I was attracted the medicine because I was always interested in the science of human physiology and pathology. I was in the minority of people that loved M1 and M2 years as a result. When I hit the wards, I saw that all the science was taken out of medicine. The biggest weapon was not your fund of knowledge, but your ability to get a good history from a patient. Rather than solve a puzzle of the most likely diagnosis, I felt like everyone just used the shotgun method hoping to catch something (cxr, ekg, belly labs, blood culture, ua, urine culture on every patient in the ED). People just followed pre-set algorithms of treatment once they found the likely diagnosis. It felt pretty dumbed down, and IMO, a waste of a medical education.
Surgery was cool, but not cool enough to justify the hours (even urology and ENT, where residencies are pretty brutal).
Then, there was radiology. Where the vast, vast majority of your work is real medicine. You are looking directly into a patient's body (the ultimate physical exam), while thinking, formulating differentials, considering every possible disease process that is consistent with the findings. Your ultimate weapon in this field is your fund of knowledge (vs in medicine, where it's your shmoozing skills). Every case is like a puzzle, and no you may not always be 100% certain of the diagnosis and need to hedge, but you are able to look inside and give true objective data. There are no bull***t social work issues to deal with, no unpredictable hours, minimal paperwork, just medicine. At its core.
My line of thinking would also justify path, but I was always more of an anatomy guy than a histo guy. Also dead bodies freak me out.
In addition, you get to do short, focused procedures. CT-guided biopsy, angio procedures are basically like playing a video game (looking at a screen while using a controller to guide it). Only in this game, you get paid for it and get to prolong a patient's life.
