I think I've chosen the wrong specialty

[JohnnyDoc]

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Hi all,

I am a neuro prelim who just started intern year two months ago, and currently on my first block of medicine ward. I think I've chosen the wrong specialty. I hate chart reviewing and presenting. I never know what to look for and take too long reviewing a patient, and I always screw up my presentation. It has got so bad that my attending makes sneer comments about me to the team about not doing anything in front of my face. I came from a below average school that has only one medicine ward rotation, so I never got really good at chart reviewing or presentation. But on top of that, I honestly haaate chart reviewing and doing the morning routine and word vomiting a patient that I looked up an hour ago. I know this is medicine but I know that neurology would be the same but worse. Everyone I went to said that it gets better with time or "you get more efficient", without telling me how to do it correctly.

What is the process of applying to another specialty? because at this point, I don't know if I can keep doing for the life of me.

 

[sharkbaitwhohaha]

eh...it gets much better and much easier with time. You're just an intern, wait it out a little more. Plus, neurology is more often history and exam focused and not detailed chart review like medicine can feel at times.

 

[liquidshadow22]

It sucks. This is why surgery is better.

 

[DrSatan]

Are you burned out?

 

[Postictal Raiden]

Yeah it sucks. Pre-rounding, rushing to finish notes before attending arrives, presenting, rounding till late afternoon on an empty stomach (with some old school attendings). But this is residency. As you transition to PGY3 and 4, your inpatient blocks become less frequent so the process becomes less annoying.

 

[Thama]

Everyone hates their life and feels wildly inadequate early in intern year. It's the nature of the beast.

Luckily the real world practice of neurology has little to nothing to do with what you're doing now.

 

[aye_emm_gee]

I hate chart reviewing and presenting. I never know what to look for and take too long reviewing a patient, and I always screw up my presentation.

I had the same issues an an intern. Many of us did! You are not alone!

I know this is medicine but I know that neurology would be the same but worse.

It's not! Medicine and neurology are worlds apart. I was miserable intern year,largely due to struggles similar to the ones you are having. PGY2, despite being the hardest year of neurology residency, and typically thought of as harder than PGY1, was a breath of fresh air for me. A lot more history and exam, a lot less chart review. Presentation is also less difficult, as you're not managing every single system in the body all at once; you're just doing neuro, and so the presentation is much more manageable IMO.

Everyone I went to said that it gets better with time or "you get more efficient", without telling me how to do it correctly.

Gotta ask for specific instructions on what you're doing wrong from the attendings--or probably more usefully--from the senior on your team, or maybe the chief resident. It sucks that your attending is not supportive. I was blessed to have very nice attendings and seniors who shepherded me through a tough time where I was definitely not up to par. I think someone has to sit down with you and watch you chart review and see what is taking you so long. There's probably some simple UI/EMR stuff that can speed you up, as well as just some simple workflow tips for IM-style chart review that will help. I think you would definitely benefit from some very hands-on feedback, as that is what helped me. Good luck! Feel free to PM if you have any questions.

 

[DocMom1]

HANG IN THERE. There are many subspecialties that are less chart-review/presentation oriented in neurology that you should explore once you progress in residency. Also remember that as a doctor caring for any complex patient (even as a surgeon or dermatologist), chart review is essential to make sure you know what has happened to the patient in the past and the medical history beyond what the patient is usually able to convey. You WILL become more capable at this as you gain more experience; it is like driving a car as the skill becomes second nature and less cognitively demanding after ~1 year of training. To make chart review more enjoyable, you might try listening to classical music or jazz when reviewing charts, or pairing the chart review with some enjoyable habit (like drinking coffee or tea).

 

[Dave1980]

It has got so bad that my attending makes sneer comments about me to the team about not doing anything in front of my face.

It's a snide comment FYI. Come to Radiology!

 

[Telamir]

PGY-2 was without a doubt the worst year of my life. Re-tern year is horrible. Just when you get the hang of medicine you are thrust into a new specialty that you know very little about and you're still "the bitch". I also went through a phase where I was about to quit during PGY-2, so believe me I get it.

One thing that you will get a knack of is WHICH portions of the chart to review. Remember, you're in a specialty so you focus on that. If you're consulted for AMS for example look at the reason for admission, medications they might be on; new, old, discontinued during the hospital, (antibiotics included) if they have a history of dementia, CHF w/ a bad EF for example. Look at the workup if they have done any: CT? MRI? EEG? and go from there. Once you get the hang of it the chart review portion of it becomes much quicker. Remember, unlike with medicine when you admit someone or get consulted for something it's usually a more specific reason/complaint.

Apply that to your H&P as well to get faster at the interviewing process.

I hated every second of PGY-2, and it really made me doubt that I even liked neuro. I wasn't really sure I liked it until the beginning of PGY-4 almost. That being said it does get better and once you feel like you know what's going on it becomes much more enjoyable. I'm out of training now and I'm satisfied with having chosen neuro. It's not without my pet-peeves (not many objective measurements, you're asked to "rule out" or prove a negative often, not to mention the psych stuff) but you'll get that with every specialty.

Hope that helps some.

 

[Splenda88]

At least you are in neuro, not in IM. Besides, you don't have attending who want to know if patient was on multivitamin at home, or one who is upset because you did not make adjustment in blood pressure meds on a 68 y/o whose BP is 148/89. I have had attending like that. Can't wait to be done with that sh***t where every attending thinks they are best thing that happen to the world. Count down--10 more months to go!

 

[Postictal Raiden]

At least you are in neuro, not in IM. Besides, you don't have attending who want to know if patient was on multivitamin at home, or one who is upset because you did not make adjustment in blood pressure meds on a 68 y/o whose BP is 148/89. I have had attending like that. Can't wait to be done with that sh***t where every attending thinks they are best thing that happen to the world. Count down--10 more months to go!

Funny you mention that. I had an attending rip me a new one couple days ago for not asking about vitamins and herbs on a patient we’re consulted for encephalopathy.

 

[neglect]

Hi all,

I am a neuro prelim who just started intern year two months ago, and currently on my first block of medicine ward. I think I've chosen the wrong specialty. I hate chart reviewing and presenting. I never know what to look for and take too long reviewing a patient, and I always screw up my presentation. It has got so bad that my attending makes sneer comments about me to the team about not doing anything in front of my face. I came from a below average school that has only one medicine ward rotation, so I never got really good at chart reviewing or presentation. But on top of that, I honestly haaate chart reviewing and doing the morning routine and word vomiting a patient that I looked up an hour ago. I know this is medicine but I know that neurology would be the same but worse. Everyone I went to said that it gets better with time or "you get more efficient", without telling me how to do it correctly.

What is the process of applying to another specialty? because at this point, I don't know if I can keep doing for the life of me.

You don't know if you hate it because currently, you your own admission, you suck at it.

Get better. Look around you. Look for the interns and residents who's presentations grab attention, are ordered, are thoughtful, and leave everyone on the same page. Go up to them and ask for help. Your attending's comments are rude and demeaning, but they MAY be from a well intentioned place. After rounds, seek her out and ASK. If you wallow in the same ****, you're not going to improve. If you ask what she wants, at least you're showing that you are coachable. They will tell you to stick to fundamentals: every patient is a story, get the history, PMH, relevant meds, SH, FH, VS, exam, tests, then stake your claim on a plausible diagnosis and treatment plan. That's the job right there.

You graduated med school two months ago. You think of yourself as fairly mature, perhaps you think you should already have mastered this. Wrong. To all your attendings, you're as green as a been sprout. You're a 20-something that's closer in age to their kids. They really will help you. But you have to show that you are smart, able to learn and self-reflect, hard working, and a good teammate. I speak from experience. EVERY attending was once like you: clueless. (Remember this feeling BTW, so you can actually help people yourself). Only the most arrogant forget what it's like. In my intern year I was once so anxious that on rounds I could not name a CAD risk factor. But I tried really hard, showed up early, aped what the best interns did, got help from good senior residents and attendings. By the time I was a PGY2, I had ice water for blood and would go up against anyone, wage any turf war.

Perhaps you really don't have what it takes, but you're really only kicking the can down the field there. Think surgery is THAT different? Rads, anesthesiology, OB? Same process.

Best luck.

 

[mrbreakfast]

Lot to touch on here, but:

1) You suck at medicine. Duh, you're not a medicine resident, you're just acting like one for a year. You're comparing yourself to your peers who spent their past year taking medicine sub-Is. Of course they're better at it, right now. Trust me, I took exactly one medicine rotation in med school (my required clerkship) and it was my first clerkship ever. The start of intern year was rough for me, and while I eventually figured it out, I had some 100+ hour weeks my first few blocks. We've all been there.

2) You suck at being a resident. Again, you've just started. Our current interns on service (who, at my program, are mostly off-service IM PGY1s) are basically glorified med students. You'll get better. A few tips:
-Something I was taught on overnight admitting (hopefully a service you have, as you'll master writing H&Ps) is 20/20/20: 20 minutes to see the patient and place admission orders, 20 minutes to write the HPI, etc, and 20 minutes for A/P and med orders. Time yourself and try to get faster.
-Get used to problem based presentations, and challenge yourself to find everything wrong with the patient. Example labs: Na 131, Cr 1.41, HgB 11.6, WBC 12.5. Four relatively minor lab abnormalities, four points in your presentation. Etc.
-Learn to dictate. I don't care how fast of a typer you are, once you get used to it you can dictate 3-5x words/minute faster than you can type. You can dictate an entire H&P in 5-10 minutes.

3) You'll get better; way better, in fact better than your categorical colleagues, because you'll (likely) have so much more inpatient time than them. Just wait.

4) And after this year, things will get way better, because - while neurology PGY2 year is certainly busy - you won't take care of such complicated patients. That decompensated cirrhotic with AKI/HRS, 35 plts, HgB 8, COPD, and CHF coming in with a fever, leukocytosis, and AMS? "Too medically complicated for neurology, will follow along as a consult."

Intern year is tough, as is PGY2 year, and all of residency. But if you really like neurology, you'll be fine. Take this time to master your craft of medicine and get to the point where you can treat the basics. Ultimately, that's all you need from intern year.

 

[Giovanotto]

Post above me is gold. I feel the exact same way OP, but I am glad so many posters on here are giving sage advice! I was feeling like a complete ***** last month, and then realized medicine interns spent a lot of 4th year doing medicine Sub-Is...