Revisiting Rounds: Lessons from the General Medicine Ward

Each year, I spend a month attending on general medicine, serving as the supervising physician for two house staff teams that, together, care for about 20 to 30 patients at a time. Although my colleagues elsewhere are amazed that I still do ward work, I enjoy the time with the trainees, taking, as our former chairman said, “a sabbatical from your lab.”

With a schedule that demands intensive patient follow-up and documentation, I round seven days a week. Unlike the house staff, I do not have a limitation on the number of hours I work in the hospital. Although I do not spend nights prowling the wards or taking admissions in the moonlight hours, my days are filled to overflowing because my other academic work does not really stop. Taking care of sick patients is very tiring because, in the world of hospital medicine today, there are no easy admissions.

For a rheumatologist, general medicine is familiar territory. While called subspecialists, we are really generalists because our diseases are incredibly diverse, spanning organ systems and pathogenetic mechanisms. No other subspecialty has to treat patients with so many different afflictions. I often try to think of the common threads of our diseases. After all, what unites fibromyalgia, vasculitis, and osteoporosis—not to mention rheumatoid arthritis and myositis, among many others? My best answers are pain, complexity, and systemic involvement. I could also add treatment with steroids for many.

Just like a camel, which is a horse designed by a committee, rheumatology is a specialty designed by tradition, accident, and the penchant of rheumatologists for variety and the opportunity to grapple with problems that have eluded others. A general medicine ward is the perfect place for a rheumatologist because, after all, for our rheumatic disease patients we constantly think about strokes, myocardial infarctions, pulmonary emboli, infections, and unremitting pain. I know a little about a lot, but I think that’s doing better than most specialists.

Munchkins Aspiring to Be Giants

Attending on a general medicine ward provides an opportunity to look back as well as forward. My mind bubbles with a litany of war stories from my own house staff days. During one of my intern rotations in the 1970s, we alternated between schedules called Black Week and White Week. During Black Week, we were on call in the hospital Saturday, Sunday, Tuesday, Thursday, and Friday. White Week was only Monday and Wednesday.