docLive Chat Series

Welcome to SDN’s newest feature, the docLive Chat Series. On Sunday, May 4, Dr. Harry Rosen, author of The Consult Guide to Internal Medicine, sat down with a few SDN’ers to answer their questions about Internal Medicine, third year clerkships, and selecting a specialty. For those who were unable to attend this event, the transcript is presented below.

Keep an eye on this space for our next docLive event!

<HarryRosenMD> Hi… Feel free to ask anything

> Well I’m just a M1, but what kind of tips can you give me for my clinical years? I’ll be rotating thru both medicine and Emergency Medicine this summer as part of a program at my school.

<HarryRosenMD> Mainly… take advantage of the time on the wards. Its a short time - in which you can ask everything - with minimal responsibility.

<HarryRosenMD> Relax… and try to enjoy learning.

<HarryRosenMD> Read on your patients. Eventually you’ll be surprised how much you have actually taken in over a short time.

> Yea, I’m suprised at how much I’ve learned this year.

<HarryRosenMD> Next year will be awesome. Much more clinical - being the year you actually start to merge the disciplines - rather than them being separate entities. It’ll freak you out in a great way.

> What is the most thing that I need to do to perform well and get great evals?

<HarryRosenMD> To perform well…. read and read and read. Repetition is key in medicine. To get great evals… you also need to be liked by your Attending and team. Be a team player. In exchange for being taught… do some of the interns busy work or ’scut’. That way… they will have the extra time to put towards teaching you. And you will start to get a feel for how internship is/ will be.

> Any tips as far as performing HandPs? I’ve volunteered at a free clinic and tend to get nervous when performing one.

<HarryRosenMD> Dont worry about the H/P for now. It will come - and takes years to really get a great grasp on. You need to focuse on simply learning as much as you can right now…

> So what types things should I be learning?

<HarryRosenMD> If you think about… look at how much you have to gain by simply sitting and reading. You’ve got another year. Stay focused on understanding that you will soon be up against STEP1. Its a very important test - and actually somewhat fair. You need to do as well as you can on it.

<HarryRosenMD> Learn your curriculum. Or some variant of it. You will be exposed to so many things next year - that the question will not be waht - but how. But it’ll be no problem if you are honest with yourself - and take the time needed to simply read.

> So reading is very important. Does it matter what you read?

<HarryRosenMD> To some extent. You need to be realisitic as to what volume you want to take on - amidst a sea of other topics. Stick to small texts and review books…

> Yea review books have definitely helped me this year.

<HarryRosenMD> Do not look for the absolute best - because it doesnt exist. Just find one or two that seem to give the infromation in a way you like - and easily relate to. Among those that fulfill the first criteria… one may stand out once you begin to go through it.
<HarryRosenMD> Review books are fantastic.
<HarryRosenMD> Its just that there are so many to choose from now… that the choice itself becomes anxiety provoking for some.

> Dr. Rosen, I’m going to have a lot of downtime on my medicine rotations… is there anything we should do [aside from studying] that can help us get ahead?

<HarryRosenMD> Why so much down time?

> No idea; it’s just what I’m hearing from this year’s M3’s

<HarryRosenMD> The 2 things to focus on are reading and being a team player. If you have down time to the point where you are simply bored as all hell… well… you can lsiten to medical podcats on your ipod. Hows that sound?
<HarryRosenMD> It may either spark you … or simply lull you to sleep

> Haha, sounds good.

<HarryRosenMD> If you really take the time to read up on your patients’ medical syndromes… you should have more than enough to fill in the down time. But… you need to be ready to read about conditions over and over again in order to begin to truly understand them.
<HarryRosenMD> Not from a tome like Harrisons… but from something much more manageable.

> Harrison’s is way too big :P

<HarryRosenMD> Definitely
<HarryRosenMD> You need concise… but thorough. For IM… you can also use sources like emedicine as your primary. Very nice (and free) site.

> What about Pocket Medicine?

<HarryRosenMD> Very nice for quick review. One of the best out there.

> I also heard the UCSF Hospitalist handbook was good.

<HarryRosenMD> Also nice. You can get it online as well. Just google it.

> Is the consult manual small enough for the pocket?

<HarryRosenMD> The first edition is not. My bad on not ensuring that pocket-size was adhered to. The second edition will absolutely be.
<HarryRosenMD> Out this August by the way

> Did anything have to be cut out to make it smaller?

<HarryRosenMD> No… In fact I added about 20 or so chapters to it. Just had to use a different printer to accomplish it.
<HarryRosenMD> I will definitely take long break once its finally out on shelves :)
<HarryRosenMD> Make sure you get both the:
<HarryRosenMD> Tarascon Pocket Pharmacopoeia & The Sanford Guide to Antimicrobial Therapy in addition to any pocket book for the wards
<HarryRosenMD> Must haves

> Well I’ll just wait on the second edition.

<HarryRosenMD> Definitely.

> Heck, I even use the consult manual at work as a paramedic.
> [Mostly to satisfy personal curiosity, but still…]

<HarryRosenMD> I love to hear that!!

> Does epocrates cover those two books?

<HarryRosenMD> I have never used epocrates - so I’m not sure. I do, however, know that some people swear by it. I’m just not into PDAs.

> We get it for free, and I have a PDA. I’m just cheap :)

<HarryRosenMD> LOL
<HarryRosenMD> Then just use that. It should be much better than fine. One great thing about the Sanford Guide as a ‘quick look’ antibiotic general sensitivities listing in the middle. Usually several pages - but nice.

> Any advice for going into third year trying to figure out what you want to do?

<HarryRosenMD> Nope. Just try to get the most out of each rotation. You will end up knowing full well what you dont want to see /smell again. But if your lucky… you’ll need to decide between 2 or 3 that get you.

> That’s kind of where I find myself now, there’s a couple things I think I’ll like - but the problem lies when there isn’t a lot of 3rd year exposure to them - like EM, some IM subspecialties, etc.

<HarryRosenMD> For me it was Internal Medicine vs. ER. vs. Psych.

> How’d you choose?

> Its unnerving starting rotations in 2 months and not having a clue as to what is going on, haha

<HarryRosenMD> Yeah… that can be an issue. Try to get an elective of your potentials early in 4th year. Other than that… follow your heart.

<HarryRosenMD> I want to attach the following answer I gave on an SDN thread for you. Give me a sec.

<HarryRosenMD> Ultimately… your main goal is to learn. Try to relax and have some fun with it. Don’t be scared to ask questions - that’s your job!! Don’t be scared to run everything by your intern - that’s your job!! Dont be scared that you don’t know how to function on the wards - you will learn. It’s not rocket science. You will come to realize that there is a huge amount to learn… with you only being able/ responsible to grasp

<HarryRosenMD> I realize that some students want to know everything - YOU CAN’T. No one can… so focus on the big picture. Don’t read/ learn about Zebras - what a waste! Read - and read - and read about the disease syndromes your patients have: pneumonia, COPD/ asthma exacerbation, DVT/ PE, acute coronary syndrome, heart failure, renal failure, cirrhosis, diabetes, etc…

<HarryRosenMD> If a patient has a Zebra - dont take it. You need to grasp the fundamentals. The stronger your base… the better you will be as a physician for life. These next few years are your chance to ask away with minimal responsibility. Take advantage of it. Take in the big concepts like antibiotic treament and fluid management which will help you throughout your career.

<HarryRosenMD> I chose IM because its diseases interested me the most.
<HarryRosenMD> I liked to read about the diseases… I also did not want to work with infants/ children.
<HarryRosenMD> Love them… but get very emotional when one is hurting.
<HarryRosenMD> My wife is a pediatrician - and for the life of her cannot fathom why I have chosen a field dominated by geriatrics.
<HarryRosenMD> Some times I cant either :)
<HarryRosenMD> So… I’m gonna sign off now. It was nice texting with all of you. If you have any other questions… please feel free to email me at: harry.rosen@gmail.com
<HarryRosenMD> Take care.

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