Training on the wards

I could not agree more with Ken Flegel and Anita Palepu¹ that the primarily in-hospital education that house staff receive leaves them less than fully prepared for their future careers. However, this is not something new. I vividly recall my first day in internal medicine practice almost 20 years ago. I felt like I was on top of my game and, with complete confidence, I attended my in-hospital patients, treating acute myocardial infarctions, strokes, pneumonia — the whole gamut of acute care medicine. That afternoon, I returned to my brand new office. My very first patient walked in, sat down in my consulting room and told me his chief complaint. To this day I hope that he did not see the blank look on my face as I listened to his story, knowing full well that I had not a clue how to even begin addressing his concern, never mind trying to formulate a differential diagnosis. Certainly my 4 years of residency hadn't trained me for the complexity of his problem.

This patient's presenting symptom? Fatigue.

Ian Blumer Physician Ajax, Ont.