Internal Medicine Rotation: Recommended books

[Guest Ian Wong]

Here's just some recommendations for both textbooks and ward books based on my experiences in this rotation. I don't claim to know what's best, but this is what I used for this rotation.

 

Recommended books for Internal Medicine:

 

In your white coat pocket:

1) Tarascon Pharmacopeia

2) Maxwell's Quick Medical Reference

3) Sanford's Guide to Anti-Microbial Therapy

4) On Call: Principles and Protocols ISBN: 0-7216-5079-1

5) Oxford Handbook of Clinical Medicine ISBN: 0-19-262988-3

6) Pocket Medicine ISBN: 0-7817-1649-7

7) Quick reference card for interpreting EKG's

8) Patient Lists and To Do List premed.freeservers.com/download.html

 

At home so you can read up in your spare time (ha!)

 

9) Talley and O'Connor Clinical Examination ISBN: 0-86542-689-9

10) Pick any oversized Internal Medicine textbook for here. eg. Cecil's, Harrison's. I bought Blueprints Internal Medicine ISBN: ISBN: 0-6320-4484-5 and it looks good, but I never got around to devoting the time to read it!

 

Tarascon, Maxwell's, and Sanford's should be de facto members of your white coat until you graduate med school, and probably still after that.

 

On Call will be a life-saver if are early in your clerkships and aren't yet comfortable with getting paged late at night by the nurses for patients with low urine outputs, fever, high or low blood pressures, chest pain, etc. Otherwise, if you are comfortable managing the above "typical" ward calls, you can leave it at home; I stopped carrying it after a week because of all the other junk in my pockets.

 

The Oxford will be very useful to get a quick refresher of all of your patient's medical conditions. The Pocket Medicine is incredibly useful when it comes to formulating a treatment plan for your patients. I think that EVERY medical student who goes through Internal Medicine should have a copy of Pocket Medicine; this truly is an awesome book.

 

I think the big textbooks may be overkill if you have ready access to the above. Getting journal articles can also be useful as they often lead off with a description of the disease, and then present evidence-based current therapeutic regimes for your patients. You can get this articles online; lots of the Internal Medicine people subscribe to www.uptodate.com, an online journal repository that is always updated. Other sites would include Medline/PubMed (although you'll either have to pay to download the article, or look it up at your local medical library) or www.mdconsult.com (which is pretty good but may be limited).

 

I think Talley and O'Connor is a great book, and there is nowhere better in the clerkship rotation to ditch the Bates Clinical Skills book for this one. A large part of your clinical grade (at least in my experience) was based on how strong of a history and physical examination you were able to perform. Talley and O'Connor will not only describe all the relevant physical findings you might elicit in a given body system (eg. rheumatological), but will provide some of the pathophysiology as well. If you can pull off the level of clinical exam as described in this book, you'll look like an absolute superstar in front of your residents and attendings.

 

The major goal you should get out of Internal Medicine is multifold, since this is such a vast rotation.

 

A first goal is to develop a systematic approach to managing your patients. Have a mental pathway to follow through when managing a patient for electrolyte abnormalities, know what you need to do when assessing a patient with decreased level of consciousness, know how to approach a patient with chest pain.

 

As the above alludes to, get comfortable with managing the everyday ward complaints that you will get hit with (chest pain, fever, altered level of consciousness, etc). This is important stuff that you will certainly need throughout the rest of your rotation.

 

Learn how the hospital works, and how the other health professional can help you out. In no other field will you see them as often. The Internal Medicine service relies intensely on dieticians, physiotherapists, occupational therapists, pharmacists, social workers, respiratory techs, nurses, etc. Each one of these players is destined to bail you and your patient out at some point during your rotation. Meet them, learn about them, and learn to work together with them and use their skills.

 

Learn how to keep on top of your patient. By definition, Internal Medicine patients are complicated patients. You need to know what their lab values are at all times, what procedures they have already had done (and their results), as well as the plans for any future investigations. You need to be the contact person for any specialists that you might consult on to help your patient out, as well as the liaison between that patient and his/her family. You may need to track down Radiology or a specialist and hound them to make sure that they are actually performing their tests. Just because you wrote an order requesting an abdominal CT, or for GI to perform endoscopy on your patient doesn't mean that the requisition actually made it there. Follow up on your orders!

 

You may need to call up the patient's family doctor, or perhaps to nearby hospitals, and get any pertinant past medical records faxed over to your department. You need to know what medications your patient is on (often the elderly patients, of which there are many in Internal Medicine, are on incredibly complicated medication regimes). It may be your job to assess whether your patient needs help from one of the other health care providers (eg. physiotherapy to regain mobility) and to ask physiotherapy to see your patient (depending on your hospital, they may not until you formally request it). Using a patient sheet like the above, and compiling a To Do list on each patient (and ticking off each point as it gets done) will help you keep your patients in order when you're on the 26th hour of your 30 hour shift, and all five of your patients are starting to sound exactly the same!

 

Finally, this is your opportunity to hone your history and physical exam skills. Your patients will present with a huge array of longstanding disease processes, and this is your opportunity to hear all sorts of murmurs, find all the physical signs of chronic liver disease (not just jaundice!), do a good neurological exam, etc.

 

Ian

UBC, Med 4

[Guest Ian Wong]

Floating back to the top...

 

Ian

[Guest Ian Wong]

I would also add the following little pocketbook to your labcoat arsenal. This is called the Tarascon Internal Medicine & Critical Care Pocketbook, ISBN: 188274232X.

 

It's a little more expensive than the Tarascon Pharmacopeia, and is about twice the thickness or so. It's jam-packed with all sorts of good info, and is definitely handy to have for any ICU or critical care type rotations, with the additional bonus that most of the information is directly applicable to things you'll encounter regularly on the Internal Medicine services.

 

Here's the Amazon.com listing for it, with some additional reviews:

 

Amazon review for Tarascon's Internal Medicine and Critical Care Pocketbook