Reflections on a Consult Service

Since October I've been doing a first-year elective in Infectious Diseases. Mostly this entailed observing in the HIV clinic and on in-patient rounds in the QEII. Occasionally I'll get to listen to heart/lung/bowel sounds or help with history taking, though the latter typically only ever occurs in clinic. Initially, the plan had been to split my time equally between clinic and in-patient rounds, but the latter has ended up taking the lion's share of my time, something that I've liked.

Clinic is fairly non-threatening and low-key, and from the start I could appreciate the sorts of issues HIV patients face - side effects, compliance to meds, and all the psychosocial aspects unique to their situation. When I first went on in-patient rounds, I had to go meet the ID resident in Emerg where he was reviewing a consult. At this point, I could scarcely find my way around the hospital much less understand most of what I was hearing. As the afternoon progressed, I'd ask the odd question, but mostly I just listened, writing things down to look up later. I wrote down a lot.

As time went on, I met new residents coming onto the ID service more or less monthly. Everyone rotates through ID, and while most of the residents I've met have been in internal medicine, there have been others in physiatry, general surgery, neurosurgery, and ENT, along with a few actual ID fellows. I've really appreciated being able to meet so many people, to say nothing of the extremely varied patient exposure. I've been nearly everywhere at both sites of the QEII; ICUs, IMCU, Haem/Onc, CCU, MTU, Emerg, ENT, Ortho, Urology, various other clinics, and the dark, patient-less unit commonly known as Radiology. Even so, I still have only a vague sense of where many things are.

I'd say also that I've learned a lot about charts, how residents summarize patients for staff, and how a consult service works. I'm not sure whether I want necessarily to work on a service like ID in the end, but that's perhaps a topic for another post. In the end, I've enjoyed myself progressively more since January, both as I've learned more in class and as I've been lucky enough to end up with residents and staff who have been more open to teaching and having me listen and/or feel things for myself. This has really made all the difference. At this point, I can pretty much understand most of what the residents and staff are staying, and when I don't, I feel more confident and comfortable peppering them with questions. I know way more than I did in October, but the amount I don't know and have yet to learn always seems somewhat insurmountable.

I guess I'll get to that stuff eventually. My little assignment from today was to look up these:

Non-anion gap acidosis
Tumour lysis syndrome