Dime a dozen question

[Dral]

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I'm a third year med student currently trying to figure out my life. I've liked all my rotations, but I realize some of them I like because of circumstances that are outside of 'the day in and day out stuff' one would do for the rest of their lives.

I've always had Path in the back of my head as something I'd be interested in, and unfortunately my school does not have a 3rd year rotation in Path. I plan on taking a pathology elective first thing my fourth year, but was hoping to get some insight into the field of Pathology.

As a disclaimer, I know I'm the only one that can make a decision and do not expect anyone to make my decisions for me, but was hoping I could get some input.

So as I said, I've liked all my rotations...and to be honest, I'm really good with patients. I do like working with patients, but honestly, the part of my day I like least is having to get up, go into the hospital and pre-round (not being a morning person does not help this). I was one of the 'cutters' in my anatomy lab group and I have considered surgery, and I have an interest in a few surgical fields, but I'm not sure if the lifestyle is what I want to dive into. (as an aside, I'm 30 something and have a PhD in molecular genetics). Also, I really do not like clinic, but oddly enough, I did enjoy surgery clinic because it was so focused and quick.

I've read through the sticky threads and they've given me a good amount of insight. I guess what I'd like to know is what is a typical week in the life of a Pathologist like?...especially from any of you that have patient contact. In regards to that, I know I'd be more interested in FNA's than heme/apheresis. I really do like procedures. I've thought about rads, but 2d pics would bore me...I know I'd rather deal with the real stuff. I also have an undergrad degree in art and am a very visual person. I also know I want procedures/patient contact to be a part of my career, but I don't need it to be the only thing I do, nor do I need it to be the main thing I do.

I did a lot of microscope work during my PhD research and I never got sick of running an experiment and getting to that moment when you slid that slide on the stage and turned on the scope to see the results.

Finally, I will not lie, money is something I'm concerned about. I'll be over $200,000 in debt coming out of school...however, I'm pleasently surprised to see how much Pathologists make/have the potential to make (Dermatopath for instance).

Ok, this is getting long at this point. So any insight or advice from anyone? I know that going through my 4th year electives will help (luckily I got all my 'interested in' fields stacked at the beginning of my 4th year)...but being more sure now would help me sleep a lot better at night, heheh.

TIA

 

[HbyHA]

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I've always had Path in the back of my head as something I'd be interested in, and unfortunately my school does not have a 3rd year rotation in Path. I plan on taking a pathology elective first thing my fourth year, but was hoping to get some insight into the field of Pathology.

TIA

I hope your 4th path elective is a LOT better than mine was. i came to med school wanting to do path (FP, specifically) and was still sent home at 11 am everyday. i wasn't allowed to touch anything. the highlight of the month is when one of the residents let me dictate the gross exam of some teeth. not kidding. thank goodness this experience did not discourage me from doing path.

and i know not all depts are like that b/c the rotation in my program is a million times better...

so here's hoping you get good exposure to what path is really like.

BTW, a typical week doesn't really exist. a typical week on Surg Path? cyto? CP? it will change depending on your rotation. and you HAVE to do heme (did you mean hemepath? blood bank)/apheresis if you are an AP/CP or CP only resident. and if you like procedures, what's not to love about dissecting a gross organ on surg path? or doing an autopsy (i just can't get enough of that evisceration!)

PS- patient contact is overrated. slides are much better behaved.

 

[Pathologic T]

I recently ditched a FP rotation because they changed the description greatly without notice which included 3 days sitting with a secretary? I would say, avoid FP in 4th year and stick to surg path and heme path. Pathology is something to experience....keep an open mind and get into an elective ASAP. Try to find any excuse to go to the path department....on surgery rotations etc. Good luck.

 

[sohsie]

Also, I really do not like clinic, but oddly enough, I did enjoy surgery clinic because it was so focused and quick.
TIA

Funny, surgery clinic was the only thing I liked about my surgery rotations, much for the reasons you stated. I liked the fact that I could actually offer a solution to some of the patients medical problems, not that I had any interest whatsoever in taking part of that solution. As it says in the House of God, "A chance to cut is a chance to cure"

 

[yaah]

Haha, I liked surgery clinic because it kept me out of the OR. Anything to keep me out of the OR.

 

[Dral]

I really like the atmosphere of the OR which is confusing me too. I absolutely enjoyed it when I had the chance to actually get involved with surgeries, even if it was just stitching someone back up.

I guess the main thing right now is the patient contact thing. I know it's so old to hear it around here probably, but I truly get fulfillment from knowing that patients appreciate what I do for them...like when they make comments about how they're glad I actually just paid attention enough to let someone know that they need a med change. Just tonight as I was leaving a patient room, I said "Ok, I'll see you tomorrow morning" and he reached out his hand to shake mine...even though I'd be seeing him in another 14 hours. Sometimes you get that silent appreciation gesture or sometimes it's said outright. I really love it when I get that. One of the things I found makes people really appreciate what you do is when you actually explain to them what is going on with them from a medical standpoint. Like today I actually explained what sciatica is to a patient instead of just telling him he had sciatica or 'some nerve problem'. Just during this year, I've had a wife of a dying patient hug me as I was leaving the service...just having met me 3 days prior, because she was so appreciative of what I did for her husband (which wasn't much more than just pulling a chest tube, and checking up on him and chatting every day). I really do get a lot out of those types of interactions.

I know I wouldn't get any hugs from doing FNAs, but I'm just trying to determine if I could get those interactions or something similar out of Pathology. I was thinking about autopsy and I assume you explain things to families after you've finished the autopsy. For similar reasons I stated, I'm thinking that may actually be fulfilling as well in regards to being able to explain to a family the medical reasoning behind a death or sickness. It seems that if done properly it could really help a family understand and maybe make it easier to come to terms with what has happened. I dunno, maybe I'm in lala land.

Anyway, I emailed one of the Pathologists here today to hopefully meet and talk to her about what she does (I know she does a decent amount of FNA's). If anyone has anymore input, keep it coming.

 

[Dr. McDreamy]

I hope your 4th path elective is a LOT better than mine was. i came to med school wanting to do path (FP, specifically) and was still sent home at 11 am everyday. i wasn't allowed to touch anything. the highlight of the month is when one of the residents let me dictate the gross exam of some teeth. not kidding. thank goodness this experience did not discourage me from doing path.

and i know not all depts are like that b/c the rotation in my program is a million times better...

so here's hoping you get good exposure to what path is really like.

BTW, a typical week doesn't really exist. a typical week on Surg Path? cyto? CP? it will change depending on your rotation. and you HAVE to do heme (did you mean hemepath? blood bank)/apheresis if you are an AP/CP or CP only resident. and if you like procedures, what's not to love about dissecting a gross organ on surg path? or doing an autopsy (i just can't get enough of that evisceration!)

PS- patient contact is overrated. slides are much better behaved.

That's interesting b/c my experience was similar. I was seriously considering path 3rd year and despairing b/c i was finding that I really hated 95% of clinical medicine. I was REALLY banking on loving my path experience. I was randomly assigned to work with only one faculty member -- I didn't meet any residents or even see the rest of the department. All we would do is meet in his office for an hour every day and look at slides, one on one. He was a man of few words from somewhere in Russia. Let me tell you, it was an awkward experience.

Me: breaking the silence...."So, uh, why did you decide to become a pathologist?"
Him: "I like to be wiz ze microscope".....silence.....

Luckily, i gave it a second chance and really enjoyed my other pathology rotations and got to actually hang out with the residents and interact with more faculty members. But it really wasn't until I found a great mentor in my last path elective that I was totally convinced that this was for me.

I would ask people in the 4th year of your school who are doing path what path rotation is the best at your school and who to work with. I think that makes a big difference.

 

[yaah]

Well, the truth is that some people hate patient contact, some people enjoy it but don't really need it, and others enjoy it and need it. I'm kind of in the middle group. I thought it was neat to have patients thank you or to be able to explain things to people or see them in vulnerable states and help them. But I found that I liked pathology more. And there was so much else about patient care that was a turnoff - paperwork, negotiating with social workers and consult services and nursing homes and primary doctors and whatever, walking around in white coats all day, doing procedures (I hate procedures - to me they are anti intellectual and not fulfilling at all). It was not worth it to me to give up pathology AND put up with all the garbage just so I could have a fulfilling experience with 20-30% of my patients (because there are a lot who don't really care, and a lot who fight you every step of the way no matter how good you are).

You have a lot of personal interaction in pathology. Not much with patients. More so with other physicians.

 

[HbyHA]

I was thinking about autopsy and I assume you explain things to families after you've finished the autopsy. For similar reasons I stated, I'm thinking that may actually be fulfilling as well in regards to being able to explain to a family the medical reasoning behind a death or sickness. It seems that if done properly it could really help a family understand and maybe make it easier to come to terms with what has happened. I dunno, maybe I'm in lala land.

yeeeahh not so much with the explaining to the families the findings on a hospital autopsy. in fact (it may be different at other places, but i'm thinking not) we only send the reports to the clinician that cared for the patient. we tell the clinical team that they will have to call that doc to get a copy/get an explanation.

on the other hand, ME's talk to families all the time. i like being in the position of possibly providing insight into a death that would help the family. some people ask me how i can stand all the "difficult" things i must see, but the way i feel about it is that the patient is no longer suffering. that's the part i can't stand. i had one patient die during a pheresis in the MICU, with her entire family in the room mind you, and i bawled my eyes out. besides, i'll do the autopsies, and the other pathologists can do everything else and i won't miss a day of it, thank you very much...

 

[HbyHA]

That's interesting b/c my experience was similar. I was seriously considering path 3rd year and despairing b/c i was finding that I really hated 95% of clinical medicine. I was REALLY banking on loving my path experience. I was randomly assigned to work with only one faculty member -- I didn't meet any residents or even see the rest of the department. All we would do is meet in his office for an hour every day and look at slides, one on one. He was a man of few words from somewhere in Russia. Let me tell you, it was an awkward experience.

sad, isn't it? but i guess it helps to keep pathology the best kept secret in medicine;-)

 

[Dral]

yaah, I understand what you say about procedures not being intellectually stimulating, but I came across surgeries where you reach some odd anatomy (or for whatever other reason) and the surgeons really stopped and thought things through and came up with the best approach/technique they felt was needed to get the job accomplished.

I'm not trying to argue that procedures are intellectual...simple routine procedures are just that...routine and not intellectual. However, it can be found if you're involved in a more complicated procedure such as some surgeries. I witnessed a few times surgeons looking at CT's in the OR before the surgery figuring out their approach, technique, etc. I guess you could refer to it as cognitive more than intellectual though.

I dunno, I'm usually a very jaded person and maybe I just haven't gotten jaded by patient care yet. I just feel those one or two patients that show such appreciation make it all worthwhile...and I feel that patients will be more likely to show that if fewer physicians fell into that whole countertransferance thing. But that's for a different discussion elsewhere.

Anyway, you all are giving me some good input now. I tend to overthink things and this decision will be no exception. Thanks for the help thus far.

One of the things I did really enjoy during my research years was attending meetings and that sort of thing. Lab meetings and journal clubs always excited me as an interesting exchange of thoughts and ideas. I KNOW I would love that part of Pathology for sure as far as case discussions, tumor boards, etc. go.

I'd envision a scenario where I would spend most of my time doing surg/anatomical path, with somewhat less time spent on seeing patients for FNA's and doing research. Even just talking to a few patients a week doing FNA's would keep me satisfied I think...just to get to talk to real patients about what's going on with them. Is that kind of division of time feasible?

 

[Circumflex]

I had planned on doing surgery, did my acting internship and got letters of rec for applying to surgery, but something was holding me back. I have a PhD as well and was always interested in having some research component to my career. Many of the surgeons I met were very tired and some expressed regrets on their career choice. During my 2nd month of 4th year, I did surgical pathology and loved it. I liked that some knowledge of anatomy was used and that there was a wide variety of career choices.

I admit that I somewhat missed patient contact and the feeling of participating in codes, emergency procedures, etc. But, it has faded, and I am happy with my choice. With regard to being involved in patients' lives, it is possible to feel involved in patient care without the responsibility of taking care of the patients. Depending on your institution and the type of case (hemepath, neuropath, etc.), many times the clinicians will come to look at the slides and actively discuss the case with you and ask your opinion. I have found this especially to be true for neuropath and hemepath. You get the history and pertinent physical findings and get to discuss their treatment options. You get to participate intellecutally, which can be fun.

Pathology has many practice options and it comes with a relatively good lifestyle.

 

[HbyHA]

I'd envision a scenario where I would spend most of my time doing surg/anatomical path, with somewhat less time spent on seeing patients for FNA's and doing research. Even just talking to a few patients a week doing FNA's would keep me satisfied I think...just to get to talk to real patients about what's going on with them. Is that kind of division of time feasible?

depends on what type of practice you work in. probably wouldn't work well in a large academic center (but i could be wrong).

 

[HbyHA]

the clinicians will come to look at the slides and actively discuss the case with you and ask your opinion. I have found this especially to be true for neuropath and hemepath. You get the history and pertinent physical findings and get to discuss their treatment options. You get to participate intellecutally, which can be fun.

we have a similar situation. i always enjoyed this on hemepath (when they made an appointment instead of just descending on our tiny sigout room!!!). even better when a heme-onc fellow would sit with us for a week. i think we need to increase the exposure of clinical residents to Pathology. it would make for better understanding of what Pathology is and isn't and make them more educated consumers. it would also help the path resident see the clinical implications of the finer points of a particular diagnosis. especially in a field like hemepath, where the treatment of hematologic malignancies seems to change rapidly, even since i graduated in '06.

we also have anesthesia residents hang with us in the blood blank for 2 weeks which is GREAT. we are building an army of anesthesia-pathology liasons! now only if we could get the surgeons to come hang out...

 

[yaah]

Hey, don't let me sway you from surgery. I'm just saying I don't find it intellectually stimulating - I know plenty of people do and I can see why. Since I also don't like doing procedures it's kind of like a double whammy. Interestingly enough I got my only third year honors grade in my surgery clerkship 🙄 I guess they liked my efficiency, showing up early, lack of complaining, plus my random pathology knowledge.

 

[Dral]

I talked to a Pathology attending today for over an hour. I got a lot of good insight. She assured me that after a month rotating through, I'll probably have a good yes or no answer. I'm scheduling an anatomical path elective first thing 4th year, so hopefully I will have a good decision soon.

She explained to me that she was really good with patients and went through a 'mourning' period of losing patient care, but she loves what she does that much, that it was a tradeoff she was willing to make.

So I'm gonna ride things out and see how my rotation goes. Thanks for all the replies and help. I gained decent perspective from responses to this thread.