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WHY INTERNAL MEDICINE ?
Well I have always liked the fact that internal medicine is an intellectual subject. We get to use our brain, solve the clinical complexities arising from multiple multisystem diseases and multiple medications, get to manage the patient as a whole and coordinate care with other specialities. Ever since I entered the third year clinical posting, internal medicine has always fascinated me. It™s a thinker™s job. Plus I have a good grasp of pathophysiology and I think this is the field that I can excel in. Plus internists can specialize in a wide range of subspecialties/ opens door to a wide range of possibilities, including hem/onc that I am particularly interested in. That™s because there are very few hemonc in our country, and I thought I should specialize in hemonc from a reputed state of the art hospital. That™s why I have come to this country to do my residency. During my internship in medical school, I worked for 3 months in internal medicine department. There I realized that this is what I should get into. I used to independently see patients in the OPD, ER and the GMF. Also while I was volunteering in xxxxxxxx internal medicine department, my interest was further bolstered/ strengthened. I cant think myself as doing anything else.
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PRESENT AN INTERESTING CASE
give the setting- where was the patient, ER, OPD, GMF ?
then state what he presented with, what you thought is going on, but how you were wrong, or how it turned out to be something else, what you thought would be the course, but what unexpected happened, and what you learnt from the case.
Eg, When i was in general medical floor, there was a patient we admitted with the suspicion of SLE- she was a young woman in her thirties with ............................................
but it turned out to be.....................................
she started deteriorating with the medicine.......................................
finally......................................
sth like this.
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WHAT CAN YOU CONTRIBUTE TO OUR PROGRAM ?
a. I think the clinical experience I gathered during my internship in my medical school will definitely help me take care of patients better. My teaching experience in China will probably help make the program more didactic for everybody™s benefit. My volunteering at Cook County Hospital will also add to the efficiency of this program during my internship, I have no doubt about that.
b. my friendly nature, my devotion to patient care, my interest in academic activities and updating myself with the latest evidence in medicine, and my ability to get along with patients from diverse cultures will add to the efficiency of your program
c. I am interested in clinical research so that we can improve our patient care make it more evidence based. I plan to not only work as a clinician, but also conduct some research in different aspects of medicine, so that I can bolster the practice of EBM
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HOW DO YOU SEE YOURSELF ADAPTING TO THE HEALTHCARE SYSTEM OF THE STATES
a. I like
i. orderly workplace in the US hospitals,
ii. the nice electronic record keeping system which gives access to every information about the patient at the click of the mouse,
iii. the protocol and guideline based health care, not putting the patient at the mercy of a doctor™s whim,
iv. the capping system on the number of patients any particular housestaff has to handle,
v. the ACGME rules/ RRC (Residency Review Committee) on the hours on duty that are usually followed around the US, so that the staffs aren™t overburdened.
vi. I like the sharply defined roles between different specialties and ancillary staff, so that I don™t have to run around doing everything for the patient like I had to back home, from drawing blood to transporting patients or doing bone marrow aspiration. Of course I can handle a little bit of everything, but in our part of the world, it was so overwhelming that it resulted in too much chaos, and caused poor patient care.
vii. Considering these facts, I think I will actually enjoy working in US healthcare system. One thing I have to adapt to, however, is not making the decision for the patient, and giving him complete autonomy over his body.
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WHAT PROBLEM WILL THIS SPECIALTY FACE IN THE NEXT 10 YRS TO COME ?
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HOW WILL YOU AS A PHYSICIAN HELP TO CONTROL THE RISING HEALTHCARE COSTS.
a. Send less investigations, use my clinical judgment instead;
b. try to cutdown the days any patient stay in the hospital; many patients stay in hospital for investigations that can be done on an out patient basis. This costs thousands of dollars each day. I will try to make sure that patients stay in the hospital only for the minimum days required.
c. Also I will focus more on preventive medicine, like patient education, vaccination, early diagnosis and treatment of chronic diseases like cancer, heart diseases, HTN and DM. If pts come with complications, it takes far more resources to take care for them.
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WOULD YOU HAVE TROUBLE WORKING IN THIS PREDOMINANTLY CATHOLIC HOSPITAL ?
a. No, I respect every person™s right to religion and other faith. I have worked with people of different faiths, from Moslem to catholic to hindu to atheists, and I have always mixed in. I studied in a catholic school during my premedical years. I deal with them professionally. Even if they don™t agree with me in certain things, taking care of their health is a different issue- we have to both agree on what we are doing for that.
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DESCRIBE THE WORST ATTENDING YOU HAVE EVER WORKED WITH ?
b. Worst attending was when I worked in internal medicine itself. He used to come late, didn™t attend the morning reports he was supposed to attend and give feedback to the residents, never did his rounds on time( we had to wait for him to come and start the round), the patients rarely saw him, he was very arrogant and abusive towards both the patients and the residents and medical students. He had a private practice, and always used to leave early for his private practice without any consideration for his patients in the hospital. He even used to refer his hospital patients to his private clinic, in front of us. He was the incarnation/ personification of what a clinician shouldn™t be like. I used to say to myself this is how I should never be.
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WHAT KIND OF PATIENTS DO YOU HAVE TROUBLE DEALING WITH ?
a. Yes there are certain personality types that are difficult to handle, especially patient who don™t respect the rush we are working in and always want everything to be done then and there, have a lot of time pressure, and don™t realize there are other patients under our care too.
b. but I try to act professionally with all of them, and put extra effort to make them comfortable- after all I understand everybody becomes selfish and stubborn when they are sick- its like a defense mechanism.
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WHAT IS YOUR ENERGY LEVEL LIKE ? HOW DO YOU HANDLE STRESS ? HOW DO YOU HANDLE DEATH ?
a. Well when I was in medical school, there were too many patients, not enough physicians. So a single firm would have to see almost 30-40 patients, and we had to stand for 3-4 hours in the round, and another 4-5 hours taking care of inpatients, then we had to do nightfloats which would start at 6 and end at 5 pm the next day, almost 36 hours. I have survived that, so I feel like I will survive residency. On top of that, we don™t have crazy work hours like that in the US, atleast here, coz I have heard that this hospital strictly abides by ACGME rules. Working some extra hours a day is really not a problem for me, but very taxing schedule like in some NY programs- its really very difficult to handle. People here know that residents function poorly if they are sleep deprived. So infact I would be very comfortable working here.
a. I have worked for one and a half month in ER of our hospital in my final medical year. It was one of the most crowded, most stressful ER I have ever seen. Lack of adequate ancillary staff compounded the problem even more. We had to handle multiple patients at once, send the bloodworks ourself, open the lines ourself, insert Foleys and NG, do blind LP because there were no USG guided procedures in our hospital. So it was pretty stressful.
b. I have been though a lot of deaths in my ER postings. Initially it made me feel kinda queasy, but I got used to it later on. We start feeling mechanistic after a point, as if the human body is just the heartbeat seen on the monitor, and if we cant revive that beat on the monitor, then the person is dead. We try our best, but there is no point worrying about what we couldn™t do. The more difficult part is to make the patient™s family come to terms with it.
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