Internal Medicine – The ‘House’ of Vet School

I just recently finished my first required senior clinical rotation – Small Animal Internal Medicine.

Despite my trepidation at taking on such a broad and deep field, I seemed to have escaped the six weeks relatively unscathed, having learned several new skills and improved others.

Time is money, as they (whoever “they” are) say, and no one likes to see the minute hand move past 5 at the end of the day. The clinicians do not have time to treat you like a junior vet student, and at this point you cannot really afford to be acting like one. For every one of my cases, after gathering history from the client and performing a physical exam on the patient, I was required to form a Problem list, Rule-out list, and Diagnostic plan. This forced me to form mental catalogues in which I could organize my rule-out diagnoses by body system.

Vomiting?

– Primary GI – foreign body, enteritis secondary to food intolerance or toxic substance ingestion, developmental anatomical dysformation, primary neoplasia, autoimmune condition, trauma such as gastric dilatation & volvulus

– Secondary GI – inflammation/infection such as pancreatitis/hepatitis/cholestasis, paraneoplastic syndrome, central nervous system dysfunction

From this algorithm a list of diagnostics and the information you hope to glean from them is much easier to form.

Due to the hectic atmosphere of our IM department, I quickly learned to move confidently in forming and initiating my diagnostic plan. This included communicating effectively (employing well-placed pleasantries) with the other departments in our hospital, such as radiology, ultrasound, and occasionally surgery. Many a time I would traverse the 300yd hallway with a request in-hand to diagnostic imaging where I would communicate in subtle tones that while I wasn’t officially deeming this request an emergency, we would like it very much, please and thank you, if it could be done as soon as possible. No one will do anything even close to spectacular for you if you are a grouch.

Finally, the all-important client communication. This is the part of the program where we take all that gibberish from above about -itis’ and para-cancer thingys and translate it into layman’s terms without making you, the client, feel like a third grader being lectured on the finer points of astrophysics. I gained some experience with this in Community Veterinary Services and Small Animal Surgery (both junior year clinical rotations), but frankly in CVS the most intense it gets is delineating the twelve different kinds of flea/tick products and why the client still needs to buy one for Fifi who “never-ever-ever goes outside”, and in Surgery the clients seem to accept the fact that they will never understand all the intricate, surgeonesque feats performed on their animal – as long as Roofus is eating well and doesn’t look sad in his cage.

Internal Medicine, on the other hand, is quite a different beast. This is the place where clients learn that their dog is a new diabetic and will need to be given twice daily injections of insulin (with a real needle!!) along with diet and exercise modifications, monitoring for complications of hypo- and hyperglycemia, frequent urine cultures and blood glucose curves. I had one such case and immediately learned the need for communicating without causing information overload – a disastrous outcome that would reflect heavily on the patient’s wellbeing.

In conclusion, these last six weeks expanded my knowledge base, showcased my tenacity and initiative, and gave me experience in effective and empathetic client communication.

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About becklegacy

Emergency Veterinarian by night; Crossfit athlete by day; Redeemed work-in-progress by the Grace of God.
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