicine. There are 4 programs in the area as we are not moving. If I get into one program, I will be thrilled. If I get into no programs, that is alright too as I will be able to practice medicine either as an internist or a hospitalist.

Hopefully I will have more time to write. In the meantime, come to the old premeds conference this weekend in Washington DC.

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