Ever wondered how a doctor spends his or her day? Well, it varies greatly, depending on the specialty of the doctor. It also depends on whether or not the practice is an academic one with students to teach, etc, or a more clinical, private practice setting. My practice is the latter, a 100% clinical infectious diseases (ID) practice. My days vary a bit depending on whether or not I have clinic. My preference is really seeing patients admitted to hospital but I also see patients in clinic on 2 half days per week.
Today, I will write about a typical clinic day, which is usually busier, with an earlier start. On clinic days I do not have time for morning exercise, or leisurely reading; well I suppose I could wake up earlier and make time, but it does not happen. The post is a bit on the long side, because I decided to chronicle a day from start to finish. Nevertheless, I think you will find it interesting. Students thinking of going into the medical field may find the post particularly intriguing. Here goes…
5:00am – snooze alarm
5:15am – get up, heat water for tea
5:20am – have cup of green tea, then some greek yogurt, while reviewing new labs results and notes on my patients, since I saw them yesterday
6:00am – share my newest blog post on social media
6:15am – check email
6:45am – prepare breakfast, lunch, and afternoon snack to take to work
7:15am – get ready for work
8:00am – receive text from clinical pharmacist: “what time are you going to round in ICU”
– my reply: “In about 20 mins”
8:15am – leave for work
8:25am – arrive at work
First stop is ICU. On my way past the waiting room, I see the daughter of a very sick patient. She was admitted a week ago with abdominal pain and found to have appendicitis AND cholecystitis (infected gall bladder). They were both removed but she got sick a few days after surgery and was found to have a severe infection in her abdomen. Yesterday she was taken back to the operating room and there was stool in her abdominal cavity because a part of the bowel where the appendix was removed, got starved for blood and ruptured. The infection was now so far gone that today, she was not responding to her surroundings, and her kidneys were shutting down.
Her daughter approaches me on my way to the ICU and asks if the nurses told me what was going on. So I tell her I reviewed her chart and saw what was happening, that she appeared to be very sick right now. She told me what some of the other doctors did and I told her what I thought I would do today but that it may change depending on what I saw when I actually went to examine her.
8:30am – a call comes in from another hospital. I start to answer it but at the same time I am walking into the ICU and the clinical pharmacist and the nurse for the same sick patient happen to be just on the inside of the door. I go straight into the patient’s room and she is really sick, 5mls of urine output since yesterday (normal is at least 700mls in a 24 hour period), blood pressure very low, she is completely unresponsive. After examining her, I tell the pharmacist the changes I am making in the antibiotics, then head over to the other side of the ICU where cardiac surgery patients recover.
In the cardiac surgery recovery unit was a middle aged woman with heart disease, kidney disease, diabetes, etc, who had valve replacement surgery a few days ago. I was seeing her for pneumonia that she picked up since coming into hospital about 3 weeks ago. She was doing a bit better overall.
Then I head upstairs to see my other 3 patients in that hospital before I go to clinic.
One was a 30 something year old woman who had a heart valve replaced. Her own valve got badly damaged after an infection related to her past habit of injection drug use. She was doing well since her surgery the week before.
8:45am – my nurse texts me from clinic to say “first one is ready”
I go to see an elderly woman who was admitted the day before with a badly infected heel. She has had an ulcer on that heel for over 3 years and I have treated her in the past with a prolonged course of antibiotics for bone infection. She’s been good for over a year and a half but it recently started draining a lot of pus so the surgeon admitted her. I checked on her to make sure she was tolerating the antibiotic we prescribed her (she is very sensitive to antibiotics). The heel was still draining a lot.
Lastly, I moved on to see a middle aged man admitted 2 days earlier with a large abscess in his liver. Yesterday, when I went to his room he was having fever and shivering a lot, but today he was looking better.
8:54am – I go behind the nurses station, log onto the electronic medical record. I call the surgeon of the very ill ICU patient to discuss the case and the changes I planned to make. My nurse sends another text “first 2”. I review records again and type 5 progress notes.
9:15am – I head over to clinic; on the way I text my nurse “OK. Which ones?” She texts back with a “heads up” about what’s in store for me.
9:20am – I get to clinic, log onto another electronic record, review the notes from the patients’ last visits
9:30am – I start seeing patients. First is a woman with HIV disease. She’s been doing very well though, with undetectable HIV viral load in her blood. We discuss what’s been going on in her life (one of her siblings died a few weeks earlier, and the man who gave her HIV died few days earlier). I examine her and she is in pretty good health, we go over her labs and everything looks good. I wish her all the best until I see her in 4 mths again.
The next patient is a young man who also has HIV infection. He is doing great. Last visit 4 mths ago I noticed he gained 10 lbs, so this time I congratulated him on loosing 3 lbs. We discussed what was going on with him, he was hoping to get his dream job so there was the possibility of him moving away but he would still be coming back to us for care. I wished him all the best until I saw him again in 6 months, and told him I would be paying attention to his weight and also his cholesterol levels at the next visit, as they were still high today.
The third clinic patient of the day is a 60 something year old woman who was diagnosed with an infection in her lower spine. We’d been treating her with a combination of 2 antibiotics for the past 4 weeks. We sent her for a biopsy of the area at the start of treatment but unfortunately the culture was negative so we had to give broad antibiotic treatment to cover the possible culprit bacteria. Her back was still hurting her but she admitted it was better than before we started treating her.
The fourth patient was a 40 something woman with HIV who I’ve been treating for over 2 years. In the beginning she was so depressed, was always crying, but now she is doing so well, HIV viral load undetectable. Her job was going great. Last visit she had lost 10lbs, and I congratulated her on keeping it off. We spoke about diet and lifestyle modification for optimal health.
The fifth patient also had HIV (I guess this was an HIV day) and was doing well. We reviewed his labs. Last visit he told me that he was still having nightmares as a side effect of the HIV drug he had been taking for many years. I decided to switch him to a new drug unlikely to have significant side effects.
The last patient was a no show; he was someone I treated for an infected toe a few mths ago.
11:00am – I started typing the 5 clinic notes; then I reviewed lab results in my queue.
11:45am – I heat my lunch, but since it’s so early, I decide to go home and have lunch
11:55am – I arrive at home, have lunch, check email
1:05pm – I head back to the hospital
1:15pm – I go to the rehabilitation facility across the street to see a 50 something year old woman there for physical therapy, having recently had surgery on her knee to clean out a severe staph (Staphylococcus) infection, MRSA to be exact. The infection was so severe, the bacteria got into her bloodstream as well. She was on an antibiotic that can damage the kidneys so I went to make sure everything was still normal. She was doing ok.
1:22pm – type note for rehab patient
1:25pm – head 2 floors down in the same building, to one of the long term acute care hospitals (LTACH). I have 2 patients there but 1 is rock solid stable so I leave her for tomorrow, and instead see a 90 something woman with multiple bedsores, including a large on over one of her hips, all the way to the bone. She seems to be in a good mood today – said a few words, though mostly unintelligible speech as she has severe dementia. (On her bad days she is quite combative.) I review her labs and dictate her note (no electronic medical record here, so much less time wasted!).
1:30pm – I head to another hospital across the street (all the medical institutions in this town are a couple blocks apart, walking distance really, but I drive).
1:35pm – I head to the ICU to see a patient there who I treated last month for MRSA infection involving multiple areas along his spine. His blood also had MRSA. Because at that time he could not walk, we had sent him to a university medical center for neurosurgical intervention but they said he was not a surgical candidate and sent him to yet another facility for 6-8 weeks of intravenous antibiotics. He was there for less than a week. He was getting blood thinners because of a clot in his heart. Yesterday, they found that his blood count dropped dangerously low. When they did a CT scan because he complained of a left sided pain, they found a massive amount of bleeding into the area behind his left kidney. For this reason he was sent to our hospital for intensive care. Because he was still undergoing treatment for the MRSA infection, they called me to help with his care. He did not look terribly ill, but he was a bit confused; his abdomen was very swollen and tense on the side of the bleeding. I made sure his antibiotic dosing was correct especially given that his kidneys were not working very well at the moment.
1:50pm – head to the ground floor of that building where there is another LTACH. There, I have 10 patients to see. Most of them have multiple medical problems, are not very ambulant, and have infected wounds. A few are on the ventilator because they are so weakened, they cannot breath on their own. Some have been on the ventilator so long, they get pneumonia. I go to their rooms one by one, examine them, make sure the nurses have no new issues with them.
2:35pm – I go to the computer to start typing these notes. As soon as I sit down, I get a text from my nurse telling me of another new consult for me to assist with antibiotic treatment.
I decide to type all the notes for the 10 patients I’ve just seen and go to see the last new consult afterwards. I am usually quick with typing my notes (fortunately, I went to typing school as a child) however the electronic medical record system was so painfully slow today it was taking twice as long to complete the notes. I was also trying to hurry because some bad weather was moving in.
4:25pm – I finally finish typing the notes and head over the the other side to see the last patient. On the way, I call a doctor who had tried to reach me earlier, to discuss a case.
4:30pm – I see the last LTACH patient. She is a sharp 80 something year old, but unfortunately she is bed bound from multiple sclerosis. She has several bed sores that got infected so I was asked to choose antibiotics for her, in light of the fact that she had several antibiotic allergies listed on her chart. She was not sure about the allergies. One wound over her tail bone, looked the worst. I adjusted her antibiotics, ordered some blood tests, and planned to check with her again tomorrow.
4:45pm – type note for last patient
4:55pm – head out to the parking lot. On the way out, I phoned another doctor to discuss a case. Then in the parking lot, I see one of the hospital doctors and we discuss a mutual case currently admitted.
5:00pm – I head home
5:13pm – I arrive at home, get out of my hospital clothes, bathe, etc.
5:40pm – relax a bit while my husband prepares dinner; check social media
6:00pm – eat dinner, relax some more
7:15pm – wash the dishes and tidy the kitchen
8:00pm – relax in living room with my husband, draft new blog post, drink cup of tea
10:05pm – prepare to go to bed
So there you have it…a day in the life of a clinical infectious disease doctor. The beauty of my specialty is that there is never a dull moment. Yes there is a lot of hassle with slow medical records, and pointless rules, etc. Sometimes patients die and that is usually a very sad moment. However, the human connection with patients, and seeing them strive to get better, gives so much joy. Nurses are also really great people to work with.
The field of infectious diseases is not as popular as it used to be, probably because it is one of the less lucrative specialties. However, if I had to choose all over again, I woulds still choose infectious diseases.