Doing the Little Things

“Where is all of the fun in internal medicine these days? When did examining specimens under a microscope and reading radiographs become boring?” Does this sound like a typical Professor Emeritus who has never ordered an invasive test? Instead, these are common themes I found during my tenure as a chief resident in internal medicine.

While rounding with a medical team this past year, an intern presented a patient with diarrhea, severe dehydration, and renal failure. Several specimens had been sent to the laboratory for evaluation the previous evening. When the attending asked whether the house officer had examined the urine for casts or the stool smear for fecal leukocytes, the reply was, “Are you kidding?”, implying that …