Internal Medicine Rounds
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- čas přidán 8. 08. 2023
- Oh no, anything but c diff
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Do you have any idea how hard it is to condense 8 hours of rounding into 2 minutes?
If Johnathan writes the script, not hard?
Ask surgery😂😂
You did it masterfully. 😁
Surgeons do it every day, why can't you?
8 hours? I thought internal medicine rounds were a minimum of 27 hours.
As an FYI: the chief of the FDA, Robert Califf, enjoys dropping references to your videos during internal meetings. You have fans in high places!
😂tell him I said hi
@@DGlaucomflecken If I ever speak with him directly, then sure thing.
I need examples immediately
❤
😮
I had an internal medicine doc as my PCP and he would occasionally say “I’m 95% sure it’s (x). We can do expensive and intrusive tests and get to 97% or you can take my word for it.”
Added bonus I forgot to mention: he was the doppelgänger of Hugh Laurie. Added richness to watching House.
I’m borrowing this as an expectation to set, thank you 🤭
The rare 5% it’s not x:
Would be most reasonable to assume it's this.
Dang, I really like that, actually. Exact numbers make the situation very clear, and they're open and honest about the worth of testing. You know exactly where you stand with this doctor.
as an IM resident, It would not be inaccurate to say with a high likelihood that this most likely represents and could potentially be consistent with Internal medicine rounds.
With no citation of landmark papers or estimates of how pre-test probability may or may not have gone up or down? I think we might need to do a 7 AM journal club before rounds this Thursday. I’m off service, so you can lead the critique :).
Also considered family med rounds given broad coverage of organ systems while rounding for at least 3 hr qAM. However, absence of pregnant and pediatric pts argues against this. Still, cannot rule out med/peds
Most consistent with*
You can CONSIDER it
@@Defahnit would not be unreasonable to consider it
You make 14 years of schooling and residency worth it to understand the brevity and joy of these skits
@@lindsaykress36🏅
"Would you mind if 8 students come in here and examine you awkwardly?"
Had this with a GI exam for my (diagnosed and managed) crohn's disease. And, like that time, I will always welcome such things. It might be awkward, it might be intrusive, but helping the next generation of doctors learn their trade is too important to let my discomfort get in the way.
It’s also probably kind of fascinating as the patient. A gaggle of scared students here to see little old you
My grandmother was shushed once when students were asked what was in those x-rays and she shouted it was her HTEP...
Agreed! I love being able to help with education. Like, if I'm gonna feel miserable anyway, might as well get some use out of it.
They asked if a student could observe when I had my first IUD put in. I didn't mind at all and we all had a good discussion about the history of the devices while it was being inserted. They gotta learn somehow and it was a welcome distraction. Lol
@@DeathnoteBBWell, in my case they weren't exactly here to see the front of me-or the end that can see them back, while we're at it.
The "great question, why don't you present that tomorrow" is so true and shuts up med students really quick. However, I did know a guy in med school that made up presentations in advance and then "set himself up" by asking questions. The next day he would have this perfectly put together talk for the attending.
That's genius
Internal Medicine truly loves his job. His gleeful reactions are priceless.
Nobody could do this job for long if they didn't like it. Rounding kills souls.
This is why i want an internal medicine doc as my primary care provider.
@@nancylindsay4255 Ironically, 90% of IM docs I know hate outpatient
I've shadowed a Rheumatologist before, internal medicine running after Rheum is spot on 😂
Why do they run? Coz they're difficult to find?
One of the rheumatology fellows leaned in the workroom door pointedly until my gen med attending looked up, stroked his beard, and said, "I wanted to lay eyes on the man who consulted rheumatology at 7:30pm. Just...wanted to look at him." Then walked out without another word.
@@shinyumbreon696💀💀💀💀 this is hilarious
Infectious disease's restraining order level patient history will always come and save the day!
Cat scratch disease added to the differential
dr house level of stalking
Yep, whenever you want to know your patient, look at the ID report.
@@NoNameAtAll2house was a rookie
Must have been 10am on the 3rd Tuesday of the month for him to have found Rheumatology in the corridor
I thought they were a myth!
Hey that’s not fair! It’s because we’re in the clinic solving rare cases the rest of the time 😂
As a pharmacist I'd kill to have physicians using generic names vs brand names for meds, especially antibiotics 😂
As a GP working in a hospital, If I have time, I write the brand name and the generic name in a bracket, and told the pharmacist, if the patient can afford it, to give them the brand medicine.
As a patient, who likes knowing the actual name of what he's taking, I also would like for all doctors to have brand names and trademarks excised from their vernacular.
To be fair, a lot of brand names are easier to say for laymen than the generic/full medicine name. Not all brand names but yknow.
Edit: I, myself, like to know the medicine name but I just cant blame a lot of regular people using brands instead
Me realizing I’m allergic to “Bactrim and sulfas” not even knowing the proper generic name
Here, in lithuania, you get all your recipes as generic names, and then at the pharmacy you get to even choose between brands if there are multiple options.
This can be considered sufficient mockery. I wouldn't say it is insufficient, but I need more studies to make a conclusion
It would not be unreasonable to consider this sufficient
as tolerated, of course
But maybe get an echo…
Considering the complex co-morbid conditions, a multi factorial answer continues to be part of rhetoric differential, but given the available variables in our records, the most likely explanation that could be suggested is that that was a moderately accurate and funny comment.
Hear that... it sounds like a tuning fork. There is a Neurologist nearby! Thomas, curbside him.
Feeling this in my soul while on IM now. Patient triggered a 15 minute discussion on heart block by causing rapid response when he took his telemetry leads off.
And that's not including the 45 minute tangent on an unrelated subject.
Lol.
@@georgeobrien9748 My reaction exactly when I read this above comment! I was the rapid response nurse and was frequently called to med surg!
To be serious tho, this is the best way to learn. Problem is, there is SO MUCH to learn in INternal Med
Notable that IM is one of the few characters that smiles
absolutely. im docs are usually really nice :D
And I love going to them because they like to converse and teach!
Also pathology
I was the medical unicorn for the dermatology students once. Had a crazy allergic reaction opportunistic fungal infection combination on my tattoo. Must have had every student come through to look at it. I think they all became convinced to never get a tattoo admirer it.
Did you learn a lot in the process, and how did the treatment go?
@@reddragonflyxx657 I learnt how incredibly sick a skin infection can make you. I also learnt that I’m allergic to Epoxy resin. The treatment took about a month of dressing changes and some kind of ointment. It was early Covid otherwise I probably would have been in hospital for a few days. Community nursing visits daily for the first while then every few days then weekly.
I got another tattoo from a different studio, it healed 100% no issues. Just can’t have my skin wrapped in glad wrap.
Oh no. Did your tattoo survive?
@@safaiaryu12 fortunately yes it did. They did a biopsy but it was to the side of the tattoo.
After spending over a month in the hospital due to a cocktail of uncommon disorders and complications from major emergency surgery, it brings me some comfort knowing that I might have at least made an internal medicine doctor Very exited.
Did they manage to diagnose you? Wishing you all the best for recovery!
@Alex-vq9vj some of the disorders I was already aware of and actively looking into getting under control. Unfortunately, many were not, which contributed to my most recent hospitalization. Others I only learned about in the hospital as they appeared.
It's going to take some time to process what happened and take in all of this new information. The important thing right now is that I know I'll get it all sorted with time. I have a lot of support from family and friends, plans to get more specialized treatment from a variety of different doctors, and I can be very resilient when I need to be. Admittedly, none of this is easy, but I have faith that I'll learn, adapt, and improve my conditions. Just need to be a bit patient with the process.
Hopefully, that answers your question!
@@katieramsey5425 That's great to hear! Good that you are able to focus on the positive aspects and support.
When I was a medical student there was a General Physician whose nickname was 'Shifting dullness', because of the exciting quality and length of their rounds!😀
🤣🤣🤣
😂
🤣🤣 Good one!!
I got roasted by my attending on 4-hour IM bedside rounds today, thank you for delivering this gem!
You've nailed the mental marathon of IM residency, my friend. That was 14 yrs ago for me. The unending joy of pre-rounds, morning report, rounds, noon conference, post-round rounds, and running the list was nothing short of sadomasochism.
And I endured this during my first trimester of pregnancy. Exhaustion as I have never known it since!!
I'm not a doctor or anything close. I used to work housekeeping and laundry in long term care facilities, and the "(sniff) oh no, C diff" hit ME hard
🤣8 med students coming in for an interesting patient got me! Happened after my emergency c-section and I had an infection spreading. Me surrounded by teams of drs and students talking over me as I awkwardly attempted to breastfeed. Oh, good times. Well, I hope at least someone learned something that day!
The patient getting discharged even before the reports of 'urgent' investigations are available is the trust thing ever😂
Ahhh... the unique (not to mention clinging) smell of C. Diff. Runs a close second to its friend, Pseudmonas 😂
That's what Vicks under the nose is for.
@@Alacritous you betcha!
Don’t forget the GI Bleed
@@michelleferguson9104I nearly puked, my gosh you NEVER forget the smell of a GI bleed
The cleaning staff can diagnose c-diff before the lab does!
RIP To the poor student who has to consult Cardiology without an echo
It never fails. It never fails. Whenever I see a Glaucomfleken skit on internal medicine rounds, I automatically smile and simultaneously get ptsd from my memories of grand rounds back when I was in PA school. Thanks Dr. G for the diversion and trip through memory lane.
You forgot to mention anti gravity rounds are only suggested by the attending when they are the attending who refuses to take elevators in a 11 floor hospital
Not to mention Liver Rounds, when the herd adjourns to the local pub.
Thanks to Dr. G. For sitting through enough Internal Medicine Grand Rounds to give us this!
Can’t click a notification from CZcams faster than this 😂.
Edit 1: Just finished the video. Internal Medicine seems good teacher like he tries to explain everything despite a little too detailed.
I saw the title and wondered if I'd have time to watch the whole video before dropping my kids off at school tomorrow 😂
I absolutely adore how happy he is about all of this.
"I love taking the stairs" produced a flashback of my entire internal medicine rotation. Thanks for the stroll down memory lane
Why do they love taking the stairs? Other than burning calories
@@Noblebird02 An internist in motion must remain in motion; an internist at rest does not exist
1:17 😂 This happened to me when I was admitted for my grade II pineal parenchymal tumor of intermediate differentiation. I had at least 2 fellows and/or med students (could have been more while I was sleeping lol) show up in my ICU room, because they were fascinated, because of the rarity of said tumor. One guy actually said to me, "Oh wow, you know, this is one of those tumors you only ever hear about in med school, but you never actually see it!" I was very torn between wanting to laugh, and being irritated at being a spectacle 😂. It was definitely an experience. Things like that though, are pretty funny to look back on.
Since I’m not in an academic setting so I don’t round at the hospital and I haven’t had students recently I tended to think I was closer to Family Medicine than Internal Medicine but somehow this really hit home. Not that I got really excited about hearing a regularly irregular heartbeat and tried to show my medical assistant how the patient had atrial flutter varying from 4:1 to 5:1 or anything. And I certainly don’t agonize over whether a potassium of 5.3 needs a work-up. So what if my patient’s problem list has 48 items? I just picked up an alpha thalassemia trait (2 deletions) in a patient who has never been told she has anything wrong! ( Seriously though, I have made it my life’s mission to get people with hemoglobinopathies off unnecessary iron-for example a 17 year old male who has been on iron for 5 years who had Beta thalassemia minor, along with his father and two brothers). Thanks for reminding me that I am still an Internist at heart.
Thank you! Iron is an evil drug! Prescribed and maintained way too long, especially in thalassemics!!
This is a shining example of why to go into surgery instead. There, the beatings don't last all day. Uh, I meant meetings... same thing when you really get down to it.
Anyone who has smelled C. diff will never forget it.
Never ever.
And yet, most people can't describe it accurately. My attempt is combination of rotting muskmelon with spoiling raw chicken.
@@mikebarushok5361 There is a really acrid high note to it too, almost like a mix of synthetic citrus or pine mixed with barn fire: tar, detritus and cowflops ignited and smoldering.
As someone who was forced to hang out with c. diff for a while after clindamycin nuked my digestive system, I agree... anything but c diff 😥
Been down that road myself. Twice. 😝
probiotics ordered? If not, yell at the attending physician next time. 🗣️😅. (& let the nurse see it)
I'm exhausted by watching this 😅
Great job!!!
These are basically all of my ADHD hyper-fixations in 1 skit, too!
as someone with a few uncommon & chronic medical conditions, the "8 med students examining you awkwardly" bit is SO real
Yup. There was a time about 25 awkwardly watched an interview I had with a doctor but didn’t interact. It was brutal, I felt like a sideshow freak. I didn’t have the strength to say ‘sorry, I can’t do it like this’. I generally don’t mind helping out students and residents learn, but that was too much.
As an Infectologist: that *sniff* it's C. Diff got to me. You know you're in deep when you diagnose it via smell
I started medical school this week! I don’t get all the jokes yet but they make me laugh anyway, which is much needed after the past 3 days 💀
You will! Levity is what's needed when faced with all the pressures of training. You'll get through it, and congratulations on the start of an exciting journey!
I hope you're doing well, 9 months later!
@@A_T216 thank you! I’m 2 weeks away from finishing up my first year of classes and it’s honestly been great so far. Couldn’t be happier with my choice of career and school.
@@densestlemon6241 I'm so happy to hear that! I wish you the best with everything going forward too, and that you can continue to do what fulfills you!
I like the part where the patient was treated in a timely and efficient manner. 🙃
The hatred for brand names spoke to me as 4th year pharm student
After finishing third year of med school I can’t even laugh at this anymore. I get palpitations thinking about it.
We need one with your Ortho Bro meeting OUR Ortho Bro… Orthodontist. I can hear them comparing drills, wires, and metal already 😬❤😂
As someone who has absolutely _no_ medical training, I don’t know why I enjoy these so much, but I do.
oh god, i LOVE it when we get the med students looking at me! it means the primary doctor *ACTUALLY PAID ATTENTION and didnt just blow me off with "anxiety"
(me and all my zebra friends)
Zebra?
@@tomasbeltran04050So there’s a saying in medicine. “If you hear hoof beats think horses, not zebras.” Basically it means to look for the obvious or most likely cause rather than a super rare disease.
I’m chronically ill with some weird combinations, so I’m considered a zebra because the hoof beats weren’t a horse.
Example: For years I struggled to hold food down. I would take two or three bites and it would come back up. My Gastrointerologist (stomach doctor) ran an endoscopy, a barium swallow, and a gastric emptying scan. (You eat a plate of radioactive food in a short time and over 4 hours they measure how well you digest it). All the tests came back normal.
I went to the Mayo Clinic after 4+ years of this, and we discovered that it wasn’t horses. I have a rare condition called limited gastric accommodation. Basically my stomach doesn’t expand properly when I eat.
To explain the condition imagine filling a water balloon up. The problem is the ballon isn’t expanding and it’s not bursting. That water has to go somewhere.
It’s a problematic saying because instead of looking into your symptoms doctors will say you need to lose weight, you have anxiety, or they say it’s in your head. They assume if the tests are normal then there’s nothing wrong. They don’t look for the zebras when they don’t find horses.
@@tomasbeltran04050 Zebra is something they tell the med students when diagnosing based on symptoms - "when you hear hoofbeats, think horses, not zebras"
But of course, zebras do exist, and sometimes it turns out to actually be a zebra.
@@tomasbeltran04050you know the saying, "when you hear hoofbeats, think horses, not zebras"? With some patients and their incredibly rare (and usually multiple complicated and overlapping) diagnoses, you do actually have to think zebras.
EDS?
Lol how many famous triads have been named after someone's ego
We in IM oftentimes do get carried away with what other doctors consider the minutiae of medicine… but I love it!
Wonderful! Made me love my job even more!
Our students will be back next week, can’t wait to take them on our rounds!
As a surgeon I wanted to scream “HELP!” watching this. 😂
I was waiting for neurology to walk in and start shaming on all of them. That would be a great part II
as an intern in Pakistan ,🇵🇰who had worked in medicine wards i can 110% confirm the accuracy of this, once our attending had a possible rheumatic fever pt and he spend 3hrs on bedside listening the murmers and discussing it with fellow residents and interns😂 Round ing is the holy grail of internal medicine
Just wanted to thank you. About to graduate with my BSN and your videos have helped push me to start looking into NP schools. Thanks for all you do and keep up the good work.
As an internist…this was my internal med rotations in medical school and my entire…residency 🤣🤣🤣🤣😩😩😩
🤣THIS explains why my Internist gleefully told me he remembered me after being out of physical rehab for YEARS! I'm a convoluted, overlapping mess of medical issues! So glad to tickle your brains, Docs!
Once had the attending round with us on call night to knock some work off the list. Started at 8 pm. I recall he was checking orthostatic vitals on some poor dude at 2:30 am that night.
Omg this brings me back to medicine rounds as a med student. It takes a special person to be enthusiastic after 8 hours of rounding.
And then, of course, there's the 40 minute digression on My Personal Philosophy of Teaching, complete with at least one patient vignette from 20 years ago.
So many amazing and accurate bits - and that's coming from Vet Med!
I'm so tickled that gravity rounds and a love of taking the stairs are so universal on IM rounds
As a patient who has seen many of specialists from ophthalmologists to GI to radiologists to oncologist I love your videos. Keep up the good work. Oh did I mention that I've been seeing specialist since the age of two and I'm now 46.
As an academic hospitalist, I lost it when you asked for the whiteboard.
Auscultating a murmur correctly and having your attending agree with you gives you the biggest confidence boost
As an Internal Medicine physician I can say that this truly represent us 😂😂😂.....sometimes is frustrating though 😢😢😢......
I ride a bike everywhere and almost put on sunglasses today but then I thought… ooooooo I don’t wanna go full ortho yet I still want to be rural medicine ripping it up on Texaco Mike’s fan boat
This whole video makes itchy AF.
That's how I know I'm Emergency Medicine for life.
Treat 'em and yeet 'em, that's our motto.
😂 Having been to Emergency over the weekend, I was grateful for that philosophy. It sounded like there were much more important things happening in there than what happened to me.
"The Potassium jumped from 4.2 to 4.3 over 3 months!! Get the lab on the phone to check for hemolysis and get me a creatinine, procalcitonin and 2 sets of blood cultures STAT!"
Thank you for another gem!
The eight med students hit way too hard. Granted, it was an overexcited resident, but I do wish I’d been a bit more willing to stand up for myself, but I was still a bit post-I gal. (Yes, that’s a cafe au lait spot. It feels like SKIN because that’s what it is.)
Granted, the good doctors will let med students know that there is a time and place for questions, which is usually not in front of the patient.
Hilarious and relatable as always! Thanks for the video, I love Internal Medicine
I’m about to be an IM resident in a month and this vid got me excited. Oh all the exam findings, paper reviews, “zebras”… Love it.
My adult grandson was a medical unicorn when he developed an abcessed Meckel's diverticulum. The rounding students were ecstatic!
I need to thank you, Doctor, and I have a story.
I was seeing my doctor for a really bizarre constellation of symptoms that were seemingly disconnected. Salt deficiency, constipation, night sweats, urinary problems, liver issues. Growing brain fog over years.
One of your videos with Infectious Diseases made me wonder if they were all connected. So I started to look at everything and find out how they were connected.
I had a weird bruise-like Tiger striping on my back, with salt issues, water retention to the point of edema, exhaustion, etc. I figured it might all be connected to a period I spent on an antidepressant that crashed my immune system. An MRI without contrast, two ultrasounds, a few x-rays, some weird labs, nothing conclusive.
But because my doctor watches your videos, he was willing to throw the dice- doxycycline on a ten day course. If it was nothing, it would be diagnostic at least.
Two hours after my first dose, I felt better than I had in two years. I thought it might just be placebo effect, so I looked it up; doxycycline can really act that fast. By the end of the term days, I was doing better than I had in years. YEARS. I felt mentally more like myself. Physically capable (but in poor condition after being so sick for so long). Four days off doxycycline and I had resumed my horrible condition, so he put me on a month long course.
I sincerely thank you (and Texaco Mike) for giving me the courage to lay out my argument and push for unorthodox diagnostics. My children, and my wife thank you as well, because you gave them their Dad/husband back.
That sniff and horrified "oh no" perfectly sums up C-diff. That smell punches you, I swear.
Okay but as someone in pharmacy, I agree on the brand name thing! Sometimes we swap brands and I'd rather people were using the generic name so the switch was smooth, rather than everyone treating it like a new drug!
This might be one of my favorite videos of yours!
Perfect timing. I’m taking step 1 tomorrow and I needed some laughs before bed :)
As a medical student doing clinical rotations in surgery, we actually had a pheochromocytoma patient, whose pheochromocytoma was discovered by a medical student who got very appropriate praise.
I was fortunate to be able to scrub in and hold “idiot, sticks“ and I was even allowed to help close. I had practiced very hard on my best, Plastic Surgery imitation and had a great time closing!
The comments are just as hilarious as the skits
Consulting Cardiologist without an ECHO😂. Thats brutal
In small animal veterinary medicine, the line is, “sniff…PARVO”
We had those differential lists in vet school too. List every possible differential for each individual clinical finding, including things that were very clearly ruled out by all the other clinical observations. It was like being an alien at a cult
Great as always❤
“Shifting dullness.” The DeGowin brothers would be so proud of you.
Brilliant as always!
And this, my dear friends, is why I'm a surgeon.
Love the enthusiasm at finding the JVP with lighting... and then still not being able to see it. SO true
Throwback to that time my doctor asked a bunch of students/residents (idk) to come in, and I didn’t realize she was asking *them* when she said “do you know what these lines are?” I said “yeah, those are stretch marks!”
I was like 15 and had grown so fast I had stretch marks on my back. Probably frustrated my doc quite a bit to have that teaching opportunity taken away.
Moral of the story, if a bunch of medical noobs are in the room, and your own doc asks a question, it probably isn’t one addressed to you
Ha the med students coming in to examine hits so hard. When I was a kid, I was testing out an invention and a med student tried it out on me (when asked, I said yes but my face/body language said no because I felt pressured). The student failed to do it properly, I had to redo it for him 😂.
Hahaha so damn accurate i had 9 years of academic medical training those 2 mins sums up all the pain endured all along (im out of it for good)
Hey doc, being an anaesthesia Medical officer in Sri Lanka I totally get this... and its so true how Int. medical people are enthusiastic about these things.
After a couple of weeks of ID consult rounds, I long for the sweet brevity of IM rounds.
"Why don't you look it up and present it tomorrow"
Oh, that hit deep in my psyche
Consulting cardiology without an echo... a truly terrifying threat!
I feel personally attacked. But in a good way 😂
our on call IM professor came in because of a case at midnight and decided to see all the new admissions (at midnight). a patient complained the next morning about not getting enough sleep during grand rounds. and he...asked us to explain how insomnia could fit into the pathogenesis of his working diagnosis
Beautifully done