Is surgery mentally stimulating?

[Archdelux]

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Hello everyone,

I haven't chosen a specialty yet or even started clinical rotations, but I have always been going back and forth with surgery.

One of the things that I love about Internal Medicine is the puzzle--figuring out what's wrong with the patient, and putting the pieces (the symptoms) together.

On the other hand, I love working with my hands and all that surgery entails. Does surgery (and feel free to go into the various sub-fields) offer a lot of mental stimulation like medicine does? An ideal field will be one that has the best of both--LOTS of procedures and surgeries and a lot of 'puzzles' to solve.

Thanks for the advice!

 

[SocialistMD]

I think the field of medicine is about solving puzzles no matter what the specialty. Playing "find the lesion" is a popular game amongst neurologists. Internal medicine can turn into an episode of house, and pediatrics is a lot like being a vet in that many children cannot yet communicate a history that is at all helpful. Surgery, too, has its diagnostic dilemmas, although most are solved by an imaging study. However, there are added treatment dilemmas that, while requiring a less Holmsian character, can still be quite interesting. Plus, you really get to "cure" people (vs medicine, which I still contend prolonging a death or complication of CHF with medical treatment isn't curing breast cancer with an R0 resection).

If you are really into problem solving, look into emergency medicine. You'll find that most of the detective work is done by the emergency room, with consults to the necessary services placed after the diagnosis is mostly made. Plus, they do quite a few procedures.

Each field has a positives and negatives. A quick and dirty way to figure out what you should do is this: at the end of each rotation, think about what you hated the most about that rotation and decide if you could get up every morning knowing that is all you would be doing that day. If your answer is yes, that is the field for you.

 

[Mango]

It depends on what you find mentally stimulating...

For instance: do you want to sit around a table for an hour discussing which antibiotic to use for a hospital aquired pneumonia, or would you rather work up a pt with abdominal pain, order studies based on your H&P, evaluate the films/labs, and then make a treatment plan which may or may not send a person into the OR where you personally will try to fix the problem?

Would you rather debate the cause of the pt's hyponatremia, or renal tubular acidosis, or discuss whether they have an acute process requiring operation?

In the end, medicine people will tell you that they are the more cerebral specialty; but if you think surgery isn't mentally challenging, you're wrong. Although I am very biased, to me surgery is the diagnostic skills of an internist PLUS the surgical skills to effect a change in many disease processes.

Just my opinion,
Mango
PGY3 General Surgery

 

[uclachris]

In the end, medicine people will tell you that they are the more cerebral specialty; but if you think surgery isn't mentally challenging, you're wrong. Although I am very biased, to me surgery is the diagnostic skills of an internist PLUS the surgical skills to effect a change in many disease processes.

Could not agree more. As well, given my limited experiences as a student, surgery is a field where there is an expectation of solving all problems which impact the patient now. Pt with Fever? Treat it and figure out the source. Pleural Effusion? Drain it then figure out the reason. This is not to say that IM people don't do that but I can ennumerate many instances where such things have been done in the opposite manner (or not even managed) while the IM attending was "trying to figure something out."

If it's the puzzle and the Housian thing you want, then IM is for you. Add some procedures by sub-specializing. If you want to be procedure heavy, there are many fields that will offer you this and there will be smaller, sometimes simpler, puzzles to be solved (i.e. DDx with maybe 5 things instead of 15).

If you really want to be "cerebral" then there is always academic medicine/surgery where you find one or two problems to study in depth... But that's another story.

 

[MS3er]

I'll throw in my two cents as well, being an MS4 that decided to go into surgery. Something I appreciate about surgery over IM is that the discussions you have about patient care are more directly pertinant and do not often regress to the point of hypothetical-absurdity. For example, in IM if a patient has hypokalemia you might spend the next 30 minutes discussing the 15 different causes of hypokalemia (12 of which you might not ever even see), wheras in surgery your more likely to get the response of "dude his K is low because he hasn't eaten in 3 weeks, go replace it and lets more on to something more relavent."

I think the mental challenges (or "puzzles" if you will) in surgery are in part in perfecting what your doing. Whether its a lap chole or a whipple, if your the kind of person that always finds yourself thinking about how you can do things more effciently, quicker, better, and with less morbidity than that becomes a mental challenge to you. The challenge is in the perfection. I also think post-operative care, particularly of complications (like fistulas or leaks for example) requires quite a bit of 'mental puzzles' and weight pros/cons of a particular course of action. The puzzles might present themselves after a diagnosis is made, but they are there nonetheless.

 

[filter07]

I disagree that Emergency Medicine is intellectually stimulating. I feel that too much of Emergency Medicine involves the kitchen sink approach and most times you rule out a few things and never really find out what the true cause of the symptoms were. I can't comprehend how that can ever be intellectually stimulating at all.

 

[Blade28]

For instance: do you want to sit around a table for an hour discussing which antibiotic to use for a hospital aquired pneumonia, or would you rather work up a pt with abdominal pain, order studies based on your H&P, evaluate the films/labs, and then make a treatment plan which may or may not send a person into the OR where you personally will try to fix the problem?

Would you rather debate the cause of the pt's hyponatremia, or renal tubular acidosis, or discuss whether they have an acute process requiring operation?

Well put! Couldn't have said it better myself! 👍

 

[lennox23]

in medicine there are "thinkers" and there are "doers"

we (surgeons), although mostly "doers", also "solve puzzles", a whole service full of them, just before seven AM!

then move on to the "doing" of fixing them.

 

[SocialistMD]

For instance: do you want to sit around a table for an hour discussing which antibiotic to use for a hospital aquired pneumonia, or would you rather work up a pt with abdominal pain, order studies based on your H&P, evaluate the films/labs, and then make a treatment plan which may or may not send a person into the OR where you personally will try to fix the problem?

in medicine there are "thinkers" and there are "doers"

we (surgeons), although mostly "doers", also "solve puzzles", a whole service full of them, just before seven AM!

then move on to the "doing" of fixing them.

Way to perpetuate the stereotype...🙄

It's funny, but being in the emergency room has made me appreciate internists more than I ever did. For as much as we general surgeons feel we get dumped on from every service, the internal medicine service is actually the true dumping ground; every patient that doesn't have an acute surgical issue or a complication from a procedure (even if they have a very complicated surgical history) is sent to the medicine service. As much as I hate admitting that face trauma to the general surgery service when his only hospital issues are a ruptured globe (Ophtho) and a maxillary fracture (PRS), it sure is better than taking the abdominal disaster with "something" causing pain that doesn't show up on the scan or in her labs.

I would argue that surgeons do not have the diagnostic skills of the internist. If we can't find a lesion to define pain, it is just abdominal pain NOS. Internists then take over to make the diagnosis of fibromyalgia or whatever other chronic pain syndrome it may be. Well, maybe we have the skills, we just lack the desire to do it because it isn't something we can treat...

 

[msl2007]

Of course you solve puzzles! Ones with many pieces that you get to take apart and put back together!

seriously, I had the same concern and was considering going into the diagnosis of rare congenital diseases-and then I realized that once I made a diagnosis, little could be done. Now that I am through 4th year surgery, I am more intellectually stimulated than I realized that I could be. I asked my resident-mentor the same question that you have asked and she also said that she feels very stimulated.

hope that helps!

 

[spicysoup55]

What surgery subspecialty is the most intellectually stimulating?

 

[Winged Scapula]

What surgery subspecialty is the most intellectually stimulating?

That depends on what YOU find stimulating, no?

 

[spicysoup55]

That depends on what YOU find stimulating, no?

I agree certain people may find certain organ systems or certain surgical techniques to be more simulating. In a broader sense, I think intellectual stimulation comes from 1) diagnosing and figuring out what is wrong with a patient and 2) deciding on the optimal treatment plan. So I guess to make my question more specific:
-What surgical specialties are diagnosis-heavy?
-What surgical specialties have the most options for treatment?

 

[massmocha]

If you are interested in the stimulation of complex diagnoses, you might prefer an interventional medical specialty more than surgery. Their emphasis is usually on diagnosis and balancing medical versus interventional treatments.

 

[Winged Scapula]

If you are interested in the stimulation of complex diagnoses, you might prefer an interventional medical specialty more than surgery. Their emphasis is usually on diagnosis and balancing medical versus interventional treatments.

Not so much.

Perhaps you had a skewed experience but most surgeons spend a considerable amount of time working patients up and making the diagnosis. That's especially true for me: the majority of the patients come to me undiagnosed.

There obviously exceptions, but it's not as if every patient walks in the door with a complete work up, diagnosis and surgical plan in hand. In addition many patients we see either don't need or qualify for surgery, or would benefit from a non invasive treatment.

 

[Pir8DeacDoc]

Biased response upcoming..

I think otolaryngology is the perfect mix of medicine and surgery. Because there is no medical equivalent of what we do, we get to manage things both medically and when necessary surgically. Speaking in generalizations, We aren't as cerebral or pontificating as a medicine doctor and not as "surgery is the only thing we do" as an orthopod. Another upside of this is it gives us the flexibility to have a medical only practice as we age. Like any speciality there are annoyances. But overall I like my position in the medical world.

/biased opinion over

 

[ACSurgeon]

Biased response upcoming..

I think otolaryngology is the perfect mix of medicine and surgery. Because there is no medical equivalent of what we do, we get to manage things both medically and when necessary surgically. Speaking in generalizations, We aren't as cerebral or pontificating as a medicine doctor and not as "surgery is the only thing we do" as an orthopod. Another upside of this is it gives us the flexibility to have a medical only practice as we age. Like any speciality there are annoyances. But overall I like my position in the medical world.

/biased opinion over

I've always heard this about urology/ent/gyn having a great medical-surgical mix. The thing is, it's mostly one specialty or organ system that you address medically and surgically. At least for me, I wanted to be as close as possible to an internist in knowledge while having surgical skills. General surgery (+critical care in my case) gives you a lot of general medicine knowledge while training you to operate.

We never reach IM level knowledge. I like to think most of what we don't learn are things that are rare or not really clinically relevant, but I know that's not true.

 

[massmocha]

Not so much.

Perhaps you had a skewed experience but most surgeons spend a considerable amount of time working patients up and making the diagnosis. That's especially true for me: the majority of the patients come to me undiagnosed.

There obviously exceptions, but it's not as if every patient walks in the door with a complete work up, diagnosis and surgical plan in hand. In addition many patients we see either don't need or qualify for surgery, or would benefit from a non invasive treatment.

I guess I am skewed by my ortho rotations. I can't say I often see what I would call "complex diagnoses."

1) Clinic is usually something along the lines of: review imaging, history, physical exam, diagnosis. Surgical candidate: yes/no.
2) Trauma rotations were mostly: this bone is broken, we will fix it tomorrow morning or cast it and send you home for fixation next week.

Not nearly as much ambiguity as on my medicine rotations when a lot of the time we had no idea what it was we were treating and had to constantly re-evaluate. Certainly most people come in undiagnosed to ortho, but I most often observed the "intellectual stimulation" in the planning phase and operating room when the surgeons were trying to approach the problem of how best to surgically repair the injury, not how best to diagnose it.

 

[Dr.LeoSpaceman]

Nobody sees complex diagnoses.

There are indeed few "mysteries" anymore. It's not common that the diagnosis is in doubt. However, surgery is mentally stimulating not in trying to figure out the problem, but in deciphering the how to implement a specific solution. I don't know if it's a surgical maxim, but if you hear "It's just an [insert procedure]" before a case, it's guaranteed to be horribly complicated and not straightforward at all. Every case has it's own complexities, and can present it's own challenges. That's one of the reasons it can be fun.

I'd also say the complexity of the decision making is one of the reasons I enjoy surgical oncology. Some of it is algorithmic, but there are always those cases that don't fit neatly in the box. And if I had to pick a conference to go to for the rest of my life, it would certainly be a tumor board/surg onc pre-op planning conference.

 

[ACSurgeon]

There are indeed few "mysteries" anymore. It's not common that the diagnosis is in doubt. However, surgery is mentally stimulating not in trying to figure out the problem, but in deciphering the how to implement a specific solution. I don't know if it's a surgical maxim, but if you hear "It's just an [insert procedure]" before a case, it's guaranteed to be horribly complicated and not straightforward at all. Every case has it's own complexities, and can present it's own challenges. That's one of the reasons it can be fun.

I'd also say the complexity of the decision making is one of the reasons I enjoy surgical oncology. Some of it is algorithmic, but there are always those cases that don't fit neatly in the box. And if I had to pick a conference to go to for the rest of my life, it would certainly be a tumor board/surg onc pre-op planning conference.

And as others mentioned, post-op management tends to be unpredictable. A patient not progressing as they should can have a million different problems. Post-op management of patients is certainly more mentally stimulating than working on disposition for grandma admitted with her third PNA this month.

 

[KinasePro]

The "cerebral" vs "non-cerebral" specialty discussion always grinds my gears. Just another example of posturing that pits us against one another.

There are cook book doctors in every single field--- from IM to general surgery, derm, ortho, etc... Likewise, there are thoughtful, compassionate, and "cerebral" physicians in every field. IMO, the difference in cognitive decision making between medical and surgical fields is that surgeons obsess over treatment (how to fix, who to fix, etc....) and medical specialties obsess over prevention, diagnosis, and management of chronic conditions.

There are countless subtleties in all fields that are lost on practitioners outside of said field. For example, some people deride urologists as glorified plumbers, completely ignoring the thoughtful research and decision making that goes into managing uro-onc/incontinence/infertility. Ortho is everyone's favorite field to deride (mostly our own fault 😉), but few practitioners outside of the field appreciate the complicated controversies in joint revision, trauma, spine, sports, and ortho onc to name a few.

I guess what I'm trying to say, is that it all boils down to each physician. You can be a technician in any field, and you can be an expert, "cerebral" physician in any field as well. It all depends on how much of yourself (and your brain) you invest in your craft.

 

[ACSurgeon]

The "cerebral" vs "non-cerebral" specialty discussion always grinds my gears. Just another example of posturing that pits us against one another.

There are cook book doctors in every single field--- from IM to general surgery, derm, ortho, etc... Likewise, there are thoughtful, compassionate, and "cerebral" physicians in every field. IMO, the difference in cognitive decision making between medical and surgical fields is that surgeons obsess over treatment (how to fix, who to fix, etc....) and medical specialties obsess over prevention, diagnosis, and management of chronic conditions.

There are countless subtleties in all fields that are lost on practitioners outside of said field. For example, some people deride urologists as glorified plumbers, completely ignoring the thoughtful research and decision making that goes into managing uro-onc/incontinence/infertility. Ortho is everyone's favorite field to deride (mostly our own fault 😉), but few practitioners outside of the field appreciate the complicated controversies in joint revision, trauma, spine, sports, and ortho onc to name a few.

I guess what I'm trying to say, is that it all boils down to each physician. You can be a technician in any field, and you can be an expert, "cerebral" physician in any field as well. It all depends on how much of yourself (and your brain) you invest in your craft.

Agree. Ortho conferences are very cerebral and seems like a different language for an outsider. not managing any of the non-ortho issues doesn't make one non-cerebral. Just means you're very focused on your specialty.

 

[rigid]

I find decision making around tailoring operative intervention to patient needs to be extremely enjoyable. A lot of times you have to think about how to best approach a tumour for example and depending on location and patient co-morbidities etc you think of an operative plan then you actually get to do it and see the outcome

 

[KinasePro]

Quit it.

The first rule of Fight Club is...

You're right, my bad. Bone is broken... Ortho fix bone.

 

[jl lin]

Hello everyone,

I haven't chosen a specialty yet or even started clinical rotations, but I have always been going back and forth with surgery.

One of the things that I love about Internal Medicine is the puzzle--figuring out what's wrong with the patient, and putting the pieces (the symptoms) together.

On the other hand, I love working with my hands and all that surgery entails. Does surgery (and feel free to go into the various sub-fields) offer a lot of mental stimulation like medicine does? An ideal field will be one that has the best of both--LOTS of procedures and surgeries and a lot of 'puzzles' to solve.

Thanks for the advice!

IM to Critical Care Medicine: adults and peds. 🙂 Seriously, a lot of thinking goes on in the intensive care units.

 

[jl lin]

Nobody sees complex diagnoses. There is no Dr. House. They run the algorithm, make the diagnosis, and treat it. Medicine just pretends like there's a puzzle because they don't do much for treatment beyond write an order in the chart. The only "puzzle" is why they take so long to write their notes.

Wow Tired. LOL

Anyway, the ability to treat is sort of a relative thing. I remember I was recovering a CT Fellow's CABG patient, and He looked at me and smiled and stated, "We cured him." I smiled back and said, "No. You successfully modified him. Now he needs other things to treat his underlying diseases." And those physicians that are successfully involved in helping such patients, when possible, are in fact adjusting for particulars in their diagnoses and treating them as well. It's still quite a road for the successfully surgically treated cardiac patient with DM, HTN, COPD, etc. And some of these folks are complex for other reasons--as in a number of pediatric patients. The co-morbidities complicate the picture and make them more complex. If they were not and this was not a concern, I suppose they might be fine with an NP or PA managing them. But since they are, in many, many cases, I am not comfortable with that level of treatment for this kind of patients--and they are not as few in number as people want to think.

Sorry. I am really considered a bit of a nobody here; but I found this thread interesting. I agree, from what I've seen, that both surgery and medicine involves solving puzzles--and hopefully looking not merely at algorithms, but the peculiarities and specifics of the individual patients.

I suspect the writing of the notes has to do with all the various details they must include, alone with the large number of patients they must see. But I am trying to be kind. 😉

 

[dienekes88]

If you are interested in the stimulation of complex diagnoses, you might prefer an interventional medical specialty more than surgery. Their emphasis is usually on diagnosis and balancing medical versus interventional treatments.

Not sure I agree. When your reimbursement is directly linked to how many interventional treatments you perform, the amount of medical management is limited.

I find decision making around tailoring operative intervention to patient needs to be extremely enjoyable. A lot of times you have to think about how to best approach a tumour for example and depending on location and patient co-morbidities etc you think of an operative plan then you actually get to do it and see the outcome

Operative planning can be quite tricky. Congenital heart surgery is crazy in that respect. I would say mitral valve repair is similar and complex aortic lesions too.

Every field has its routine stuff that ends up being just that routine. Most gallbladders don't require extensive operative planning. Similarly, the 55 year old hypertensive who needs a second agent doesn't really require complex decision making.

 

[Pir8DeacDoc]

Not sure I agree. When your reimbursement is directly linked to how many interventional treatments you perform, the amount of medical management is limited.

Wow, you don't have a lot of faith in the ethics of your fellow physicians.

 

[Pir8DeacDoc]

I'm guess that you haven't (1) read the literature on coronary stenting and (2) spent time with a Cardiologist.

Both of those would be correct. Enlighten me on what I would find if I did....

Maybe at the early part of my career I'm showing my naivete, but I like to think people make the best decisions for patients based on the best decisions and not $$. I realize there are outliers, but everyone I work with generally seems honest.

 

[addy]

Stents do not improve mortality, even drug eluting stents. CABG does (30% or more). But Cardiologists can place stents, and can't crack a chest, so they keep putting them in.

It's the same in every specialty. My own continues to scope arthritic knees, despite truly excellent data (including a sham surgery study) that this does nothing, or maybe makes some people worse.

I'm not saying proceduralists are unethical or motivated by money. But when you have a hammer, and the patient wants you to put in a nail...

I keep reading this, that stents require more revasculrization compared to CABG...why isn't the trend going to other way with regards to cabg vs stent?

my uncle is about to get a stent put in and i almost want to talk him into getting a CABG instead.

 

[dienekes88]

Both of those would be correct. Enlighten me on what I would find if I did....

Maybe at the early part of my career I'm showing my naivete, but I like to think people make the best decisions for patients based on the best decisions and not $$. I realize there are outliers, but everyone I work with generally seems honest.

It's not a crisis of faith in my fellow physicians or that people are being grossly dishonest. It's more a recognition that we are all captives of a healthcare system that values interventions more than outcomes.

I don't see people going crazy with absurd interventions for the sake of a buck.

Stents do not improve mortality, even drug eluting stents. CABG does (30% or more). But Cardiologists can place stents, and can't crack a chest, so they keep putting them in.

It's the same in every specialty. My own continues to scope arthritic knees, despite truly excellent data (including a sham surgery study) that this does nothing, or maybe makes some people worse.

I'm not saying proceduralists are unethical or motivated by money. But when you have a hammer, and the patient wants you to put in a nail...

Impressive. You know what they say. The heart is the most important organ in the body. It pumps antibiotics to the bones!

It's a little more specific than that. Stents have not been shown to improve mortality over optimal medical therapy in stable coronary disease (COURAGE and FAME-2). CABG has been shown to be superior to coronary stenting time and again; the most recent data is from FREEDOM (Diabetics) and SYNTAX 5y f/u (LM or 3V dz).

For better or worse, the real world patients don't always fit the mold as proposed by the studies, and there is a very significant gray zone. Angiographically determined 3V disease is not always consistent with FFR-directed evaluation of disease (maybe one or even two of those stenoses isn't actually significant). Additionally, mortality is not the only clinically important end point. In the COURAGE trial, patients did have symptomatic improvement, and patients had a decreased need for urgent revascularization in the FAME-2 trial though there was no difference in myocardial infarction.

 

[dienekes88]

I dunno what this "antibiotic" thing is that you're talking about, but the heart does pump Ancef well. And Ancef is good, because it only has 5 letters, so I don't usually misspell it.

While I respect the scientific rigour that you guys in the medical world have with your large studies, I have never been able to get over your insistence on creating crazy names just for the sake of a fancy acronym.

I think the crazy acronyms are freakin' awesome. REMATCH. MIRACLE. INTRePID. ASCERT. I could go on...

This is a dangerous line of reasoning, but arguably more common in my world than yours. "Well the studies don't show a benefit, but this patient is a little different, so..." The answer may be, "...maybe they'll actually get benefit from the intervention." But it could just as easily be, "...so this intervention could well kill the guy." We always seem to unconsciously presume that the "missing" evidence for our specific situation is positive, but there's no particularly reason that this should be true. It may well be very negative. But that thought never comes into our heads. It probably should.

It is a dangerous line of reasoning, but that is one of the big difficulties in cardiology and cardiac surgery. I went into this field partly because there was so much research and things were becoming so well defined. Little did I know that things aren't as simple as they appear. Even the simplest thing like indications for an aortic valve replacement are only Class I, Level of Evidence B. With the amount of stuff that is coming out, the studies and the data are always going to be years behind.

And believe me, I'm not knocking your field. My grandmother died 5 days after her CABG of a massive stroke. In her case, I think I would have preferred a stent, but hindsite is always a ballkicker.]

I'm sorry for your loss.

However, I'm confused, because my field is the one that performs CABGs.

 

[deleted547339]

I asked this same question when I was in med school. I remember getting some great advice:

The longer you do something, the less intellectually difficult it gets. Do a job where you enjoy the day to day practice.

I know that seems very basic, but I believe it's true. Once you've done cards or ortho or general surgery for 20 years, it's not interesting, per se. You may love reading EKGs or nailing tibias or fixing hernias, but that's probably not going to "interest" you in the same way it does a med students. Once you have a particular knowledge base or skill set, using it becomes basic.

If you like medically optimizing CHF patients, do cards; if you like total joints, fractures and quick clinic, do ortho; if you like doing lap chole's, do gen surg.

Personally, I like being in the ER. I like seeing acute problems, diagnosis and treating when appropriate and dispo'ing.

 

[addy]

I asked this same question when I was in med school. I remember getting some great advice:

The longer you do something, the less intellectually difficult it gets. Do a job where you enjoy the day to day practice.

I know that seems very basic, but I believe it's true. Once you've done cards or ortho or general surgery for 20 years, it's not interesting, per se. You may love reading EKGs or nailing tibias or fixing hernias, but that's probably not going to "interest" you in the same way it does a med students. Once you have a particular knowledge base or skill set, using it becomes basic.

If you like medically optimizing CHF patients, do cards; if you like total joints, fractures and quick clinic, do ortho; if you like doing lap chole's, do gen surg.

Personally, I like being in the ER. I like seeing acute problems, diagnosis and treating when appropriate and dispo'ing.

As a MS-3, thank you for sharing that. Great advice, one that I figured was true but had never heard articulated as such.

 

[doc05]

I asked this same question when I was in med school. I remember getting some great advice:

The longer you do something, the less intellectually difficult it gets. Do a job where you enjoy the day to day practice.

I know that seems very basic, but I believe it's true. Once you've done cards or ortho or general surgery for 20 years, it's not interesting, per se. You may love reading EKGs or nailing tibias or fixing hernias, but that's probably not going to "interest" you in the same way it does a med students. Once you have a particular knowledge base or skill set, using it becomes basic.

If you like medically optimizing CHF patients, do cards; if you like total joints, fractures and quick clinic, do ortho; if you like doing lap chole's, do gen surg.

Personally, I like being in the ER. I like seeing acute problems, diagnosis and treating when appropriate and dispo'ing.

very true. so depending upon how you define "mentally stimulating", perhaps nothing in medicine truly is. Very little room for creativity unless youre into research etc.

 

[mercaptovizadeh]

If I lived forever, or at least a very long time, after doing IM-peds, I would then do Gen Surg followed by CT and peds fellowships. But I don't live forever, and my research interests are in basic science WAY outside of the realm of surgery, so that didn't make sense. But if I do decide that it makes sense to work abroad and give up on research and US medicine, I might reconsider doing that gen surg residency 😉 4+7 (+2+2) years...

There's intellectual stimulation in many fields. I do think you'll encounter more in IM or peds or a more diagnostic field because you generally see the patient before they are differentiated (unless the ED does that already), so you will indeed see surgical illness that you need to competently diagnose and medically manage and appropriately refer to surgery. Surgery tends to be so busy that I would think many medical issues they come across they would refer back to the PCP for workup rather than ordering the diagnostic tests themselves and sending to the appropriate specialist. But that's OK, they are focused on surgery, and do surgery well, and we're focused on diagnosing undifferentiated disease.

 

[mercaptovizadeh]

Nobody sees complex diagnoses. There is no Dr. House. They run the algorithm, make the diagnosis, and treat it. Medicine just pretends like there's a puzzle because they don't do much for treatment beyond write an order in the chart. The only "puzzle" is why they take so long to write their notes.

I don't know where you got the idea that we don't do anything. We do plenty. We just don't use scalpels, suture, and suction to do it.

 

[thedrjojo]

If I lived forever, or at least a very long time, after doing IM-peds, I would then do Gen Surg followed by CT and peds fellowships. But I don't live forever, and my research interests are in basic science WAY outside of the realm of surgery, so that didn't make sense. But if I do decide that it makes sense to work abroad and give up on research and US medicine, I might reconsider doing that gen surg residency 😉 4+7 (+2+2) years...

There's intellectual stimulation in many fields. I do think you'll encounter more in IM or peds or a more diagnostic field because you generally see the patient before they are differentiated (unless the ED does that already), so you will indeed see surgical illness that you need to competently diagnose and medically manage and appropriately refer to surgery. Surgery tends to be so busy that I would think many medical issues they come across they would refer back to the PCP for workup rather than ordering the diagnostic tests themselves and sending to the appropriate specialist. But that's OK, they are focused on surgery, and do surgery well, and we're focused on diagnosing undifferentiated disease.

Most medical guys have no clue how to competently diagnose surgical disease

 

[mercaptovizadeh]

Most medical guys have no clue how to competently diagnose surgical disease

Perhaps true. But don't flatter yourself that you surgery guys are any better at medical diagnosis or management.