Monthly Archives: April 2026

Goodbye Medicine Wards

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If a person is admitted to the hospital for any reason other than surgery (or illness requiring critical care) then they likely end up on a medicine hospital ward. General medicine wards are run by internal medicine physicians. Since internal medicine is my residency path, I’ve spent close to 50% of my time in residency on general medicine wards.

Recently, I finished my last shift on the medicine wards…possibly forever. As a primary care physician, I won’t work in the hospital. There are things I’ll miss about inpatient medicine – like the fast pace and the medical surprises. But, mostly, I’m glad to be done.

On the medicine wards I enjoyed investigating acute illnesses and how to help people feel better. I liked the pressure of trying to solve medical problems and overcome challenges efficiently. I enjoyed the variety of pathology. On the wards I’ve seen my share of rare and unusual cases. Moreover, after years on the wards, I’m comfortable managing the common medical conditions that bring patients to the hospital from infections to heart failure exacerbations and abdominal pain to new confusion. Being comfortable makes me confident that it’s time for the next phase of my career.

The art of preventing medical conditions in the first place (preventative medicine) and managing conditions before they require hospitalization is different than the art of treating acute illness requiring hospitalization. I look forward to shifting to 100% preventative medicine and management of chronic health challenges. I can’t wait to get to know my patients over years in my clinic rather than only briefly during a terrible time of their life (like when they’re admitted to the hospital).

I felt a pang of sadness as the medicine ward doors closed behind me after my last shift there. But the sadness was brief. Hospitals will be there if my career takes an unexpected turn and takes me back inpatient. Until then, I’m thrilled for clinic life.

Goodbye medicine wards – to the excitement and the headache. To the physicians who remain on the medicine wards, I know you’ll take good care of my patients when they’re admitted. Please send them back to me in clinic without too many changes to their outpatient blood pressure medications. Leave the chronic medication tinkering to me.

Spring Ponderings

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Springtime has arrived in Richmond with flowers galore and the tiniest of new leaves already on the trees. Warm weather and the sunshine return to Virginia sooner than Vermont, which is one reason I moved here. While the earth is waking up – the birds singing and soaring and the pollen exploding – I find myself taking a breath of relief.

Even in Virginia the winters are gray. This year we had a period of fierce snow and ice for the first time since I moved south. I’m excited to see the osprey on the James River again. They’ll stay for the summer. Their chicks will be visible soon in their nests; they look like little dragons until they grow true feathers. I never thought I’d live in a city that had osprey screaming overhead, but I’m happy I do. I also look forward to scouting for native passion fruit and pawpaws this summer. And, of course, looking for bats overhead at dusk in the downtown park. There’s something joyful about nature finding a way to thrive in the heart of a city.

I embrace spring cleaning. The literal interpretation – organizing the house, rearranging the plants, reviewing my wardrobe. And the metaphorical one – brushing away the cobwebs that settled around my innovation and motivation when sunshine was scarce. This is a more exciting spring than usual. April 1st marked 90 days left of residency. This spring I’m reflecting on what I’ve done these past 3 years of residency and what needs to change once I graduate.

Becoming a doctor is a sacrifice. It takes years of dedication, intentional work, and intense focus. I’ve found that the most challenging part about the journey through medical school and residency is that the process limits one’s freedom. Freedom to choose one’s schedule. Freedom to choose one’s location of work. Freedom to decide how to spend one’s day. Freedom to have energy and time to do other things.

This spring I’m preparing for my next step in the doctorhood quest – passing my board exams and starting to work independently. I’m also taking time to look at the other parts of my life. It’s time to remember my hobbies – the ones that have been sitting dormant for years as there was no time to pursue them. My other goals like personal health, social activities, and world improvement that have all atrophied during residency. This spring isn’t just when the earth rejuvenates, it’s the spring I rejuvenate too.