Last day of outpatient

Today was my last day of outpatient internal medicine. It’s hard to believe I am now 1/12 of the way through third year. There were several patients who were returning for cholesterol follow-up, and several other miscellaneous complaints. One of the most interesting was a 93 year old lady (still very sharp) who had multiple problems such as abdominal pain, constipation, osteoporosis, etc. Her son had been doing a lot of internet research and had convinced himself that she must have celiac disease, since many of the problems that she has are found in people with celiac disease. The doctor did not want to order a celiac disease test, because it is almost impossible that this lady has the disease, but he ordered it anyway to make the son happy. This brings up an issue that doctors often have to deal with—waste money and avoid offending patients, or refuse patients and save taxpayer money. Of course with the latter, there is always a remote possibility that the doctor could actually be making a mistake and then look like an idiot when another doctor orders the test and it turns out to be positive. Fortunately, I still have a couple years before I am responsible for those decisions.

Another interesting case was a man who started having diarrhea three weeks ago but without any other symptoms. He had no change in his diet, the only new medication was one which does not cause diarrhea, and he had no signs of infection. The doctor ordered several electrolyte tests, if they turn out to be normal he will have to get some more aggressive tests.

Tomorrow will be my first day of inpatient medicine at the VA. It should be interesting, I have no idea what to expect—I’m not even sure if it will be a full day, or just orientation to the hospital. Within the next couple days I will have to turn in my preference list for what surgical rotations I want to do next month. Everything’s going by very fast.