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Strange questions, please don't take offense

Discussion in 'Neurosurgery' started by cephalexinRX, 01.15.12.

  1. cephalexinRX

    cephalexinRX

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    This message is addressed particularly to resident/fellow/attending Neurosurgeons.

    I am not a medical student but a cytotechnologist (work with/for pathologists) hoping to start medical school in 2014 (at age 29, oh well)

    ------

    During my career I have been present at some procedures (aspirations, etc) in order to collect brain/spinal/etc material for "quick reads" and further diagnosis (Pap stains, immuno stains, etc).

    Not even in medical school, I admit I know virtually nothing about neurosurgery. As of now, I would do a residency in pathology. However, I am aware that when I hopefully get to medical school that may change. I am currently arranging shadowing sessions with physicians of multiple specialties as part of my preparation to apply to medical school. I was lucky enough to secure three days of shadowing at NS private practice group.

    I am particularly interested in pathology because of it's role "final diagnosis" under a microscope. I know there is no "end all and be all" of medicine, but in a way both pathology and neurosurgery seem close to it: the nervous system controls everything and pathologists make diagnoses that clinicians base their decisions on etc. As a pathologist, I could make diagnoses of multiple organ systems and essentially be a generalist and specialist at the same time.

    How do you feel about neurosurgery? Do you experience a balance of procedural and diagnostic work?

    The thing is, I like the idea of doing something in medicine that is as close to the "end all and be all of medicine" as possible. I hope that doesn't sound egotistical or anything....I don't mean it that way. I'm using quotation marks because this is so hard to explain.

    So, do you feel neurosurgery is pretty close to this "end all and be all of medicine" that I am trying hard to describe?

    I'm really sorry if this sounds strange.

    And...if you are going into neurosurgery...kudos to you:D
  2. powermd

    powermd Lifetime Donor

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    Not a surgeon, but I was browsing the forum and thought I'd comment.

    Your attitude is very typical of pre-meds and early year med students. What seems appealing and makes sense to you now will likely change with exposure to medicine. Personality seems to play a huge role, and it's usually apparent from the outside looking in where people will and won't fit. Pathologists are usually very smart, but also somewhat strange, weird people. They almost invariably would seem like misfits in specialties with live patient contact. Neurosurgeons are usually also very smart, have amazing academic credentials, and have unusual drive and energy. That makes sense, since most people will not tolerate the insane hours and sheer length of training.

    Your values may change substantially as well, if for no other reason than you will age 7-12 years by the time you finish training.

    I came into med school interested in surgery. I liked the acuity, thinking on your feet, working with one's hands. Then I learned all this cool medicine stuff, and thought "wow, wouldn't it suck if I never really got to use any of this?" So I started broadening my view. One month getting up at 4:30 am to work with a bunch of a-hole surgery residents at a crappy hospital sealed the deal on picking an alternate field. No way would I tolerate 5 years of anything close to that. Maybe I would have felt different if I had done my surgery clerkship at a good program. I started thinking about anesthesiology because I really did like the OR and critical care, but hated rounding, call, and the whole getting up before 5 am thing. I also like to scratch my nose from time to time. I did clerkships at a few good programs and that was it for me. I also noticed my personality clicked well with the anesthesia residents I met. Basically they were smart, but relaxed guys who enjoy a stressful moment or two, but otherwise like to have a good time. Most had interests outside medicine- they were well rounded people.

    Fast forward a few years into training. I liked anesthesia, but I couldn't see myself babysitting lap choles into my 40s and 50s. Supervising CRNAs was also of limited appeal. I also felt like I had much more to offer my patients than just anesthesia and critical care skills, and wanted the opportunity to work outside the OR. So I did a fellowship in pain medicine. Now I'm happy as a clam. I do almost 100% outpatient work in a comfy clinic. I've learned musculoskeletal diagnostic skills that I never used as an anesthesiologist, and also the various kinds of injection blocks to confirm or refute my diagnostic suspicions while also treating the patient. There are no imminent life and death issues to contend with, which greatly improves my stress levels. I have time for family and taking care of myself. The biggest downside to the specialty is having to deal with drug seeking opioid patients who will never ever get better. I solved that by joining a non-narcotic practice. There was definitely a time in my life when I would have said "f it, I want to be a surgeon more than anything." I'm so glad I had time to figure this out for myself.

    When I look at what I'm doing now, I kind of wish I could be an orthopedic surgeon, but as they are fond of saying in my state "ya can't get there from here". I never would have made that choice back in med school, so I'll just have to be content with where I'm at, which isn't bad at all!


  3. gooze

    gooze Removed

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    Why do you wish you were an orthopedic surgeon?? just curious...any other type of surgery you'd think about doing if you were able to go back and choose again?? thanks.
  4. powermd

    powermd Lifetime Donor

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    I wouldn't say I wish I ware an orthopedic surgeon, however there are days when I feel that would have been a great alternate career.

    Plastics would have been cool, but it's almost impossible to get in to. Ortho is appealing now since I spend so much time dealing with musculoskeletal problems. At times I envy the fact that these guys can throw up their hands and say "well, I fixed you, I have no idea why it still hurts!" When I see this patient I can only think to myself "well, an anxious/depressed/PTSD patient only vaguely meeting criteria for surgery probably shouldn't have been operated on in the first place." For political reasons, I keep those thoughts on the inside.

    Speaking of politics, ortho seems to have a good lobby and has an easier time with reimbursement cuts than we have in interventional pain. Insurance plans seem to have no problem telling us "that's experimental, we won't cover it", when there are surgical procedures no better supported in the literature that get covered simply because the surgeon says it should be.

    As a med student I was much more interested in physiology than anatomy, which is why ultimately I was drawn toward anesthesiology. Now, as a pain specialist, I see the benefits of being in a field where problems and solutions are more concrete.
  5. gooze

    gooze Removed

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    hey, thanks for the reply! just also wondering what your thoughts are on the field of urology...i'm trying to decide between ortho and urology but having a hard time as im getting a lot of conflicting advice...and it's hard cuz i think i'd prob. enjoy both. any thoughts/suggestions/advice?? thanks!
  6. powermd

    powermd Lifetime Donor

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    I'm sure some surgeons will chime in to help you here. From my perspective the urology residents where I trained (Columbia) were a little more cerebral (like ENT, but not so much as neurosurgery) than the orthos. The orthos very much fit the stereotypes- great guys, just a bit more aloof in a jock way.

    I think both fields have a great future, as both have an older bread and butter patient population- although ortho may have more young people thanks to sporting injuries. Young people who play sports are also very likely to be employed and have good health insurance. That may help bouy ortho incomes as Medicare continues to cut.

    In terms of the work itself, there are some stark differences here, so you'll have to judge for yourself. I'm not sure how call differs, but I would assume it's worse for ortho. I'd say more, but I'm out of my element here.
  7. rigid

    rigid

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    neurosurg: lots of patient contact, lots of bad outcomes, good outcomes can still leave patients worse for wear, technical skills involved, ridiculous work hours

    path: sit in room with microscope all day looking at slides and smears and what not.

    they aren't similar at all
  8. yappy

    yappy

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