So, I have been the ID fellow on the wards doing clinical infectious diseases for over a month now. Transitioning from the leisurely pace of the microbiology lab was no joke. I probably dropped about 5-8 lbs in weight. I’m actually not sure since I haven’t weighed myself. I’m just hoping that it’s not closer to 10 lbs which is quite possible because I’m swimming in my clothes. It’s quite a sad sight. In the first week I found no time to stop and have lunch nor dinner. And since I don’t typically eat breakfast first thing, oh well.
It is overwhelming getting used to the practices of a new hospital, the idiosyncrasies of a new computer system, and the new responsibilities of being a fellow. All of a sudden, I’m being asked tough questions and I’m thinking wait a minute, a couple of weeks ago I was just like you, an internal medicine resident, why would I know the answer off the top of my head? I’m being asked questions about complex infections in patients, various infection control scenarios, interpretation of lab results not quite covered in our brief microbiology course, and what to do in various travel related situations. I get called by area hospitals and clinics when they get stumped on an issue. I’ve had to visit our state’s department of health website a few times and read off to the person calling me, “well, the DPH says blah blah blah…” This is actually irritating because they could have just as easily searched the webpage for themselves.
Don’t these people realize I’m just a fellow? A fellow training in infectious diseases who is not yet the specialist with decades of experience?! At least through finding the answers for their questions I teach myself. I suppose that’s the point.
Let’s not even talk about clinic where I see a lot of patients with HIV. Each HIV medication has 3 names. For example, AZT is known as azidothymidine (though we don’t use that typically), zidovudine, ZDV, or the brand name Retrovir. Since there are about 25 medications used to fight HIV, and more underway, I need to keep about 75 names in my head and know which names are interchangeable for the other. Why?
Because the patient comes in and says I’m taking AZT. Of course that is if I’m lucky and the patient knows the name of their medications. Some just tell me I take the pill that is “round & white”. Big help right? Anyway, in my head I’m supposed to convert AZT to ZDV so that when I discuss the patient’s case with the precepting attending physician I can say “the patient is taking zidovudine” because saying AZT is so passé now.
Then there are the combination pills like Atripla which made a splash not too long ago. Since we prefer not to use brand names in medicine, when talking to other medical professionals I’m supposed to say the patient is on combination efavirenz/tenofovir/emtricitabine or in the 3 letter designations EFV/TDF/FTC. Uhhhh, yeah! Obviously, I’m still working on that.
Medicine in general is a lot of learning on the job, but you get to a point where things become routine, because you’ve encountered the clinical scenario before and now you know what to do. I had become a good internal medicine resident, but I’m once again at the bottom of the learning curve here in infectious diseases. I’m constantly having to look into my handy Sanford Guide, my state’s DPH website or the CDC’s homepage to figure out what next to do.
Ugh! I cannot wait for a few more months to come by so I can begin to feel comfortable with my new responsibilities.
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