As a medical student, do you ever wonder what it’s like to specialize in internal medicine and pediatrics? Meet Joanne Loethen, MD, an internal medicine and pediatric specialist, and a featured physician in the AMA’s “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties.
Dr. Loethen is an AMA member and is actively involved in the organization’s Ambassador Program. Check out her insights to help determine whether a career in internal medicine and pediatrics might be a good fit for you.
The AMA’s Specialty Guide simplifies medical students’ specialty selection process, highlights major specialties, details training information, and provides access to related association information. It is produced by FREIDA™, the AMA Residency & Fellowship Database®.
“Shadowing” Dr. Loethen (@JoanneLoethenMD)
Specialty: Internal medicine and pediatrics.
Practice setting: Academic hospital and clinic.
Employment type: Hospital and university.
Years in practice: Three.
A typical day and week in my practice: As a resident, I don’t necessarily have a “typical” week as my routine changes based on what rotation I’m in. When on the wards, I work six days per week on average, allowing for one day off. When on a clinic-based rotation or in my personal clinic, my schedule typically follows the clinic’s schedule, which means I work weekdays in the clinic. Occasionally I have a call shift over the weekend, which means I’ll work an overnight shift on Friday or Saturday night.
The most challenging and rewarding aspects of internal medicine and pediatrics: The most challenging aspects of caring for patients likely resonate with many physicians in the current health care environment: Administrative tasks and documentation, and patients who are uninsured or underinsured, which becomes prohibitive to their getting the care they need.
The most rewarding moments of my job are sitting down with patients and taking time to just listen. Hospitalized patients have so many people coming in and out of their room on a given day. Typically, we are there to get information, do an exam, complete a given task and update the patient.
But rarely does anyone take the time to sit down and allow a space for the patients to express their understanding of the illness, concerns or fears they may have, or merely learning about the patients outside of their active illness. I’ve found that when I minimize how much I talk and allow, instead, a space for patients to do so, I learn all that I need to take care of them and learn so much more about who they are and what is important to them.
How my lifestyle matches, or differs from, what I had envisioned: I came in anticipating long hours and extended stretches of time without a day off—a “prepare for the worst, hope for the best” kind of mentality. In doing this, I wasn’t surprised when those expectations came to fruition. I also made some non-negotiables for myself that, no matter how long the hours or days, I would maintain for my own sanity and well-being.
My two non-negotiables since the beginning of residency have been regular exercise and good nutrition. Even if it’s only a 20-minute walk when I get home from work, I like to get something in most days of the week. As for nutrition, I use my day off or the start of each week to chop veggies, buy fresh produce for the week, or even prepare a smoothie that I’ll be able to grab in the morning as I’m heading out the door.
More recently, a third non-negotiable has been sleep. The days that I get seven to eight hours of sleep are remarkably more productive and more enjoyable for me compared to those when I get six or less. Of course, this means my bedtime comes early, but it pays dividends the next day.
Regarding differences in the lifestyle that I envisioned, I still haven’t come to terms with the lack of flexibility in my schedule to attend important personal events. I’ve still had to miss many important life moments to those who mean a lot to me—family weddings, nieces’ and nephews’ birthdays, etc. This continues to be frustrating and though the schedule may still be demanding, I hope to have more autonomy in this regard beyond residency.
Skills every physician in training should have for internal medicine and pediatrics but won’t be tested for on the board exam: Being a med-peds physician means that you’re wearing the hat of a pediatrician and an internist at any given time. Though much of the medicine is related, it requires adaptability and understanding the differences between pediatric and adult medicine.
Likewise, the way you approach children with their parents in the clinic visit is different than how you would speak to adult patients. Being attuned to these differences and embracing the ongoing transitions between the two is important to optimizing your communication with the patient.
Books every medical student interested in internal medicine and pediatrics should be reading: How to Win Friends and Influence People, by Dale Carnegie. I read this book before ever considering medical school and I continue to draw from its principles daily. Though many perceive it as a book geared toward sales and business, its content applies to any profession that relies on person-to-person interactions. Medical school teaches us the facts and science of medicine, but without also learning to be an effective communicator, leader, and the ability to gain the trust of others, we are limited in what we can accomplish.
Being Mortal, by Atul Gawande, MD. Really, anything by Dr. Gawande is worth a read, but Being Mortal is by far a must. Every medical student, resident and physician will face the death of a patient and end-of-life considerations—some more often than others. This book expands on medicine’s ongoing struggle with the inescapable realities of aging and death or discomfort in having effective discussions surrounding end-of-life, and the default medical interventions we do to extend life when these same measures actually rob a patient from quality of life.
How Doctors Think, by Jerome Groopman, MD. This book was recommended by a close mentor of mine and, now that I am practicing, couldn’t have been more accurate. In it, Dr. Groopman explores the forces and influences behind a doctor’s thought process and exposes how such processes can lead a physician to err, despite our best efforts. An eye-opening account of well-explored research.