Rounds with Dr. Gerber

I'm rather excited about Neurology and am now wondering if I've made the wrong choice to pursue Internal Medicine! We had a grand total of 4 patients on our census, and with the 3 residents, 4 students, and one attending, we outnumber the patients 2:1! But that's not what excites me about neurology. For the very first time I was able to see evidence-based medicine at the bedside. We have 2 rather unusual cases, and after discussing them the attending, Dr. Gerber, went immediately to PubMed and searched to find case reports, reviews, articles, etc. that would substantiate his hypothesis or generate alternative explanations. But I'm also missing an important point here: Dr. Gerber, the attending, performed a full physical after a thorough, focused, history on every patient while we were rounding. Amazing! Never before have I seen an attending perform a full physical, often relying on the reported abnormal findings from the residents and focusing on the problem at hand. While there's nothing wrong with either approach, I feel that I learned much more from a complete exam than a focused one. The former has the advantage of being thorough, but the latter is much more efficient.

This makes me realize how important it is at various institutions to enforce a limit on the number of patients a person sees. While I understand that part of the training is how to handle a large number of patients effectively and efficiently, I also feel that this "rushed" medicine doesn't give patients the full attention they need and reinforces the message that it's ok to do just the minimum in order to get through all the patients. This might be ideal setup for future practice where your livelihood is dependent upon the number of patients you see, but I feel it's completely contradictory to the idea that we should be the patient's advocate.