ACHQ Posted March 18, 2014 Report Share Posted March 18, 2014 Hi guys, I was wondering if someone was interested in internal and really liked acute medicine, besides ICU/Critical Care, would internal be a good career option? Link to comment Share on other sites More sharing options...
A-Stark Posted March 18, 2014 Report Share Posted March 18, 2014 Yes! Lots of sick patients in cardiology of course, heme, resp, nephro, infectious diseases... it goes on. Depending on where you work you'd see the strokes and other neuro stuff too. Link to comment Share on other sites More sharing options...
ACHQ Posted March 18, 2014 Author Report Share Posted March 18, 2014 Yes! Lots of sick patients in cardiology of course, heme, resp, nephro, infectious diseases... it goes on. Depending on where you work you'd see the strokes and other neuro stuff too. Nice! That's good to know. Which fields would be more acute then others? (besides the obvious cardio and ICU) Is it possible just to deal with acute stuff from that field? I know this is a stupid question about whats the rough % of acute vs chronic? Link to comment Share on other sites More sharing options...
Ttoronto Posted March 18, 2014 Report Share Posted March 18, 2014 There is no such thing as a stupid question. Well, there are but yours isn't. When deciding on a specialty or subspecialty you got to think if you like the "bread and butter" of that speciality. The interesting cases in every speciality are rare and on daily bases you deal with the bread and butter. For example in cardio, your daily work would be CHF and CAD. The emerg consults for arrhythmias and MI will be less frequent! I would say ICU would be your option for exclusive acuity. Emerg is another specialty for acuity and weird medicine presentations but again you would still have to deal with the bread butter of the elderly patient who presents with CP for the 4th time this month. Link to comment Share on other sites More sharing options...
Lactic Folly Posted March 19, 2014 Report Share Posted March 19, 2014 How much acuity do hospitalists see? Link to comment Share on other sites More sharing options...
A-Stark Posted March 19, 2014 Report Share Posted March 19, 2014 There is no such thing as a stupid question. Well, there are but yours isn't. When deciding on a specialty or subspecialty you got to think if you like the "bread and butter" of that speciality. The interesting cases in every speciality are rare and on daily bases you deal with the bread and butter. For example in cardio, your daily work would be CHF and CAD. The emerg consults for arrhythmias and MI will be less frequent! I would say ICU would be your option for exclusive acuity. Actually most cardio emerg consults are for MI/ACS and, yes, arrhythmias (new afib, the odd VT, post-arrest). Less commonly you see pericarditis/pericardial effusions, cardiomyopathies. Any of the above may be in failure, of course. How much acuity do hospitalists see? Probably depends on the location. As a general rule, where there is an admitting medicine service, hospitalists aren't going to be seeing the sickest patients. Link to comment Share on other sites More sharing options...
burrb Posted March 19, 2014 Report Share Posted March 19, 2014 General internal medicine will see some acute medicine. Common things like decreased LOC, septic shock, symptomatic hyponatremia, hepatic encephalopathy, severe thrombocytopenia which aren't severe enough to warrant intubation/central line/pressors will go to general medicine. Although a lot of these may go directly to sub-specialties (like I've seen people with plts of 5 acutely bleeding go to heme and ICU), depending on which hospital you work at. GI will see acute GI bleeds (for scoping and yelling at ER/GIM for not doing DREs). Cardiology (or general medicine, depends) will see acute coronary stuff, syncopal patients secondary to severe arrhythmias. ICU obviously is clearly where acute medicine is at. What I find super attractive about ICU is that it's not all medicine either. If you enjoy general surgery/trauma/neurosurgical/complex post-op patients, you'll love it. You know it's a good day when your list consists of cardiogenic shock guy who keeps fibbing, next to the meningococcemia close to brain dead guy, while everyone is scrambling to stabilize the new polytrauma motorcyclist who t-boned a truck. Things like allergy, rheum, ID, oncology, heme, endo will have very minimal if any acute medicine. That being said, a lot of the "non-acute" medicine sub-specs will often be asked to consult on patients who are barely stabilized (ie: ID for disseminated fungal infections, cardio for severe cardiogenic shock, endo for weird adrenal crises etc.) Edit: Forgot nephro. They'll be consulted to see the patients with acute renal failure bad enough to need emergent dialysis. The cool zebras like goodpasture's, acute glomerulonephritis are rare but patients are pretty sick and nephro will be all over that. Link to comment Share on other sites More sharing options...
A-Stark Posted March 19, 2014 Report Share Posted March 19, 2014 General internal medicine will see some acute medicine. Common things like decreased LOC, septic shock, symptomatic hyponatremia, hepatic encephalopathy, severe thrombocytopenia which aren't severe enough to warrant intubation/central line/pressors will go to general medicine. Although a lot of these may go directly to sub-specialties (like I've seen people with plts of 5 acutely bleeding go to heme and ICU), depending on which hospital you work at. At my centre admitting services need to see patients who might (or definitely will) go to ICU, as it's the consultant that determines the admission disposition not the ERP. Of course, frequently they're already tubed and vented at that point so there's not a lot of question. ICU obviously is clearly where acute medicine is at. What I find super attractive about ICU is that it's not all medicine either. If you enjoy general surgery/trauma/neurosurgical/complex post-op patients, you'll love it. You know it's a good day when your list consists of cardiogenic shock guy who keeps fibbing, next to the meningococcemia close to brain dead guy, while everyone is scrambling to stabilize the new polytrauma motorcyclist who t-boned a truck. ICU is medicine with a vent. And I'd say that it's all medicine one way or another; the only difference comes in where they go once declassed from ICU. Things like allergy, rheum, ID, oncology, heme, endo will have very minimal if any acute medicine. That being said, a lot of the "non-acute" medicine sub-specs will often be asked to consult on patients who are barely stabilized (ie: ID for disseminated fungal infections, cardio for severe cardiogenic shock, endo for weird adrenal crises etc.) Heme patients get very sick very fast very frequently - especially any on active chemo - and there are more than a few diagnoses (TTP, APML, febrile neutropenia, etc.) where people need emergent treatment. It's not really possible to avoid any of this in hematology. Link to comment Share on other sites More sharing options...
burrb Posted March 19, 2014 Report Share Posted March 19, 2014 ICU is medicine with a vent. And I'd say that it's all medicine one way or another; the only difference comes in where they go once declassed from ICU. Well a good chunk of ICU patients aren't in there for medical reasons. Surgical or trauma patients are pretty common and it's more perioperative medicine for these guys. I like how in Canada ICUs are usually mixed. It sucks when they separate to MICU, SICU etc. and you're stuck with one type of patient. Variety is the spice of life Heme patients get very sick very fast very frequently - especially any on active chemo - and there are more than a few diagnoses (TTP, APML, febrile neutropenia, etc.) where people need emergent treatment. It's not really possible to avoid any of this in hematology. Oh yeah good point. I somehow associated heme with cushy outpatient 8-4. Link to comment Share on other sites More sharing options...
ACHQ Posted March 19, 2014 Author Report Share Posted March 19, 2014 Thank you all for your insight! Link to comment Share on other sites More sharing options...
medicine man Posted March 20, 2014 Report Share Posted March 20, 2014 Hi guys, I was wondering if someone was interested in internal and really liked acute medicine, besides ICU/Critical Care, would internal be a good career option? I went through a similar dilemma as a medical student. I enjoyed acuity. There are basically 4-5 fields whereas a resident you deal with acuity on a regular basis. Those would be General Surgery, Neurosurgery, IM, ER and I guess one could say Anesthesia. At the end of the day though, you deal with acuity in all these fields only a fraction of the time. Yes you will great experience in IM dealing with acuity but a good chunk of time is spent dealing with less acute or more stable patients. I think the question you should ask is what you want to enjoy doing the rest of the time with stable patients. Even ICU docs often have other outpatient practices like Resp, or do outpatient Surgery, or do some IM whatever their base specialty is. I ended up choosing IM because I liked getting to the final diagnosis, being a specialist but still very broad and necessary consultant service and can still go into a field that deals with acuity like ICU or Cardio. EM and Anesthesia don't have follow up which is annoying so IM i chose. Link to comment Share on other sites More sharing options...
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