UC Davis 4th Year Clinics – Internal Medicine (1 of 2)

Internal Medicine is a large service and is split into 2 teams, each of which include the following:
# of Students: 5-10
# of Residents: 2-3
# of Faculty: 1-2

Hours: Variable depending on caseload, but expect to be there from 7am-9pm most days.

Rounds: Team Rounds 8-9am and 5-6pm on week days. These can be quite intense depending on your faculty and residents, but you may feel as if you are being grilled. During my first time on this rotation, we did two things during rounds: 1) case rounds and 2) topic rounds. Case rounds consists of presenting student cases in a very specific format for the group to hear and discuss. Topic rounds consists of going over a topic, such as “Cough,” where they go around the table and each person has to list a differential diagnosis, once differentials are listed, we move on to diagnostics, treatment, etc. This is when grilling is at its worst! You don’t know an answer, but they keep pushing you, and though you may have known the last 5 answers that were given, just because you don’t know the one answer to the question you were asked, you don’t get to shine like the others. Also, Grand Rounds on Wednesdays 8-9am are rounds that many other services attend in a large lecture hall where cases are presented via PowerPoint for a large audience. Expect to present a case for at least one Grand Rounds during your time on this service.

Caseload: Expect to see 1-2 appointments every day and have anything from 0-3 or more inpatients to care for in addition to appointments.

Your Role: See clients and patients in appointments to get history and physical exam. Go back to Resident/Faculty to discuss your findings and talk through where to go from there. Go back to the client with the doctor, who examines the animal and asks any additional questions. Together with the client, you and the doctor discuss differentials, create a diagnostic plan and work up the case from there. You will be involved in acquiring all diagnostics  for cases and formulating a treatment plan. In patients treatments from 8am-8pm are your responsibility – if you need help covering treatments so that you can see appointments, then communicate with a tech to help. Phone calls to clients in AM and PM with updates. Writing up treatment sheets every day. Discharging patients. Also, each team is responsible for checking voicemails left on the 999 hotline to the school and calling people back with answers to their questions, even if it is as simple as, “We recommend that you bring your pet to a veterinarian.”

Records: You must complete History, Physical Exam, Problem List, SOAPs 1x/day for inpatients, Discharge Summary, and Discharge Instructions for each patient.

On Call: Since there are 2 teams, each team takes turns taking “pick-ups” (patients that came in during Emergency Hours that are being transferred to another service) from the night before or the weekend, so some days/weeks will be easier than others.

Weekends: Responsible for treatments for any inpatients you may have at 8am and 8pm and any on-call responsibilities for pick-ups. If you have no inpatients or on call shifts, then you’re free!

Pros:

  • Caseload is usually manageable.
  • Lots of variability in cases seen (though faculty tend to draw appointments related to their specific expertise, residents usually see a bit of everything).
  • You’ll get a good tour of the hospital heading to different services for consults on specific issues.
  • You’ll learn a lot, and the learning curve is steep!
  • Lots of practice with client communication. Aside from making calls to clients in the morning and evening, you will also be responsible for calling back community members who call the Davis hotline for veterinary related questions. You listen to the voicemails with your group and divide them up and you get to find an answer to the question and call them back and relay that information. It’s great practice!

Cons:

  • Rounds can be intimidating. I’ve heard that people have cried from being pushed too far. It’s also not comforting when residents or faculty laugh at you or your classmates for their answers.
  • Very inefficient – you may just need a signature from a resident before you go home, but you may be chasing them down for over an hour before you get it! You spend a lot of time running around the hospital from service to service for consults and diagnostics to be performed. Other services have techs help you with these things so that you can see more cases. While it is nice to be a part of the whole diagnostic process, it can be frustrating when you spend 8 hours walking with a dog all over the hospital and don’t get a break.
  • Residents are overworked and can be short with you or have an attitude.
  • Cases seen are often the worst of the worst, things that regular vets have not been able to figure out, so they get referred to us.
  • I’m not going to lie – the first day or two on medicine I arrived at 7am and didn’t eat a bite of food until after 7pm as I didn’t have a break before then. It’s imperative to bring food to snack on as you won’t likely get time for “meals” per say.

Highlights:

  • Working through difficult clients. I was warned about this one client whom I was told was notoriously difficult and only trusted one doctor, so she would drive quite a distance to come to Davis and see the doctor. Usually when I hear warnings about clients I think people are making them out to be much worse than they are. Well, not in this instance! This client was beyond difficult. She stretched my ability to be patient, cool and collected when she had me weigh her dog 5 times – (yes, FIVE!) – because the weight that showed up the first 4 times (30.1kg) couldn’t be accurate. On the fifth try it showed up as 29.9 as the dog was on the corner of the scale, and the client was content with that number so we took it. And that was just the beginning of the appointment! Apparently this client has made students cry before and made some really racist comments to make others uncomfortable. Despite everything, the client ended up really responding well to me and was very happy and appreciative when I bid her farewell at the end of the appointment. I felt good enough about myself that I survived the interaction with my composure intact, but even better that the client felt that we really built rapport and was very happy with our interaction. 🙂
  • Some owners are just so dedicated! I had 2 moms of a Standard Poodle drive to Davis from 6 hours away and spend a week in a motel as we cared for their dog. They visited and brought boiled chicken to feed to the dog when the dog refused to eat for days in the hospital and were so grateful for the care we provided when we finally discharged their beloved dog for them to take home.
  • Aggressive dogs are not exactly something I prefer to deal with, but somehow I tend to get assigned to them (though I’m not sure why…). The afternoon I was suddenly selected to handle a 76 kg (170lb) Mastiff who was aggressive, I didn’t know what to expect. I handled it just fine – it was all about communicating to the clients, who knew the dog much better than I did, about what the dog would allow us to do. It turned out, not much! I was able to use my communication skills to get the owners to help me examine the dog. Once we had to take the dog away from it’s owners, however, he became more of a challenge to handle, requiring 2 muzzles and 4 strong people to sedate for an x-ray. The dog ended up having to undergo general anesthesia just to examine his ears and feet, which were of greatest concern. Overall, that dog was a great lesson in patience, maintaining calm and communicating with your clients and staff to ensure a safe environment for everyone.
  • Appreciative clients never get old. I will never get used to getting gifts of appreciation from owners. One family came to me for a re-check of a previously diagnosed condition but brought a giant box of expensive chocolates for me to share with the other students and doctors. I even knew the student who was on the case before me (from the class of 2012) and told them I’d be sure to send the student a message to let her know how the dog was doing and let her know that the owners said hello! If all clients were like this, I’d have a hard time pursuing a career in shelter medicine…

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