Do I really hate procedures or do I just need more experience?

[MedScat]

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I've been on my anesthesiology rotation for about 2 weeks now and I cringe every time i see a nerve block. The epidural almost made me pass out, even seeing them put in central line made me cringe a little bit and I had to look away. Every specialty I thought I liked (EM, Anesthesia) is very procedural. I'm totally fine with saying "ok i don't like procedures, lets move on to something else" - i have an open mind, but, is my experience something people experience and eventually get over? What bothers me is not the blood or the needle but its the thought of "what if that was me and i screwed up and killed someone, or really hurt them." Advice??

 

[IMGASMD]

It should be scary, because like you said you can get into complications for any procedures. BUT you should feel some excitement with procedures as well. For Anesthesia they are usual means to an end, mostly. Even though it’s usually not definitive treatment, there should be a sense of accomplishment when you perform these manual tasks.

You should know and learn about these complications with all the procedures you do. For central lines, you should know how to use ultrasound to avoid big red or any arteries. For nerve blocks, what nerves, other structures look like. All these things come with experience.

Maybe it’s because you’re just observing and not performing these tasks/procedures, but if you don’t get any satisfactions from working with your hands, maybe a procedural heavy field is not for you.

 

[Drrrrrr. Celty]

You can be both. In my case I know how to do procedures. I just don't enjoy doing them because they take a lot of my time and energy. When I'm trying to baby sit an icu having to put in lines on multiple septic shockers is really the best way to make me go home and crash.

Personally I think once you know how to do a procedure, it's not frequent that you'll do them wrong or bad things will happen. However sometimes things happen, that's why you get consent and explain the risks and benefits.

 

[MedScat]

You can be both. In my case I know how to do procedures. I just don't enjoy doing them because they take a lot of my time and energy. When I'm trying to baby sit an icu having to put in lines on multiple septic shockers is really the best way to make me go home and crash.

Personally I think once you know how to do a procedure, it's not frequent that you'll do them wrong or bad things will happen. However sometimes things happen, that's why you get consent and explain the risks and benefits.

So how do I factor this in when I'm trying to choose what I want to do for the rest of my life lol

 

[Drrrrrr. Celty]

So how do I factor this in when I'm trying to choose what I want to do for the rest of my life lol

In my opinion people who like procedures or surgery know very quickly how comfortable they are with doing these things or how often they want to do them. Right now knowing that I'm fairly decent with ultrasound guided lines, intubations, etc I wouldn't want to do these things more than infrequently. They occupy a lot of time and they exhaust me.

As such that guided me out of choosing fellowships like critical care or cardiology. In your position if you're similar I probably wouldn't go rushing into Anesthesia because while you'll probably become comfortable with procedures, but you might not really enjoy doing them. Most of them are simply not that hard to master as long as you keep trying and do a few.

 

[MedScat]

In my opinion people who like procedures or surgery know very quickly how comfortable they are with doing these things or how often they want to do them. Right now knowing that I'm fairly decent with ultrasound guided lines, intubations, etc I wouldn't want to do these things more than infrequently. They occupy a lot of time and they exhaust me.

As such that guided me out of choosing fellowships like critical care or cardiology. In your position if you're similar I probably wouldn't go rushing into Anesthesia because while you'll probably become comfortable with procedures, but you might not really enjoy doing them. Most of them are simply not that hard to master as long as you keep trying and do a few.

Do you know anything about EM and about the frequency that they put ultrasound guided lines? I'm sure it depends on the institution that you are at...But any info you or anyone else might have on it would be helpful. I like that EM would be a mix of stuff and not like how anesthesia has been literally just intubation after intubation, nerve block after nerve block. Theres no CC of abdominal pain in the middle to mix it up which I'd appreciate

 

[Drrrrrr. Celty]

Do you know anything about EM and about the frequency that they put ultrasound guided lines? I'm sure it depends on the institution that you are at...But any info you or anyone else might have on it would be helpful. I like that EM would be a mix of stuff and not like how anesthesia has been literally just intubation after intubation, nerve block after nerve block. Theres no CC of abdominal pain in the middle to mix it up which I'd appreciate

Depends on their rotation. At my program EM does about 4 months of critical care, some electives, and the rest EM. So basically all in all I would be surprised if they do any less than 50 Central and Arterial Lines in a year. As far as chest tubes and thoros go probably 5+?

 

[IMGASMD]

Just reading through, I really don’t get a sense you’re excited to do any procedures. Why you think EM is for you? Why not a strong IM program, you get diagnose and treat IP and OP patients? Then you still get some time to see if critical care or other subspecialties is for you?

IM programs, you only need a handful of procedures to graduate. The last time I really checked, you may not even *need* any central lines, a-lines, I didn’t do any thoracentesis or spinals as internal medicine resident. And if you don’t do them in residency, no one will expect you to do any as attending.

Even intubation for critical care attendings, depends on institution, you may not perform any. Just throwing it out there, you don’t need to do procedures to be a good clinician.

 

[MedScat]

Just reading through, I really don’t get a sense you’re excited to do any procedures. Why you think EM is for you? Why not a strong IM program, you get diagnose and treat IP and OP patients? Then you still get some time to see if critical care or other subspecialties is for you?

IM programs, you only need a handful of procedures to graduate. The last time I really checked, you may not even *need* any central lines, a-lines, I didn’t do any thoracentesis or spinals as internal medicine resident. And if you don’t do them in residency, no one will expect you to do any as attending.

Even intubation for critical care attendings, depends on institution, you may not perform any. Just throwing it out there, you don’t need to do procedures to be a good clinician.

I hear what youre saying but, I actually love working with my hands and the satisfaction of doing a procedure correct (which you described above) actually sounds awesome but, just watching someone else do it, just imagining myself in the position, horrifies me! I think once I'm actually able to do something I'll have a better feel. I like the excitement of EM, everything is different every day. Its just enough patient contact for me and the residency is only 3 (sometimes 4) years and I can start my family during this time as well (non-trad student, not looking to do 6 years of training for a subspecialty). Starting my family asap is a huge priority for me. Also all the EM docs i've met are super chill and fun - reminds me of my bartending days again which I loved. The shift work concept and no call is something I kind of like too. Even just being in the hospital for 2 weeks and my husbands like “when should I have dinner ready” and I’m like could be 4 could be 8, guess we’ll see lol

I'm still very open minded and IM is still a possibility for me I just feel for what I've seen of the day-to-day, I feel I'd get bored. But, I have my medicine rotation in 3 months so I guess I'll know then.

 

[kopftonmd]

I thought I would love to be a proceduralist, but then got to med school and it was not for me. Too stressful.

Keep in mind though that there are other specialties/subspecialties that feel more hands-on and acute like EM. For example, ER psych felt just as intense to me as EM, just without any procedures.

 

[IMGASMD]

just imagining myself in the position, horrifies me!

Most surgeons/proceduralist want the knife, instruments or tools in our own hands when the pressure is on, because I know I can control my own actions and I believe in myself.

If you can, maybe start from something smaller, like IV in a patient who’s intubated. And see how you feel about it.

I wish you luck, and please update me when you finally choose a specialty.

 

[Chemist0157]

Think if you like working with your hands and look forward to doing procedures and getting better at procedures, it’s going to be just fine. I think it’s rare that someone is inherently “bad” at it. Just depends on experience.

I gravitated towards subspecialties that were procedure light. If I never ever had to worry about a vas cath again, that would be just fine.

 

[DrMcLovin]

I dont think choosing a procedural specialty with those feelings is a good idea. At least you are honest with yourself.

I would steer clear of EM as well, they are expected to perform a wide range of procedures and fracture reductions before passing them off to the appropriate specialists. I’d imagine that would make you a lot more uncomfortable than doing a central line or intubation in the operating room.

 

[MedScat]

I dont think choosing a procedural specialty with those feelings is a good idea. At least you are honest with yourself.

I would steer clear of EM as well, they are expected to perform a wide range of procedures and fracture reductions before passing them off to the appropriate specialists. I’d imagine that would make you a lot more uncomfortable than doing a central line or intubation in the operating room.

never thought about this one....my fear stems mostly from hurting the patient by making a mistake (less so the actual procedure)...i'm not sure what goes into reducing a fracture but i imagine it would actually bother me less than traversing through muscle, ultrasound guided finagling my way around an artery, to get to a nerve for a nerve block. But either way, its something to consider. I hate that EM is a 4th year rotation and not third but, I've reached out to my home programs ED department for some more experience

 

[calivianya]

It was the needle for me, and I’m not usually bothered by needles. The first time I saw a central line placed I had a pretty negative visceral reaction to it, and the first time I saw a LP done I had to sit down. Right then, immediately, or I would have hit my head on something on the way down. Just the thought of a needle that big entering the spinal canal! I could have died on the spot. After a few exposures to each I loved assisting with procedures, which became one of my favorite things to do. During one of my last shifts at work before I started med school, I got to work as my unit resource - and it was a busy as hell night, so I basically followed the intensivist around and assisted with intubations, LPs, central line placements, and chest tubes all night. It was awesome. If you had tried to tell me on that day I almost passed out watching my first LP, that a few years later watching one would be my favorite part of my shift, I would have laughed.

How many CVC inserts, LPs, etc. have you seen, exactly? I’m not going to say you should rule out procedural specialties yet - it took me a bit to warm up when I first watched those types of procedures, and a little bit of fear is healthy.

I’d rather have someone worried about messing up placing a line in me than a cowboy excited to show off, totally unbothered by the potential for complications. Too much fear is debilitating, but just a little makes us more careful.

 

[MedScat]

It was the needle for me, and I’m not usually bothered by needles. The first time I saw a central line placed I had a pretty negative visceral reaction to it, and the first time I saw a LP done I had to sit down. Right then, immediately, or I would have hit my head on something on the way down. Just the thought of a needle that big entering the spinal canal! I could have died on the spot. After a few exposures to each I loved assisting with procedures, which became one of my favorite things to do. During one of my last shifts at work before I started med school, I got to work as my unit resource - and it was a busy as hell night, so I basically followed the intensivist around and assisted with intubations, LPs, central line placements, and chest tubes all night. It was awesome. If you had tried to tell me on that day I almost passed out watching my first LP, that a few years later watching one would be my favorite part of my shift, I would have laughed.

How many CVC inserts, LPs, etc. have you seen, exactly? I’m not going to say you should rule out procedural specialties yet - it took me a bit to warm up when I first watched those types of procedures, and a little bit of fear is healthy.

I’d rather have someone worried about messing up placing a line in me than a cowboy excited to show off, totally unbothered by the potential for complications. Too much fear is debilitating, but just a little makes us more careful.

Thanks for this - I'm hoping that my fear at this point is just because I haven't seen any of this before. Regular IV insertion is the most invasive procedure I had seen before starting rotations 2 weeks ago. Even now, 2 weeks in, I've only seen 1 epidural, about 3 brachial plexus blocks, and only 1 CVC and AG line. I'm still extremely new. I haven't even gotten to attempt any procedure, this includes IV insertions or suturing. It's hard right now to get any experience because all the residents are new and need to learn.

How long would you say it took you to warm up to procedures?

 

[dienekes88]

I've been on my anesthesiology rotation for about 2 weeks now and I cringe every time i see a nerve block. The epidural almost made me pass out, even seeing them put in central line made me cringe a little bit and I had to look away. Every specialty I thought I liked (EM, Anesthesia) is very procedural. I'm totally fine with saying "ok i don't like procedures, lets move on to something else" - i have an open mind, but, is my experience something people experience and eventually get over? What bothers me is not the blood or the needle but its the thought of "what if that was me and i screwed up and killed someone, or really hurt them." Advice??

I don't know, bud. You like what you like.

With respect to procedures, we all have anxiety about hurting people. Anyone who doesn't is a psychopath. Part of it is healthy. Part of it is inexperience (until I placed my 15th or 20th subclavian line, I would always get pretty nervous; after my 50th or 60th, I just got annoyed that I still had to be placing lines as a senior resident). Part of it is you (everyone's different, and there's nothing wrong with disliking procedures).

Depending on your field, the decisions you make can have life-altering consequences. Some fields will have more of those decisions than others. Your ability and/or willingness to deal with that is going to determine in part what you end up doing. If you hate risk and can't stand the thought of being responsible for someone having a stroke or dying, then don't become a cardiac surgeon or neurosurgeon, consider family medicine, pathology, or something with less risk.

You gotta figure out whether you mentally can take the hits.

 

[calivianya]

Thanks for this - I'm hoping that my fear at this point is just because I haven't seen any of this before. Regular IV insertion is the most invasive procedure I had seen before starting rotations 2 weeks ago. Even now, 2 weeks in, I've only seen 1 epidural, about 3 brachial plexus blocks, and only 1 CVC and AG line. I'm still extremely new. I haven't even gotten to attempt any procedure, this includes IV insertions or suturing. It's hard right now to get any experience because all the residents are new and need to learn.

How long would you say it took you to warm up to procedures?

I would say the second CVC insert still felt a little weird but I was fine by the third or fourth... LPs took me a bit longer. I think I had to see five or more of those before I felt comfortable, maybe more like 10. I don’t remember exactly. That’s just a really big needle in a really scary area IMO. Just the thought of someone causing nerve damage... ugh. I know it’s less likely because of where we do LPs but it’s still possible to hit part of the cauda equina.

I’m looking forward to doing both of those now!

Another procedure that about made me die the first time I watched was a ventriculostomy. I guess I never realized the neurosurgeons just threw those in there... always assumed there was imaging involved and it was done in a super controlled environment slowly or something. Watching the neurosurgeon poke around on the surface of the brain, think for a couple of seconds, and just shove that catheter straight into the brain without any sort of imaging or anything just about killed me. I mean, it was amazing, but holy crap - that’s somebody’s brain!!! And he just darted the catheter in there like it was nothing.

 

[Matthew9Thirtyfive]

Just in case it hasn’t been said, it’s okay if you actually don’t like procedures. Some people just don’t like them. It doesn’t make you a lesser doctor or anything if you go into a specialty where you don’t have to do them. Some of the smartest and coolest docs I’ve met have been in specialties where they did little to no procedures.

 

[QuizzicalApe]

Just reading through, I really don’t get a sense you’re excited to do any procedures. Why you think EM is for you? Why not a strong IM program, you get diagnose and treat IP and OP patients? Then you still get some time to see if critical care or other subspecialties is for you?

IM programs, you only need a handful of procedures to graduate. The last time I really checked, you may not even *need* any central lines, a-lines, I didn’t do any thoracentesis or spinals as internal medicine resident. And if you don’t do them in residency, no one will expect you to do any as attending.

Even intubation for critical care attendings, depends on institution, you may not perform any. Just throwing it out there, you don’t need to do procedures to be a good clinician.

It remains a personal point of perverse pride that I got through internal medicine residency without being signed off on any procedures, due to hating procedures so much. I begrudgingly became fairly good at bone marrow biopsies in fellowship, but now that I'm an attending I don't even do that anymore.

In retrospect I personally might be why they introduced more procedural training into the residency curriculum after I graduated...

 

[LunaOri]

If anyone had told me, the first time I saw a particular procedure, that I would end up in a specialty where I performed that procedure ALL THE TIME, I would have wet myself laughing. I thought I was going to pass out or puke...but after seeing a couple, then assisting in a few, then performing a few, it became second nature. If you like a specialty, you will get comfortable with the procedures.
There are still a couple of things I would have a hard time with (nasal septoplasty really freaks me out). But chest tubes, lines, and other ER/trauma stuff doesn't bother me a bit.

 

[Fatalis]

It all depends on the type of procedure. I love suturing, putting in central lines/ chest tubes/ I/D but I literally wanna vomit when there are ingrown toenails... you will find what you enjoy and what you will refer

 

[Matthew9Thirtyfive]

It all depends on the type of procedure. I love suturing, putting in central lines/ chest tubes/ I/D but I literally wanna vomit when there are ingrown toenails... you will find what you enjoy and what you will refer

Yeah sorry I can’t go into a specialty where there’s any chance I would have to do anything to a toenail.

 

[VA Hopeful Dr]

It all depends on the type of procedure. I love suturing, putting in central lines/ chest tubes/ I/D but I literally wanna vomit when there are ingrown toenails... you will find what you enjoy and what you will refer

I love fixing ingrown nails. Its amazingly satisfying.

 

[Matthew9Thirtyfive]

I love fixing ingrown nails. Its amazingly satisfying.

Even just reading that phrase makes me want to puke.

 

[VA Hopeful Dr]

Even just reading that phrase makes me want to puke.

Its not for everyone, my internist wife hates doing them

 

[Matthew9Thirtyfive]

Its not for everyone, my internist wife hates doing them

I’d rather do 10 rectals over even looking at a nasty toenail.

 

[LunaOri]

Every specialty has its nasty aspects: fecal impaction, gangrenous feet (gag!), vomit, decomposed bodies, yada yada. Pick the one that grosses you out the least!

 

[slowthai]

I’d rather do 10 rectals over even looking at a nasty toenail.

Listen, I once saw a foot with live maggots coming out of the toes. I immediately swore off of foot/ankle ortho. Immediately. And permanently. That is the one thing I know I cannot stomach in medicine. Worst worst worst thing I have ever seen, by far.

 

[LunaOri]

I forgot about worms and maggots! And parasites!

 

[VA Hopeful Dr]

I’d rather do 10 rectals over even looking at a nasty toenail.

That has the sound of someone who hasn't done a rectal and ended up with liquid poop go past the edge of the glove

 

[Matthew9Thirtyfive]

That has the sound of someone who hasn't done a rectal and ended up with liquid poop go past the edge of the glove

I’ve had products of conception on my face and mouth, and I’ve had **** all over me. I would do that ten more times before I do anything with a nasty toenail.

 

[VA Hopeful Dr]

I’ve had products of conception on my face and mouth, and I’ve had **** all over me. I would do that ten more times before I do anything with a nasty toenail.

Pre or post conception products?

 

[Matthew9Thirtyfive]

Pre or post conception products?

D&E for missed abortion. Doc pulled the suction out and flung it all over my face.

 

[Candidate2017]

I hear what youre saying but, I actually love working with my hands and the satisfaction of doing a procedure correct (which you described above) actually sounds awesome but, just watching someone else do it, just imagining myself in the position, horrifies me! I think once I'm actually able to do something I'll have a better feel. I like the excitement of EM, everything is different every day. Its just enough patient contact for me and the residency is only 3 (sometimes 4) years and I can start my family during this time as well (non-trad student, not looking to do 6 years of training for a subspecialty). Starting my family asap is a huge priority for me. Also all the EM docs i've met are super chill and fun - reminds me of my bartending days again which I loved. The shift work concept and no call is something I kind of like too. Even just being in the hospital for 2 weeks and my husbands like “when should I have dinner ready” and I’m like could be 4 could be 8, guess we’ll see lol

I'm still very open minded and IM is still a possibility for me I just feel for what I've seen of the day-to-day, I feel I'd get bored. But, I have my medicine rotation in 3 months so I guess I'll know then.

Maybe you're just anxious. I loved procedures and did a ton during med school but have no desire to work in a procedural field. That's because I value many other things in a job than working with hands vs not.

It seems you value having a schedule, family-making time, family time, getting along with coworkers, variety/excitement. You may not have considered that EM works during family time (evenings, nights, weekends, holidays). And EM docs aren't necessarily chill. They tend to lose their biscuits at 3 AM and throw a tantrum when a consultant refuses to come in or admit their patients. As for vareity/excitement, it's a job after a while and you usually end up seeing the same 10 presentations most the time. That's why there are hobbies.

 

[Candidate2017]

With respect to procedures, we all have anxiety about hurting people. Anyone who doesn't is a psychopath.

Have you seen how OB-GYN rip uteri open for C-sections while casually talking about switching their insurance to Geico?

 

[Neopolymath]

D&E for missed abortion. Doc pulled the suction out and flung it all over my face.

I have been in your shoes.

 

[Matthew9Thirtyfive]

I have been in your shoes.

Sorry they’re so wet.

 

[VA Hopeful Dr]

I’d rather do 10 rectals over even looking at a nasty toenail.

Literally just finished one. Wasn't infected or anything just ingrown. No grossness or anything.

 

[Matthew9Thirtyfive]

Literally just finished one. Wasn't infected or anything just ingrown. No grossness or anything.

I just am grossed out by teeth and nails.

 

[dienekes88]

Have you seen how OB-GYN rip uteri open for C-sections while casually talking about switching their insurance to Geico?

Yes. Having done redo aortic surgery with no blood products, the mindset it a bit different.