Anesthesiologists as Physicians

[Willamette]

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Since few people enter medical school thinking “I’m gonna be an anesthesiologist,” I was wondering how some of the attendings and residents deal with the fact that they aren’t involved in making diagnoses (in the traditional sense) anymore. I realize that the perioperative management of patients allows for some rather dramatic opportunities to treat acute problems (a big draw for me), but I can’t help but worry that I might find myself wanting to be involved in the “detective work” of making a diagnosis at some point. This is after all, the work that I (naively) thought that all doctors did when I applied to medical school.

Please don’t regard this question as bashing the specialty. I’ve recently “discovered” the field of anesthesiology, and think that it would be a career choice that would match really well with my talents and interests. But, since it’s an area of medicine that I hadn’t really considered before, I find it a bit uncomfortable that it doesn’t jive with my pre-conceived notions of what a “real doctor” does.

Thanks in advance for your consideration guys.

Willamette

 

[powermd]

Since few people enter medical school thinking “I’m gonna be an anesthesiologist,” I was wondering how some of the attendings and residents deal with the fact that they aren’t involved in making diagnoses (in the traditional sense) anymore. I realize that the perioperative management of patients allows for some rather dramatic opportunities to treat acute problems (a big draw for me), but I can’t help but worry that I might find myself wanting to be involved in the “detective work” of making a diagnosis at some point. This is after all, the work that I (naively) thought that all doctors did when I applied to medical school.

Please don’t regard this question as bashing the specialty. I’ve recently “discovered” the field of anesthesiology, and think that it would be a career choice that would match really well with my talents and interests. But, since it’s an area of medicine that I hadn’t really considered before, I find it a bit uncomfortable that it doesn’t jive with my pre-conceived notions of what a “real doctor” does.

Thanks in advance for your consideration guys.

Willamette

The really challenging "solve a riddle" type medical cases are few and far between. Most often, and I don't think I'm going too far out on a limb here, a patient's diagnosis is obvious from their history/presentation, and is easily confirmed by some secondary imaging or other test. Most of your time in IM is spent managing problems that already have a name. Have any of you seen that new show "House"? It's entertaining, but hilariously unrealistic. I laughed out loud when the doctor group (I don't know what level they were all at) started contemplating progressive multifocal leukencephalopathy as one of the first diagnostic choices in 16-year old with night terrors and a leg that twitched once.

Most of medicine is "managing" disease. I personally have decided it would be more exciting to spend my time managing acute problems that develop in the OR and can be fixed, than the annoying chronic problems that typical IM patients have that no one can fix.

 

[skypilot]

Sounds like the difference between being a "Physician" such as an internal medicine doc and a "Surgeon" (or anesthesiologist).

Do you want the intellectual excercise of internal medicine or the technical competence of being part of the surgical team? 🙂

 

[Tenesma]

physicians have multiple roles..... and not all of them are diagnostic...

Interventional Radiology places drains - they don't diagnose much
Cardiac Surgeons replace valves - they don't diagnose valvular defects...

the more procedural based specialties do less diagnosing and do more procedures - that is the name of the game.

Now, in anesthesia, there aren't many disease entities that are our purview (outside of malignant hyperthermia - which is ridiculously rare). However, in critical situations there is a lot of detective work, except you don't have the luxury of an IM person where you can open up the index page of Harrison's - instead you need to figure something out quick and try to fix it. Examples include unexpected cardiovascular collapse, etc...

 

[oldandtired]

Most radiologists read films which is very cerebral. They also do procedures- biopsies, drainages, lines, angiograms, etc. The heavy duty stuff is saved for the IR guys.

And for you medical students, since this seems very important to you, there can be plenty of patient contact if you want it.

 

[Tenesma]

oldandtired... don't take it personally, Rads does a lot of diagnosing (ie: pattern-recognition) on a regular basis and is a great field. My point was that there are some specialties within medicine where you can still be a physician without having to come up with a 3 page H&P for every patient 🙂

 

[Willamette]

Thanks for the replies everyone! I think that the important thing for someone like me to remember is that the IDEA of what a specialty would be like needs to be tempered by what the specialty IS like. Thus, the importance of rotating through the different fields.

What has surprised me most is the disparity between what I THOUGHT I would like, and what I ENDED UP liking.


Willamette

 

[codequeen]

The main reason I chose to pursue an anesthesiology residency was during my two electives in anesthesiology and Surgical critical care. What I was most impressed by was the fact that the anesthesiologist and the anesthesiologist -intensivist "did it all" they were highly involved in the preoperative preparation and "clearance" of the patient for surgery and many times directed care of poorly controlled medical problems They managed chronic medical conditions intraopertively as well as postoperatively. The Anesthesiologists-Intensivists that I worked with were the bomb. They knew a lot of internal medicine, a lot of surgery, basically a lot about a lot of differenct specialities as well as do cool procedures and were truly detectives in every sense of the word .

what a great field! 😍

 

[wangstar]

Since few people enter medical school thinking “I’m gonna be an anesthesiologist,” I was wondering how some of the attendings and residents deal with the fact that they aren’t involved in making diagnoses (in the traditional sense) anymore. I realize that the perioperative management of patients allows for some rather dramatic opportunities to treat acute problems (a big draw for me), but I can’t help but worry that I might find myself wanting to be involved in the “detective work” of making a diagnosis at some point. This is after all, the work that I (naively) thought that all doctors did when I applied to medical school.

Anesthesiologists are constantly making diagnosese and treatment decisions on a small time scale for basically all organ systems with many many problems that exist before or develop during an anesthetic- just think about it, shock, anemia, coagulopathies, ischemia, resp failure, and the list goes on an on. Sometimes these problems become crisis and you have to figure out and treat them instantaneously. Its awesome. I think many who want a little more medicine do a fellowship in CC or Pain or something but I think they find that there is plenty of medicine in the OR. I think you might find that the notion of IM doc being a detective is a little idealized and that a lot of ward medicine is actually social work type of stuff that isn't that fun to deal with.

 

[manixter]

Since few people enter medical school thinking “I’m gonna be an anesthesiologist,” I was wondering how some of the attendings and residents deal with the fact that they aren’t involved in making diagnoses (in the traditional sense) anymore. I realize that the perioperative management of patients allows for some rather dramatic opportunities to treat acute problems (a big draw for me), but I can’t help but worry that I might find myself wanting to be involved in the “detective work” of making a diagnosis at some point. This is after all, the work that I (naively) thought that all doctors did when I applied to medical school.

Please don’t regard this question as bashing the specialty. I’ve recently “discovered” the field of anesthesiology, and think that it would be a career choice that would match really well with my talents and interests. But, since it’s an area of medicine that I hadn’t really considered before, I find it a bit uncomfortable that it doesn’t jive with my pre-conceived notions of what a “real doctor” does.

Thanks in advance for your consideration guys.

Willamette

I'd say that anesthesiologists are definately "real" physicians. We diagnose (airway mishap, circulatory arrest), treat (intubation, pressors), constantly reevaluate. We have to deal with every medical condition known to man, both acute (pregnancy, sepsis, massive trauma) and chronic (multiple sclerosis, extremes of age and weight, congenital malformations). And all in real time. No looking up Ovid for articles-- we have to know now:
why is the patient waking up?
why isn't the patient waking up?
why is the BP low?
why is the BP high?
why isn't the patient coming off bypass? What do I need to do?

It's all about physiology, pharmacology, and rescusitation. CCM compressed into hours and minutes. And our best reward is when the patient comes back and can't remember anything that we did.
--mir

 

[Willamette]

The fantastic replies keep rolling in! It's nice to know that there's a place for someone who loves physio and pharm, likes paying attention to detail, and forsees being happiest when dealing with acute issues while focusing on a single patient at-a-time.


Willamette

 

[doc05]

what powermd said.