Saturday, February 9, 2013

Top Ten: Bringing Sexy Back (to Internal Medicine.)

 I'm bringing sexy back (Yup!)
Those high-paid specialists don't know how to act
We think it's special what you think we lack
so come to us 'cause we pick up the slack
(Take 'em to the clinic!)

I.M., baaaaabe
You see this penlight? I illuminaaaate
Start you on insulin if you misbehaaaave
It's just that no one cares for you this way. . .
(Take 'em to the clinic!)

Come here, students
(Go 'head do Medicine)
Come to the wards
(Go 'head do Medicine)
(Go 'head do Medicine)
Loan repayment's on me
(Go 'head do Medicine)
Med students who ya workin' with
(Go 'head do Medicine)
 Teach 'em right quick
(Go 'head do Medicine)
See ya' patients smile
(Go 'head do Medicine)
Come here, chile! 

Get your sexy up!
Get your sexy uuuuuupp!

Confession: Medicine is not perceived as sexy. As much as I hate to admit it--grrrrrr---it simply is not.

Hold up. I need to clarify a couple of things. When I say "medicine" I don't mean the entire field of medicine. I mean my chosen specialty within medicine--specifically Internal Medicine. See? Just saying it sounds 'B' list and unsexy, doesn't it?

Sigh. I know.

But see, it used to be sexy, man. Like back in the day with Marcus Welby (who technically saw kids and randomly operated on folks, too, but ignore that for my point) the internists used to have SWAG. And our specialty? Man. It was . . .well. . .sexy. 

Oh. The other thing I need to explain further is my use of the word "sexy." I don't mean it in the literal sense. Like, not the high-heeled stilettos and Daisy Duke shorts kind of sexy. And not the SuperBowl Calvin Klein underwear commercial "Lawdy-Lawdy-Miss-Claudie!" kind of way either.

'Cause. . . that? Just. . . whew.

No, people. I'm talking about "sexy" in the form of being . . .you know. . . chic, coveted, and on the it-list. When it comes to choosing specialties of choice as a third year in medical school, THIS is why Internal Medicine (and all primary care specialties) sometimes struggle to woo our students.

Yup. Lack of sexy.


This is where I come in. And not just me. Me and several of my fellow Internal Medicine nerds. Buckle your seat belts, people. . . because we are determined to BRING THE SEXY BACK to Internal Medicine.  Yay-yuuuuuhhhhh!!!!

*coughing spasm*

Okay. At least I am. 

Sure. Internists don't make as much as plastic surgeons, ophthalmologists, orthopods, or dermatologists. And no, we don't have the same cute neck ties and stickers as our pediatrician colleagues or syringes in our back pockets like the anesthesiologists. There isn't the excitement of jackknives through foreheads that our emergency physician pals tackle nor do we get to be the first introduced to slimy, amniotic fluid-covered babies like our friends the obstetrician/gynecologists.

Nope. But! We're still sexy, man. For real. Zoolander sexy, even. And if you don't believe me, then clearly--CLEARLY--you need to be made privy to:


Like to hear it? Here it go!

#10   --   We can actually help somebody when someone yells out, "IS THERE A DOCTOR IN THE ROOM!?"

Adam of SG Alpha -- IM second year at Wash U. in STL.

Maaaaan. I was a resident in Cleveland, right? So check it -- true story, I promise. Me and a fellow resident were rolling down Shaker Boulevard and we see this dude laying on the sidewalk on a side street. Two cars had pulled over and a lady was on the side basically freaking out and that's it. So we pull over to see if we could be of assistance. I mean, seeing as we were resident INTERNISTS and all.

Ah hem.

So we walk up on dude with our 'scopes around our necks. ('Cause that's how real INTERNISTS get down.) But just as we do, this fifty-something-looking dude walks up and trumps us like he was Trapper John, MD.

"Please back up. I'm a doctor!" he bellows all loud and authoritative-like.

So, you know, we back up. I mean, seeing as Trapper John was all flexin' on us and everything. So THEN Trapper -- I kids you not -- puts the dorsal side of his hand to the dude's forehead. Like a pulse could be found there. His semiconscious FOREHEAD. I ain't lyin'.

So me and my friend, we give Trapper a totally hairy eyeball at this point and prepare to move in on him and see what was up with this man. My friend looks over at the freaking-out lady and says, "Ma'am, do you know this gentleman?"

And the freaking-out lady is all freaking out so it was kinda hard to understand her, but she did say she knew the dude. So my buddy asks a few more questions while I give the man a sternal (breastbone) rub to see he could be aroused. And while all of this is going on, Trapper John is kneeling over the man with his brow all furrowed and two fingers tapping his lips.

"I'm a physician," he repeated to us, "and I need you kids to call 911 and give a bit of space."

And I was all like -- Hold up. Did he just try to play us?

But by this time, my buddy had determined that the man was a diabetic and had gone for a run earlier without eating much. He'd also taken his insulin a few moments earlier. So instead of completely going off on the brow-checking PHYSICIAN for trying to PLAY us, we give this diabetic dude some candy to stick in his cheek and instructed the freaking-out lady to give the man some juice. And up he pops like that lady who passed out on Pulp Fiction after John Travolta hit her with the epinephrine.

Okay. Maybe not exactly like that, but just imagine it for the story, okay?

So, all was well that ended well. Dude woke all the way up and acknowledged that he should have eaten before he took a trillion units of insulin. And Trapper John, the PHYSICIAN turned out to be a local dermatologist. And while I am certainly NOT hating on dermatologists, I'm just saying that his checking for tactile temperature like Dr. Quinn, Medicine Woman was uuhhhh. . . .not even the move.

So I'm just saying. Internists save people. Sexy, right?

Adam would have TOTALLY known what to do.

#9   --  We get to talk about everything.

The liver. The heart. The lungs. The skin. The lady parts and the man parts. The all of it. Nothing is off limits, man. But just when the skin gets really, really gross, we call Trapper-dude for a consult. And hallelujah, we get to do the same for similar things related to the nether regions. (See Urology and Ob/Gyn for nether region specialties.)


#8  --   We get cool stuff not just on holidays, but on random Tuesdays, too.

Image from here.

Maaaan. Folks are mad grateful when you reduce their cardiovascular risk factors. For real, man, they are. I have had my fair share of delicious baked goods and even received a birthday card with my actual date of birth preprinted on it that a patient purchased for me because she remembered from the year before. Bet you nobody ever made YOU a super fancy cake like the one pictured above and gave it to you on a random Thursday, have they?

Mmmm hmmm. I didn't THINK so.

Okay. Me neither seeing as I found that image on a Google search. But that's besides the point. The point is that the ones I DO get are homemade and delicious. And sometimes even homie-made, but delicious nonetheless. Mmm hmmm. See? That's the kind of effect you have when you're in INTERNAL MEDICINE, people. YAY-YUUH!

*hand splayed in your face*

And don't EVEN start telling me about how you're an anesthesiologist or some other SWANKY HIGHER INCOME SPECIALTY and somebody did this for you (MARIA, FELLOW MEHARRIAN) because clearly the person who did so was high and delirious from your gas machine. Or just happy as hell because they got an epidural. (Yeah. I said it.) See, us internists? We get real love that isn't under the influence of opiates or benzodiazepines.

So, I'm just saying. THAT perk makes up slightly for the pay differential.


#7  -- We don't have to spend five hours scrubbing in to do our job.

Here's Atul Gawande, the awesome neck surgeon and writer, scrubbing into surgery. And see? If he was an INTERNIST, he could be somewhere holding his patient's hand instead of a scrub brush.

See? Yet ANOTHER perk of the illustriously sexy field of INTERNAL MEDICINE.

(And yes. I think Gawande freakin' rocks. But I am slightly annoyed with him for not choosing to be an internist.)

#6  -- We don't really have to study too hard for USMLE Step 3. 

Alanna of SG Alpha, IM resident at UCSF

For the non-medical peeps, there are three rites of standardized test-taking passage for medical students and residents. The United States Medical Licensure Examination (USMLE) has three "steps" that you take before you can get licensed to ill practice. Step 1 is taken after your preclinical studies are completed. Step 2 is taken somewhere between your third and final year. Once you start your residency in a chosen field, you still have to clear the Step 3 hurdle -- one last test focusing on general clinical knowledge.

All of the uber-specialized peeps get all freaked out over Step 3 but not us nerdy internists! Bwaaah haa haaaaa! We are ALL OVER that sucker. Give us your broadest differential diagnoses from syphilis to wet beri-beri and we will DESTROY it all while the rest put the back of their hand on somebody's nearly unconscious forehead.

*Drops the mike and walks away.*

#5  --  We actually know the answers to the questions people ask us at family gatherings.*


Now that I think of it, this may or may not be an advantage. Nor does this do much to help the cause of bringing the sexy back to Internal Medicine.

*This may also include but is not limited to: 

Your father calling you from the golf course to talk to the man standing next to the man next to him at the driving range, your fifth cousin twice removed asking you whether or not his "nature not working" has anything to do with him not being circumcised, or the lady next door to the lady around the corner from you texting you a photograph of her grandson's nanny because "it look to her like the shingles but she ain't sure." 

On second thought, ignore that one.

#4  -- Our white coats are the whitest ones. 

Even when we're standing outside.

You know. 'Cause we're just all Marcus Welby like that. (I'm just saying.)

#3  --  We don't have to worry about being portrayed as dreamy or steamy on television.

(Just a surly, drug-abusing genius. )

Sexy, right?

#2 --  The medical students LOVE us (even if they usually aren't convinced they want to BE us.)

Now this part I'm not saying tongue-in-cheek. Us INTERNAL MEDICINE people? Maaan, we do a lot of teaching when it comes to medical students. Sure do.

No one will argue with me when I say that the Internal Medicine clerkship is considered the bread and butter of clinical training in medical school. Hands down. It's where students become real doctors and where the preclinical pieces get put together and applied. And my fellow I.M. nerds get racks-on-racks-on-racks of teaching awards.

Wendy A. with her racks-on-racks-on-racks

 It's also a very necessary part of every other specialty. The very best surgeons, dermatologists, radiologists, anesthesiologists and neurologists have a solid knowledge of internal medicine that they apply to their patients. At least the very best ones do.

So what does that mean? As teaching internists, we have a very, very important job. Our learners take a piece of us and our field into everything they do. No matter what they do. I see that as a tremendous honor and a huge responsibility.

CdR, one of my favorite medicine nerds, in action.

Sure. Someone might find it self important to say all that but that I say, "Meh. It's my blog."

Ha ha. Seriously, though. I say that because it's true. Sure is.

We also get to build some amazing relationships with our patients. And I acknowledge that my colleagues in other fields get to do this, too. But there is something unique about educating patients about the most basic aspects of their health and focusing on the very things that are most likely to either take their lives or disable them. This is what we do. All day, e'ry day.

And that makes us happy. And happy is sexy, man.

#1  --  It's a labor of LOVE.

Let's be real. Medical school is expensive. Students go into a lot of debt to become doctors and sometimes--not all the time--how much future earning potential they have gets factored into them choosing a specialty.


We can't compete with incomes that are quadruple ours. Nope. But can I just say that "a lot of money" is rather relative? Can I also say that six figures is a lot of freakin' money no matter WHO you are and that most internists absolutely make that and more? Can I also say what we get in the intangible rewards is really substantial? Like really substantial. Can I say all that?

Good. Because all of that is true.

The other thing is that we are needed now more than ever. In the U.S., we know that recent legislation will open the floodgates for many people who previously couldn't get primary care. And our population is living longer, too. So now more than ever, our patients need good internists.

But see, it has to be a labor of love. Because internists often end up taking some things for the team. And, no--that part isn't always sexy but I have to say it because it's true. But the rewards? Man. They far outweigh the lumps we take. And the impact we have? On countless levels? The best.

Sure. We can be a bit nerdy at times. Sure. We sometimes sit and think about the potential explanations for one abnormal lab result or clinical finding for hours -- but you know? Somebody is better for it.

So repeat after me: "INTERNAL MEDICINE IS SEXY."

Then, look in you mirror like Derek Zoolander and say it again. But this time with a smize -- and an even sexier voice, baby. Kind of like Austin Powers.

So what if we're a little bit country. We're also a little bit rock 'n' roll, too.

Do not--I REPEAT--do not count us out because you don't think of our field as "sexy." Instead, join my crusade and stop fighting the magnetic pull you know you feel deep down in your soul to get on the Internal Medicine bandwagon. Help me help YOU. Help ME help the WORLD.

*starts pumping fist*

Together we can BRING SEXY BACK to Internal Medicine and Primary Care specialties!! You with me?! Come on! GET YOUR SEXY BACK!!!! 

Yaaaaasss!!! The doors of the church specialty are now open!!

with Pulak P. -- F.P. extraordinaire

Disclaimer: A lot of this does apply to both Pediatrics and Family Medicine. And to some other specialties, too. And yes, I am also both trained and board certified in Pediatrics and DO fully believe in Medicine/Pediatrics combined training (like I did.) HOWEVER--this post is designed specifically to BRING THE SEXY BACK to INTERNAL MEDICINE. So don't EVEN start going off in the comments about how your cousin is a dermatologist and he saved somebody's life on an airplane and didn't just put his hand on somebody's unconscious brow. Because THAT does not help my cause. AND it does not take away from the fact that on a cold night in Cleveland, Ohio back in the late 90's, another non-internist was clueless.

Mmmm hmmm.

And that? Was so not sexy, dude. So not.

Sigh. I crack myself up sometimes.

Happy Saturday.

Future internists sign here:  X____________________________________

(And those who aren't med students but who would do Internal Medicine if they were? Y'all can sign, too.)

And lastly, a picture of my med school classmate, BFF, and fellow internist, Lisa D. to show you that we I.M. people are bringing sexy and the SWAG back to the specialty on the weekends, too. Yeah, baby!

Of course this has been playing on the mental iPod the entire time. . . . . Go 'head, girl! Get ya' sexy up!


  1. Well, I read every single word and wished you'd been writing about pediatric epileptologists. Sigh.

    I think you're sexy no matter what you do, anyway!

    1. I actually know a really sexy pediatric epileptologist. And I mean sexy in the cool way not the creepy way. He's teaching medical students and residents, so trust me, the future is brighter than you realize. :)

  2. Internal Medicine is absolutely the basis for any good physician-no matter what the specialty-you are 999 percent right about this! Yes! I say to this day, that because of my intern year on a brutal medicine service, there is very little, clinically speaking, that can scare me. Truth.

    However, my white coat was a disaster covered in yucky hospital " stuff" , that somehow never stayed white: all three of my issued coats ended up stuffed in my trunk somewhere. Heh.

    I only wish that people knew my name(well, sometimes)...if someone calls out " Anesthesia" , I am totally conditioned to look up in acknowledgment.

    You freakin rock!

    Maria, fellow Meharrian

    1. Ha ha ha. . . you're one of my favorite Anesthesia peeps. It's all love!

      YOU freakin' rock. You and your goodies.

  3. As if you had to even write this blog, you are totally sexy, even in scrubs. My IM saved my life, so if saving lives is sexy, then he is the sexiest man alive. One of my favorite blog entries and that says a lot because I have many favorites.

  4. This NICU nurse in STL may take a wander across the street to look for your cutie IM resident friend! That's only....99% creepy, right? :)

    1. Only slightly creepy. Okay, I mean he has a girlfriend. But tell him you read my blog and that I said for you to hug him for me and he'll be very nice to you. And yes, he is even more adorable in person.

  5. As someone who is currently marathon-ing House, I totally vote for him being sexier than the other guys. Sure as hell doesn't hurt he's played by a British comedian who's all kinds of intelligent to boot!

    1. Hmmm. Sexy? Well, okay. I do like when Brits play Americans so I can be swayed.

  6. You had me at penlight!

    Sorry I've been MIA, it has been a rough little patch, but I promise I'll make a bigger effort to comment more regularly. Please keep on writing and bringing the sexy back to IM!!!

    1. Ha ha! I did? Yes! Always glad to hear from you whenever you can. Take care!

  7. #2 is absolutely true! not going into IM but it is oh so important, and my IM attendings have taught me SO much.

    1. That's 'cause we are GANGSTA.

      Okay. Not really, but we do love the kids.

  8. Absolutely LOVE this post! IM had my heart from the moment I started my clerkship, and while most of my classmates think I'm crazy, I know it's the right field for me. The notion of "love what you do and you'll never work a single day in your life" is basically how I approach IM. I can't wait to be a future Internist! :)

  9. One thing for sure...internests will be the last one standing when all is said and done!! and yes..they will be sexy because that is what love is! Happy Valentine Day!

    1. Same to you, Sheryl. Hope y'all have a wonderful Dia de San Valentin, tambien!

  10. Hi Dr. Manning- I aspire to be an internist one day, and I just want to say that all these vignettes and stories (especially this most recent posting) on your blog ALWAYS serve as encouragement, and are a window into the kind of service (and service-led life) that I would like to live! Thanks again for sharing your stories and insights with us! :-)

    1. Woot woot! Another Internist! Stand up and REPRESENT!!!

      Thanks for your super kind words. And, of course, for reading. :)

  11. I think the bottom line is this: what other subspeciality of medicine is known by the term "medicine" as in the Department of MEDICINE in the School of Medicine???

    That's when I concluded that IM docs are the real stuff. The rest? They're from other departments.

    Just thought I'd point out the obvious,

  12. Jack of all trades, but the "master" of none? Kinda scary, but I think either IM or FP would be a great fit for me!

  13. I laughed because you are high-larioussss!!!!

    I'm a programmer, but if I decide to make a career change and go into medicine, this post has convinced me that Internal Medicine would be the way to go! lol -Renee


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