Medicine

The "detective" department. IM focuses on complex, multi-system adult diseases. It requires master-level optimization of chronic conditions and systematic problem-solving.

The Daily Ritual: Pre-rounding is everything. Track the "Big 4" parameters every morning before the attending arrives: Vitals (specifically 24-hour trends), Ins/Outs (fluid balance), Labs, and Culture results.

The SOAP Note Framework:

Subjective: Overnight events, pain scale, compliance.

Objective: Vitals, physical exam (always note fluid status: JVD, edema, lung crackles).

Assessment/Plan: Organized by Problem List (e.g., #1 Acute Decompensated Heart Failure, #2 Chronic Kidney Disease, #3 Prophylaxis). Never organize an IM plan by body systems; always use active problems.

High-Yield Clinical Rule: In adult patients presenting with altered mental status, always rule out the "MIST" mnemonic first: Metabolic (hypoglycemia, uremia), Infection (UTI, pneumonia), Substances (toxins, withdrawal), Trauma/Vascular (stroke, subdural hematoma).