Keeping sharp

As a general internist, there are a few different jobs that I am trained to do. I am able to see patients in the clinic, outpatient medicine. I am able to see patients in the hospital, hospitalist. I am able to address urgent issues, emergency and urgent care. Not a lot of internists still do emergency, with the rise of emergency medicine as its own specialty. That leaves the hospital and the clinic.

Everyone has their own preferences. Some like the clinic more, others the hospital. I’m not a big fan of hospitalist care. Not that I disapprove. I just don’t enjoy it. I went into medicine for the continuity of care. However, the clinic has its downsides as well. The one true thing though is that if you do one or the other, it’s easy to get rusty. If all you do is clinic work, then the hospital is a pretty intimidating place. There’s a lot of aspects to acute care that are challenging and require a lot of coordination. If all you do is the hospital, then the clinic is really difficult. Results come back in weeks, not hours, and dealing with patients with chronic illnesses is challenging.

The one thing I’ve noticed about myself is that I’m not feeling very sharp with either. I’m losing that sharpness I had in residency in the hospital. I don’t have all the answers. I’m not ‘the man’ anymore. In the clinic, I’m not as sharp as I could be, often taking weeks to take care of relatively simple issues.

To me, it seems like the traditionalist is not a sustainable model. Precious time is split too much, and there’s no expertise. And the shame of it is that I want to be an expert at something.