From clincial medicine to pathology- who has done it?

[alcmd]

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Hi guys (and gals)-

Got a dilemma for which I'd appreciate your help. I always thought clinical medicine was for me when I was a student- I liked patient care, clinical problems, etc. However, after a year of residency, I'm not so sure. I have seen the ups and down of patient care; yeah, it's rewarding when things go well, but the enormous amount of downsides (lawsuits, infection risk, paperwork, frequent call, dictations, malignant environment) have *really* made me question my decision.

I actually considered path as a student but thought I was one of those who needed the patient interaction. I love to dissect things and my home school pathologists were awesome... on the other hand, the micro-view of pathology I saw as a student involved a lot of time revieiwng countless numbers of pap smears, which I didn't exactly find exciting. However, I think grossing specimens and some of the mental challenges of pathology would be something I'd like.

Anyone been in this same prediciment? I know this is a horrendously broad question, but what are the good and bad parts of pathology? What are the things that really excite you about path? What things do you really hate about it? What is day-to-day responsibility in the "real world" of path really like?

I would appreciate your advice (whether it be positive or negative.) I'm an american grad, I had good board scores and have a pretty good relationship with my program director and chair, so hopefully a switch would not cause too many hard feelings. I'm terribly confused and want to try to make up my mind if I want to make the switch to path before signing on for another year in my current specialty.

Thanks!

 

[Doctor B.]

The downsides of clinical residency that you listed are many of the reasons I did not go into clinical medicine. I chose path because I enjoy the intellectual challenge and investigative role that pathology entails. There is something really cool about grossing in a strange tumor, making the microscopic diagnosis and ultimately helping the patient.

Thankfully, there are many more aspects to pathology than reviewing pap smears! There are a wide range of areas that we work in including microbiology, forensics, blood bank, derm path, heme path, neuro path, etc. And, if you still want patient contact, something to consider from the pathology end of things is blood bank. It is a more clinical subspecialty of path and you will see patients for apheresis procedures and other things but you won't have to do a full H & P or discharge summary.

It sounds to me like you came to the same conclusion I reached about clinical medicine: the negatives outweighed the positives. For me, the positives in path far outweigh the negatives. One downside about path for me, though, was the high initial learning curve and the large amount of reading required. It took me a while to figure out what was going on and I'm still trying to get myself to read more. Then again, having to read a lot beats having to admit a nursing home patient at 3 am 🙂

I wrote something that is on the net (http://choosepath.blogspot.com) about why I chose path. It's geared more towards 3rd and 4th year medical students but I think it might still be helpful to you. Feel free to PM me or post more specific questions.

 

[cookypuss3]

Out of the 8 residents I work with currently, at least 3 of them started off in regular clinical medicine and made the switch 1, 2 or even 3 years into that residency. All of them seem very pleased with their choice.

I think that you are wise for asking the downsides of path. Granted, I'm only a 3rd year, but know for sure I'm going to be doing this so I have mentally dissected the whole thing a billion times over. A lot of people say that they miss the patient contact. OK, that's fair. Others think it is boring and monotonous with the same thing over and over. OK, that's fair too. Dictation? Oodles of that. Ick factor? Fairly high. Autopsies? Not fun. Breathing formalin fumes all day? Will burn off your corneas. However, you get the luxury of being able to take one of a billion different paths in terms of specializing. Call is minimal. Overall it is mellow. No whiny patients, less lawsuits, less administrative insurance type paperwork, less malpractice insurance fees. The best part of all is that it is impossible to know everything -- so the learning can never end. In addition, expanding technology is allowing for an amazing direction of growth. It's all very exciting.

 

[alcmd]

Thanks guys- this is helpful and I appreciate the fast responses.

I agree, there are many nights where right after I fall asleep I get that call of why I need to come talk to so-and-so because "they need to see a doctor, now" for their abdominal pain that has been unchanged over 2 weeks. Or the one to dictate the umpteenth chart of a patient I barely know... or how about the family that is screaming at us, threatening to sue after we worked all night trying to help their loved one... you get the picture. I just don't know if I have the passion for the good things to make all the BS worthwhile.

At first I thought it was normal to question whether the downsides are worth it but I have been finding myself doing this on a daily... wait, make that an hourly basis lately.

So here I am, the answer is becoming pretty clear; I think all I am lacking is the courage to take the jump and make a change.

Keep the input coming- I'm approaching a few busy days but will write back later this week.

Thanks!

 

[alcmd]

Btw doctor b great job on your website 👍

 

[gungho]

Finished FP residency '85-have done FP, ER, administrative med. Will be PGY-1 in Path 7/1/04 and I can't wait to smell formalin, look at slides, read, etc. So, haven't actually gotten into the trenches yet, but certainly can identify with your discontent. PM me if I can be of any assistance.

 

[cookypuss3]

Don't get me wrong, I'm not saying that path is any more or less repetitious than any other specialty. Some people think grossing just blows and it bores the hell out of them. Maybe your five hundreth appendix just won't thrill you to the core the way the first one did. Looking at said appendix slides may not be the most exciting thing in the world either. However -- some people, like myself, do not need new and exciting things every day, and the one zebra that comes galloping along every once a year or so will do it for me.

Get off my case man, I was just playing devil's advocate!!! 😀

 

[Doctor B.]

Btw doctor b great job on your website 👍

Thanks! Hope it was helpful. Remember, it's never too late to change. If you're not happy, it's probably best to change fields rather than continue on and dislike your job. I remember one surgeon I saw during medical school who would constantly proclaim how he "just wanted to teach high school science". Not sure why he stayed a surgeon but he was very unhappy.

 

[Nilf]

Come to path man, you'll never look back. I've met loads of converts. Most of them did 1-2 years of internal med. The dude who was teaching path Step 1 prep class at my school defected after 2 years of ortho residency. One of the first year resident at my school has been pediatrics attending for several years before she decided to do path... Another resident switched from radiology after 2 years into the residency... Granted, I'm sure there are some who switch away from path, but I've never met anybody.

 

[yaah]

Yeah, some say that 50th appendix isn't very exciting. But then again, you might get an appendix with a worm in it or something. Every case is a little different. I, for one, do not get tired of grossing the gall bags.

I bumped up an old thread called "downside" for some more possibilities.

Good ole Col. Jessup. He was railroaded, don't you think? I think he was right, the world has walls, and those walls have to be guarded by men with guns.

I do agree with cookypuss (don't I always! 😍 ) except for the autopsy bit. I think they can be fun (or, at least, can fit a certain definition of fun. If not actually fun, they can be fascinating and very instructive).

It's funny, aclmd, I like clinical medicine too. I like meeting patients, figuring out what is wrong with them, making them better. But it doesn't really thrill me like path does. I find myself on clinical services (and this is during med school clerkships) kind of wishing more time was spent on the stuff I was interested in. Too much paperwork, trying to arrange discharges, etc. A lot of questions are left unanswered because patients either stabilize or decompensate.

 

[cookypuss3]

I do agree with cookypuss (don't I always! 😍 ) except for the autopsy bit. I think they can be fun (or, at least, can fit a certain definition of fun. If not actually fun, they can be fascinating and very instructive).

Oh sweetheart, you tickle me so. I was speaking of autopsy lethargy in general amongst the people I've worked with. I suppose, however, for every person who gets nauseous at the mere thought of the medical examiner's office, there's one who's ready to claw someone's eyes out for a forensics fellowship.

Whatever. I'm so damn happy just sitting in a little room with slides.

 

[Doctor B.]

I think most pathologists don't like to do hospital autopsies. They involve a lot of work and often little or no reimbursement (many institutions don't charge for in house patients who require a post-mortem). Also, it seems many hospital cases are not satisfying. We seem to get a lot of cases that are requested by families, not the treating physician. While you can learn something from every autopsy, some are not necessary as they will provide no more information to the clinician than they already knew. Forensic cases, on the other hand, can be very cool. You get to see a lot of acute pathology and can piece together the terminal events in a person's life to help law enforcement officials in their investigation.

 

[yaah]

Oh sweetheart, you tickle me so. I was speaking of autopsy lethargy in general amongst the people I've worked with. I suppose, however, for every person who gets nauseous at the mere thought of the medical examiner's office, there's one who's ready to claw someone's eyes out for a forensics fellowship.

True. Autopsies would generally be a bit better if you could pick the time you were able to do them. Unfortunately, you usually get paged when there is something interesting to see (During my PSF autopsy month was doubled with dermpath or hemepath, and sometimes there would be nothing to do in the morning until the slides came out, then when they did come out, THEN the autopsy page would come. Grrrr..).

I'm very ticklish also.

 

[medtechv79]

Hey,
I'm a little bored and was sorta roaming the forums and came across yer post. I'm not a med student/nor a resident but I do work with some pathologists at a hospital as a med tech (i know, not the most glorious job). Don't they call a pathologist "the doctor's doctor"? I do know they look at slides alot! (and autopsies and FNA's).The pathologists I work with have their own office and a microscope in the office. I have heard the residencies are long tho- 5 years. Good Luck! I look at slides alot in hematology. I don't get bored with slides but they can hurt yer eyes and give u a headache if u look at it too long. I find it interesting to see the different types of cells and disease states they're associated with.
I'm no expert but I know as a pathologist you will be incharge of a certain dpt. of the lab and hmmm...I know they have normal office hours! like 9-5 or so! I don't think they have odd hours on call at like 1 am or so! Good Luck with yer decision! Pathology seems very interesting and u will learn more about diseases and their originis. Sounds very interesting!