MDU 4003 Lecture 3: Lesson 3a: Internal Medicine

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University of Florida
Health Outcomes & Policy
MDU 4003
Rhamani, Mariam

Internal Medicine with Dr. Pauly chief of internal medicine, also teaches in medical school associate professor and director of division of internal medicine started with 8 to 32 staff member Faculty: Hospilice- dedicate time to inpatients, sick and need to hospitalized OR managing hypertension, diabetes - outpatients OR she does the teaching program (primary what she does) Class: Essentials of Patient Care 4 semester continuum first day to take in medical school -stethescope activity as beginning to clinical experience -exposure to patients: learn ask questions related to medical history, empathy, body language, verbal and nonverbal -interact with trained patients and real patients -2nd year: paired with one faculty member to two students grew up in west alabama school in vanderbilt (4 yrs) medical school in university of alabama in birmingham university of north carolina in sheffield hill - internal medicine residency alabama: 2 yrs of cardiology fellowship met husband, married moved to baltimore, NIH basic lab astrobiology 5 years, 2 children 1995- john hopkins residency moved to UF in 1997 interested in medicine b/c there were no physicians -traveled an hour to see a doctor kind caring and open, patient would want to carry out the therapy less than 50% prescriptions are filled after office visits internal medicine: care for adult patients -residency medicine and practice general internal medicine and open a practice -role in preventing disease by educating patients looking at screening methods, -3 yr residency program, then practice general internal medicine -many go on to subspecialize such as cardiology, gastroenterology, nephrology, infectious diseases -fellowships take 1 to 4 years academic position/ clinical practice, outpatient clinic, teach and direct course personality -curious want to carry out task in completion -good listening skills -enjoy people, interpersonal career family medicine also encompasses pediatrics ob gyn delivers babies internal medicine stresses inpatient intensive care as well as outpatient experiences -more complicated than family medicine -in general, it can expand more -subspecialties, you can pick to work in research, -managing technology, trying to keep up, trying to balance risks -evidence face medicine, “how likely is this patient going to have a certain disease” CHALLENGES HMO’s potentially eliminate care -not as dominant in some areas -underinsured i'll seek care later favorite patient stories: lung cancer couple, wife is lost moving inspirational focusing outside of themselves establish contact with the whole family Case Studies by Dr. DuBose 3rd year resident medical school in south carolina intern: caring 4-10 patients on their own 20 minutes for a patients, get to hospital early 7-10 minutes 8:00 resident, 2 interns (kein) 9:00 morning report (1 hour conference with other doctors) Case: unusual or something that's common rounds, check up on patients (30 minutes/ 3.5 hours) 1 hour to get work done 12:00 lunch and conference, and admitting patients Case: 55 yrs old, shortness of breath (heart, lungs). trip down to ohio. stop at rest area. short of breath. never had something like this before. kids are sick group by problems, organ system ask open-ended questions - pneumonia, “so how’s it going” rabbit’s foot “where’d you get the rabbit's foot” 1. history 2. past medical history 3. differential diagnosis (cardiac and pulmonary, and cancer) a. internist goes deep and uncommon diseases, 4. past surgical history 5. family history 6. social history 7. allergies to medications 8. review of organ systems 9. vital signs (tachycardia, expect a murmur but no murmur) 10. Labs (31:08 youtube) 11. EKG (very subtle, downward deflections are not normal) 12. chest x-ray conclusion: pulmonary embolus ● pulses, swelling on left side (clot starts on feet) put him on blood thinners (ventilation perfusion scan--blood flow and oxygen b/w lungs and heart) lydic therapy questions: on service, 80-100 hours a week. spend night every 4,5th night intern: 6-6pm (12 hrs) M-F , one day is 24 hours and get out earlier next day weekends (if not on call) Senior Resident - electiv
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