Avoiding the Dogma House: Rotating with Dr. Regal

Posted by David Plumley at Tuesday, May 29, 2012

I have been looking forward to my Internal Medicine rotation since the day we found out our rotation schedules.  I had ranked Dr. Regal number 1, 3, and 5 for rotation preferences hoping I would get him.  I had heard many good things about his rotation and knew how hilarious he was from previous classes (I think he is the only professor to ever use a picture of Flavor Flav on one of his lecture slides).

One the first day of rotation Dr. Regal gave me and Chuck (my rotation buddy) a syllabus of what a normal day would be like for us, what the major focuses would be, and revealed a somewhat unexpected "bench test" that would be given at the end of the rotation to test the knowledge we would be accumulating over the next 5 weeks.

As far as what we would be doing on a day to day basis, each of us would be assigned to one medical team who we would round with and be responsible for all of the patients on that service.  My service is Med Dock; the team consists of an attending, a senior medical resident, 2 interns (1st year residents), and two med students.  Each morning rounds start at 8am and by that time I should have worked up all the patients and have a general idea of what issues may come up on rounds.  My major focuses are antibiotics (choice and dosing), anticoag (dosing, monitoring, education), overuse/misuse of PPIs (a Dr. Regal pet peeve), and other chronic condition therapies that are not being maximized.  Each morning after rounds we meet with Dr. Regal and discuss briefly questions that came up on rounds and recommendations we should make, we then follow up with our teams and make sure these recommendations are relied to them and either taken or have a reason why they are not.  After that we have some time for lunch and time to work up any new admits (each team is on call 2 days a week) or read any articles that were given to us.  Then in the afternoon we meet up with Dr. Regal to do some topic discussions about articles we have read or common themes that he has seen come up on rounds.

The most interesting this so far about this rotation has been the wide variety of cases I see on a day to day basis.  So far in my first 5 days I have seen your more common infections like pneumonia, cellulitis, many UTIs, and  several heart failure exacerbations, but I have also seen some rare conditions only seen in case studies like POTS (Postural orthostatic tachycardia syndrome), plastic bronchitis, and cardiogenic autonomic neuropathy.  These are conditions that most health care providers will never see; but because of this rotation I get to see these conditions and hear the medical team discuss their treatment.

I hope you enjoyed my first entry.  I will try to keep you up to date with some of the more interesting cases I see and give you an idea of what I do on a day to day basis over the next 4 weeks.