General medicine – part one

What do you mean by medicine

What do you mean you’re doing medicine? It’s actually a confusing term for people not familiar with the divisions within the profession. For non-medical friends, not everything medical people do is medical. Specialties are broadly classified under medicine (also known as internal medicine), surgery, or there are a bunch of other specialties such as general practice and radiology that don’t fit into either categories. General medicine, at our particular hospital at least, involves a lot of deliriums and dementia, falls and related pain limiting mobility or function, chest and urine infections, and the likes.

Physicians are complex

Not too long ago, I wrote about the ego of surgeons. If they had attitude they were sort of, well, in your face. Recently, there was a conversation in which we concluded that physicians are like girls and surgeons are like guys, not only because of the gender ratio in each, but because surgeons are blunt and get to the point, whereas physicians (males and females alike) appear nice and caring but you can never tell what they’re really thinking. Complex, like girls.

Of course, that’s only stereotypes.

Improving delirium

Eighty something year old man, previously high functioning, independent from home alone. Came in with slow heart rate, was in coronary care, developed chest infection, severe acute kidney injury, and a delirium. His confusion improved markedly as his medical problems were sorted. I am generally er, disengaged, but sometimes amused.

1. Initially:

A: “Can you tell me where you are?”

B: “We’re at the zoo.”

A: “Uh are we? Can you see some elephants?” Half jokingly, I like to play along I don’t know why.

B: “Yeah they’re over there!”

A: “Hmm…”

At times during those days he was aggressive, pulling out lines, and needed constant one on one nursing.

2. Few days later:

A: “Can you tell me where you are?”

B: “We’re at the (Name-of-the) Hospital.”

A: “Good. I thought you told me we were at the zoo before, when did we leave the zoo?”

B: “Two days ago.” Impressive as it was rather true that it was around that time that his confusion started improving.

3. A week later:

A: “How are you going today?”

B: “Last night there was a patient next door crying out all night and confused. You would think that they would put these sort of people somewhere else wouldn’t you?” He complained, not unkindly.

A: “Oh… you might not remember but you were a little bit confused last week too.” I don’t want to say it, but you were alot worse!

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