Internal medicine is an extremely important rotation for learning broad swaths of general medical knowledge. The patient population is typically much sicker and has more comorbidities than other outpatient medical disciplines. After a patient is admitted to the hospital, every one of their medical problems must be assessed and managed.

Internal medicine, much like emergency medicine, really emphasized the need for thorough physical exams and taking of histories. The patient population tended to be older, were taking an extensive list of medications, and had several chronic diseases like diabetes, hypertension, COPD, kidney failure. Caring for these patients required thorough knowledge of pathophysiology and how certain medications might interact with each other. For example, a patient with hypertension and diabetic nephropathy might benefit from an ACE inhibitor more than a calcium channel blocker. I also spent one week with the stroke team and became stroke certified, so that I was able to evaluate patients using the NIHSS Stroke Scale. Because the test is somewhat subjective, it requires a lot of practice in order to make accurate assessments. I participated in stroke calls in the ER and presented findings to the neurologist. One particular patient required an external ventricular drain placement which was done by the neurosurgery team, which was comprised entirely of PAs. It was pretty amazing to see them perform such a complex procedure at bedside in the ER. I definitely felt like the stroke training was a highlight of the rotation and I would recommend all PAs become stroke certified through the NIHSS training program.

Another benefit to this rotation was working a week of night shifts. Because there was significantly more downtime at night, this allowed me some time to perform more procedures on patients that were stable. I performed several echocardiograms on patients under the guidance of an ER resident and became more comfortable using a sonogram machine, as well as manipulating the probe more skillfully in order to obtain better views of the heart.

            I enjoyed this rotation, as I think that it’s the basis of most medical practice and a crucial part of the medical field. As the population continues to age, there will definitely be a need for more internal medicine PAs to treat the various chronic illnesses that afflict people in their later years. I would like my colleagues and preceptors to recognize that I was willing to do any and all procedures that I was able to, and that I will do my best to become better at formulating complex plans for patients.