Note: What a typical day looks like is more or less similar for most specialties in Internal Medicine, so for a nice overview you can read my post on A Day in the Life in Internal Medicine.
Monday
Ward rounds were the usual. While the team was really busy, the Reg did explain and teach quite a bit along the way, which we were really grateful for. The Con grilled the MOs. I honestly didn’t know a single thing. Rheumatology is actually really broad because of how the diseases can affect almost any system in the body. I was so clueless I just tried to note down pointers as we went along. Rheumatology is also intriguing in the sense that there are signs (e.g., deformities of the hands in arthritis) you can see.
In the afternoon we had a tutorial with our Core Tutor. We did a hand exam and a respiratory exam. After which, I decided to try joining the start of overnight call. Had the chance to take blood (successful). Clerked one patient with a neurological condition. Left the hospital at 8:50pm. Overall 10/10 day. Zero studying done, though.
Tuesday
We started the day by clerking a patient with systemic lupus erythematosus (SLE). (There weren’t many patients we could speak to so we went together and my friend mostly asked the questions while I listened and took notes.)
Nothing out of the ordinary happened in ward rounds. Again, the Reg was the only one who made it fruitful for us by giving quick, brief teachings along the way. (By the way, when doctors try to teach something they almost always begin with a question, so it’s good if you know at least a bit of stuff.)
After lunch, we were waiting in the ward for our afternoon tutorial when the Reg came by and said he had a bit of time. So we had an impromptu tutorial where he went through joint pain with us. Later in the afternoon we had a beside tutorial with our other Core Tutor. We saw a patient with a cranial nerve palsy.
Then I had to leave the hospital and rush to school to conduct some volunteer training. The campus was very far so I ended up becoming very tired and not getting much done, haha.
Wednesday
Ward rounds was nothing special. Halfway through we were whisked away to Rheumatology Clinic. Basically we sat in and observed while the doctors saw patients coming in for consultations. Most of the time it wasn’t too exciting but at least Rheumatology could have very visual signs. So when you’re lucky, you’d see some hand deformities, and even rashes or plaques on the skin.
In the afternoon, we had a tutorial on fever and shock. Very important critical care stuff!
Then the very funny thing that happened was my teammates went to examine a patient with some neurological condition affecting the eyes (I wasn’t there but they came back and told me about it). This became the trigger for an hour-long discussion with us trying to figure out where exactly the diplopia (seeing double) should be and why. I think it’s one of those times you launch into a prolonged intellectual discussion on a concept in med and end up with only a marginally better idea of what you’re talking about and the definitive answer still elusive.
Thursday
Ward rounds was the usual but we ended earlier today! So the super nice Reg gave us an impromptu tutorial. My friend presented the case he clerked yesterday and the Reg brought us through the case. His teaching is so good.
After lunch we rushed for another tutorial. This one was on headache (sounds simple and straightforward right? but actually quite complex and very important, of course). The doctor brought us through two cases and we really learnt a lot.
Then we sped off to Rheumatology Clinic. There wasn’t that much to see in my room today. But basically just observed and the Reg even called us over to his room to show us a few signs. Main takeaway: our Reg is amazing. Super thankful for him.
Friday
We started the day with routine ward rounds. At 10:45am, we headed off to a conference room for Grand Ward Rounds. This was a hybrid session so those who were at the hospital (including us) were gathered in the conference room, while the rest tuned in via Zoom. Our ward team presented three interesting cases (all on vasculitis). Most of it was too advanced for us to follow, plus I hadn’t really studied these conditions. Still, I tried to listen and was able to appreciate maybe less than half of what was discussed.
We kept the afternoon free, so I did some (very slow) studying, then headed home. Overall this week was pretty amazing mostly because of the amazing Reg. One day he told us “You have to have a good understanding of the whole of Internal Medicine to be able to appreciate Rheumatology.” Which couldn’t have been more accurate. We still have a long, long way to go…
An Example of Something You Might See in Rheumatology
For patients’ confidentiality, all details and identifiers are omitted. I’m unable to tell each patient’s story (though they’ll definitely be rich and meaningful). For more on my personal experience and struggles as a medical student, you can read about my Med School Life.