Missing Clinical Medicine

[whispers]

Am I the only future pathologist who will miss pateint contact?
Please is someone else out there

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[Gut Shot]

What are you talking about? Every morning I have little slabs of patients all over my desk. And in pretty colors!

 

[gbwillner]

Am I the only future pathologist who will miss pateint contact?
Please is someone else out there

I will also miss it. But in my dealings with residents of other specialties, many of them get tired of it anyway.

 

[docbiohazard]

I'll miss some of it. I'll miss the patients that smile, that get better, that thank me... the ones with good senses of humor that I really feel like I helped.

I won't miss the ones that cursed me, refused to make even the slightest effort to improve their health or comply with therapy, or died without ever having a proper diagnosis.

It's those last ones that I hope to help more through my work as a pathologist and a researcher. I also think that the "novelty" of direct patient interaction greatly wore off over my third year rotations.

It's a tough decision, to give up the direct patient care - well, tougher for some than for others - but ultimately I think you have to think over the long term what you'll find more rewarding.

BH

 

[yaah]

I feel like I have more human interaction as a path resident than I ever did on the floors when I spent most of my time filling out paperwork, walking from place to place, and waiting on hold on the phone.

Most people enjoy some characteristic of patient care and direct patient interaction, but most also don't really miss it. Our job still is patient care, we just usually don't directly talk to the patients. Do you really want to talk to patients a lot though? In my last month of med school I remember a conversation with a patient in which we spent 45 minutes talking about how she couldn't find the apple she had been eating before she fell down the stairs, and another one in which the patient thought I was from the chinese secret service and was trying to murder her (I am the farthest thing from Chinese). Sometimes though, I would rather deal with even difficult patients as opposed to difficult self-entitled physicians.

 

[mlw03]

of course you're not the only one who'll miss patient contact. like everything in life, you have to weigh things and decide. if you'll miss patient contact that much, path might not be for you.

if docbiohazard hadn't already posted such a well-said piece, i'd have posted something very similar, that's basically how i feel. and in my experience there's far more difficult patients than appreciative ones. i think most pathologists miss the nice patient who gets lupus (or some other disease that isn't their own fault). but i definately won't miss the 250 lb dude with a 65 pack-year smoking history who presents for a COPD exacerbation - and then is missing when you do morning rounds because he went down for a smoke!! i agree with yaah in that i know that by becoming a pathologist i'll still be contributing to patient care, just in a way that's better suited to my personality and skills.

 

[gbwillner]

of course you're not the only one who'll miss patient contact. like everything in life, you have to weigh things and decide. if you'll miss patient contact that much, path might not be for you.

if docbiohazard hadn't already posted such a well-said piece, i'd have posted something very similar, that's basically how i feel. and in my experience there's far more difficult patients than appreciative ones. i think most pathologists miss the nice patient who gets lupus (or some other disease that isn't their own fault). but i definately won't miss the 250 lb dude with a 65 pack-year smoking history who presents for a COPD exacerbation - and then is missing when you do morning rounds because he went down for a smoke!! i agree with yaah in that i know that by becoming a pathologist i'll still be contributing to patient care, just in a way that's better suited to my personality and skills.

or the jaundiced 30yo with hepatomegaly in the ER who drinks a bottle of vodka a day and can't understand what the problem is.

 

[Monsterello]

...or anyone with an Axis II diagnosis that drains the life out of you...

 

[deschutes]

...or anyone with an Axis II diagnosis that drains the life out of you...

Can't promise you won't get those in Path

If I ever get delusions of missing clinical medicine, reading the nursing notes for the last week of hospitalization while doing chart reviews for in-hospital autopsies is the fastest snap back to reality.

"Patient pointing to ETT and gesturing 'out'. Family remonstrating at bedside. Patient frustrated, hitting bedrail."

 

[docbiohazard]

"Patient requested removal of foley catheter, doctor notified. Patient D/C'd his foley catheter himself..."

 

[b&ierstiefel]

Am I the only future pathologist who will miss pateint contact?
Please is someone else out there

I don't miss patient contact. In fact, I get irritated by the fact that I have to share the same elevator as them such that I can't get to my floor directly each morning without stopping on every single floor between the lobby and my floor.

Really, patient contact is so overrated. Not that I hate it (the statement about the elevators is an overstatement since there are people who are too lazy to take the stairs to go up one floor who end up interrupting my trip to the top floor each morning) but I can certainly live without it.

I don't really care about patients' social problems or their emotional quibbles. I don't care that their kids aren't doing well in school. I don't care that their parents beat them or abandoned them and that's why they're depressed. I just don't care. Really.

And for god's sake...I really really don't give a hoot about adjusting their damn hypertensive and diabetic medication doses because their blood pressure and A1C levels are too high.

I just don't care. To hell with it all. I love the fact that I'm detached from all of that! I like focusing on the diseases, as much as that makes me sound like a callous person.

 

[Anna Plastic]

To the OP-- I did miss patient care when I went into AP/CP training (finishing fellowship in transfusion medicine now). During residency, I took every opportunity to get back to the bedside--I even spent a week in an OB clinic doing physical exams. Yes, everyone else, I hear you on the difficult patients, the personality disorders, etc...I still missed it. Patient interaction was very rewarding for me, and still is--I *do* like hearing about their lives, what they think the impact of their health is on their family. In transfusion medicine, you have the opportunity to make the practice very patient interactive. I evaluate patients for transfusion reactions, I work up patients for therapeutic apheresis, and I round with heme/onc, trauma surgery, pediatric, and ICU teams frequently. I also consent patients for clinical trials and work with benign hematologists in working up patients and families with platelet disorders, directly performing medical history interviews and incorporating this information into final reports.

It is very rewarding to work with these patients. They are grateful for the interest and time spent explaining their problems. I think I have one of the best jobs on the planet--both laboratory medicine AND patient contact. My job satisfaction is incredibly high. And the clinicans I work with are all very happy to find a pathologist who seems to care about working directly with patients--believe me, this earns you a lot of credibility points, and goes a long way in promoting the pathology department where you are at.

So don't fear--if patient contact means a lot to you, you can have some form of it in pathology. Within reason, you can shape and mold your career to your strengths and interests if you are motivated enough.

 

[yaah]

I don't miss patient contact. In fact, I get irritated by the fact that I have to share the same elevator as them such that I can't get to my floor directly each morning without stopping on every single floor between the lobby and my floor.

I hate those people. We have a parking garage here that has "half" floor stops on the elevator. A half a floor is literally 15 steps, it takes about three times as long to get on the elevator, push the button, have the door close, etc, as it does to take the 15 steps. But if I ever try to take the elevator if I have to go 3 full flights or something to "try" to save time, some bozo gets on and pushes "1a" and then someone gets on yelling "HOLD THE ELEVATOR" and they push "2". I think there should be a law against yelling "Hold the elevator" and then getting on and pushing a button below the lowest level that is already lit. Or at the very least, the law should allow those already on the elevator to take vengeance.

 

[b&ierstiefel]

I hate those people. We have a parking garage here that has "half" floor stops on the elevator. A half a floor is literally 15 steps, it takes about three times as long to get on the elevator, push the button, have the door close, etc, as it does to take the 15 steps. But if I ever try to take the elevator if I have to go 3 full flights or something to "try" to save time, some bozo gets on and pushes "1a" and then someone gets on yelling "HOLD THE ELEVATOR" and they push "2". I think there should be a law against yelling "Hold the elevator" and then getting on and pushing a button below the lowest level that is already lit. Or at the very least, the law should allow those already on the elevator to take vengeance.

Wow...I guess there's someone else on this planet who has thought about this as much as I have.

 

[deleted113029]

I don't miss patient contact. In fact, I get irritated by the fact that I have to share the same elevator as them such that I can't get to my floor directly each morning without stopping on every single floor between the lobby and my floor.

Really, patient contact is so overrated. Not that I hate it (the statement about the elevators is an overstatement since there are people who are too lazy to take the stairs to go up one floor who end up interrupting my trip to the top floor each morning) but I can certainly live without it.

I don't really care about patients' social problems or their emotional quibbles. I don't care that their kids aren't doing well in school. I don't care that their parents beat them or abandoned them and that's why they're depressed. I just don't care. Really.

And for god's sake...I really really don't give a hoot about adjusting their damn hypertensive and diabetic medication doses because their blood pressure and A1C levels are too high.

I just don't care. To hell with it all. I love the fact that I'm detached from all of that! I like focusing on the diseases, as much as that makes me sound like a callous person.

you've just summed up my philosophy on clinical medicine.

there's one additional thing i've hated about the elevator story; people taking the elevator 1 floor down when they could easily use gravity to take their fat asses down those steps.

 

[mlw03]

would anyone advise being this blunt with the answer to, "are you going to miss patient contact" that i'll inevitably hear during residency interviews? i personally don't feel quite this extreme, but i want to phrase my answer so i strike a balance between someone who hates human beings with the fire of a thousand suns, but i don't want to sound like i'll miss it so much that maybe pathology isn't for me. the best answer i can come up with is a simple, "while there are a few parts of direct patient care i think i'll miss, these are far outnumbered by things i know i won't miss" and if the interviewer cares for me to elaborate about each i can certainly do so. any thoughts about how such an answer would come across?

I don't miss patient contact. In fact, I get irritated by the fact that I have to share the same elevator as them such that I can't get to my floor directly each morning without stopping on every single floor between the lobby and my floor.

Really, patient contact is so overrated. Not that I hate it (the statement about the elevators is an overstatement since there are people who are too lazy to take the stairs to go up one floor who end up interrupting my trip to the top floor each morning) but I can certainly live without it.

I don't really care about patients' social problems or their emotional quibbles. I don't care that their kids aren't doing well in school. I don't care that their parents beat them or abandoned them and that's why they're depressed. I just don't care. Really.

And for god's sake...I really really don't give a hoot about adjusting their damn hypertensive and diabetic medication doses because their blood pressure and A1C levels are too high.

I just don't care. To hell with it all. I love the fact that I'm detached from all of that! I like focusing on the diseases, as much as that makes me sound like a callous person.

 

[Zuwie]

My answer to such a question was: "I like the scientific aspects of pathology so much that I would be willing to give up direct patient contact"

would anyone advise being this blunt with the answer to, "are you going to miss patient contact" that i'll inevitably hear during residency interviews? i personally don't feel quite this extreme, but i want to phrase my answer so i strike a balance between someone who hates human beings with the fire of a thousand suns, but i don't want to sound like i'll miss it so much that maybe pathology isn't for me. the best answer i can come up with is a simple, "while there are a few parts of direct patient care i think i'll miss, these are far outnumbered by things i know i won't miss" and if the interviewer cares for me to elaborate about each i can certainly do so. any thoughts about how such an answer would come across?

 

[deleted113029]

would anyone advise being this blunt with the answer to, "are you going to miss patient contact" that i'll inevitably hear during residency interviews? i personally don't feel quite this extreme, but i want to phrase my answer so i strike a balance between someone who hates human beings with the fire of a thousand suns, but i don't want to sound like i'll miss it so much that maybe pathology isn't for me. the best answer i can come up with is a simple, "while there are a few parts of direct patient care i think i'll miss, these are far outnumbered by things i know i won't miss" and if the interviewer cares for me to elaborate about each i can certainly do so. any thoughts about how such an answer would come across?

if you receive passes on your clinical rotations, then you won't have to worry about answering that question.

don't worry about answering that question on your interviews. i had one interviewer out of 60 ask and i replied, "No." They just chuckled and said, "I understand."

 

[Tetrad]

Just say "Actually you do get direct patient contact doing FNAs, bone marrows, and seeing to transfusion reaction/plasmapheresis patients"

That was my answer to the patient contact question during interviewing. They seemed to like the answer.

 

[Tetrad]

Just say "Actually you do get direct patient contact doing FNAs, bone marrows, and seeing to transfusion reaction/plasmapheresis patients"

That was my answer to the patient contact question during interviewing. They seemed to like the answer.

 

[b&ierstiefel]

you've just summed up my philosophy on clinical medicine.

there's one additional thing i've hated about the elevator story; people taking the elevator 1 floor down when they could easily use gravity to take their fat asses down those steps.

You're gonna be a bitter man come this summer then. You will grow to despise stopping on the 2nd floor!

You'll have to remind me to show you the "super-secret" elevator when you get here though...those ones the patients don't use and you get to the desired floor directly.

There's also the fireman pole (aka, batman pole) that takes you straight from the 3rd floor to the frozen section room.

 

[mlw03]

There's also the fireman pole (aka, batman pole) that takes you straight from the 3rd floor to the frozen section room.

if this is true i may have to apply and hope for an interview just for the chance to see such a cool thing!!

 

[DW]

Another thing I HATE about the elevator is when I'm waiting in the lobby, and by the time it comes and there is a massive crowd waiting to get on, the people still in the elevator stare at you blankly for ~10 second before saying to themsevles "Duhhhhh, I should get off the elevator". Get off the damn elevator, I'm already 5 minutes late for rounds!

 

[bubblegumbezoar]

Just remember that from one resident in a clinical residency to a spouse coming up into the third year now - "The path to happiness lies in going into a field that does not involve any patient care." Many nights when I am up in the ICU or in the ER at 3 AM from my nice warm bed, pathology thoughts dance all through my head.

 

[Gut Shot]

Or at the very least, the law should allow those already on the elevator to take vengeance.

The people here, particularly at county, have the habit of attempting to pile in to the elevator before the current occupants can get out. WTF people? I mean, come on!

 

[yaah]

The people here, particularly at county, have the habit of attempting to pile in to the elevator before the current occupants can get out. WTF people? I mean, come on!

That has always been an amusing thing to me about subways and trains, I always seem to have to get out of the way of people getting on before I can get off.

We have that problem with revolving doors here. That, and too many people trying to pile into revolving doors, so that the last person races on, but trips the little sensor at the back that says someone is too close to the back, so it stops it. I hate those people and I hate revolving doors.

Actually, in general, I don't like people. My wife and I share a common dislike of people (crowds, in particular). People on an individual basis, when you are talking, are ok, but in a crowd or when they are more anonymous (like in cars or getting on elevators or whatever) they truly suck. I often wish there were areas people who think they are more important than everyone else could go, then they could all deal with each other and the rest of us could take our time or just not have to deal with them. Like if you go into a supermarket, there should be three equal pathways to take:

1) dinguses and other self-obsessed *****s. Yes, YOUR time is crucial, probably more important than mine. Now get the hell out of my way.
2) *****s who can't figure out simple instructions or don't pay attention (or do things much too slowly). I know it's hard for you to pick out a salad dressing, but please just do it and move your ****ing cart out of the middle of the aisle.
3) Normal people.

I'm thinking of creating a new thread entitled "Why people suck." Today's reason: Because revolving doors should not be a difficult concept to master.

 

[mlw03]

Like if you go into a supermarket, there should be three equal pathways to take:

1) dinguses and other self-obsessed *****s. Yes, YOUR time is crucial, probably more important than mine. Now get the hell out of my way.
2) *****s who can't figure out simple instructions or don't pay attention (or do things much too slowly). I know it's hard for you to pick out a salad dressing, but please just do it and move your ****ing cart out of the middle of the aisle.
3) Normal people.

I'm thinking of creating a new thread entitled "Why people suck." Today's reason: Because revolving doors should not be a difficult concept to master.

great idea, yaah, but the problem is that people in 1&2 think they belong in 3.

 

[b&ierstiefel]

Another thing I HATE about the elevator is when I'm waiting in the lobby, and by the time it comes and there is a massive crowd waiting to get on, the people still in the elevator stare at you blankly for ~10 second before saying to themsevles "Duhhhhh, I should get off the elevator". Get off the damn elevator, I'm already 5 minutes late for rounds!

And there are the times when the elevator door is closing and somebody yells, "HOLD THE ELEVATOR" while sticking their arm through the closing gap of the elevator door. The elevator door reopens...and then seconds later...it happens again...and again...AND AGAIN!

 

[yaah]

And there are the times when the elevator door is closing and somebody yells, "HOLD THE ELEVATOR" while sticking their arm through the closing gap of the elevator door. The elevator door reopens...and then seconds later...it happens again...and again...AND AGAIN!

Meanwhile, by this point, buttons for all of the floors have been pressed.

******* of the day: I was parking my car this morning and an dingus was riding my tail (because apparently we should all be going 40 mph in a garage where you can't see around the corner and there is two way traffic in every part). After I pulled into my spot, he accelerated quite a bit, then tore around the corner and pulled into a spot that was a fraction closer to the door into the hospital. At this point, he proceeded to sit in his car and not get out. Good thing he was in such a hurry. People here do this all the time - they get to the garage early, I guess to get a good parking spot, and then sit in the car for quite some time (some people even pull in and then sleep for a bit). WTF?

 

[Primate]

At the risk of piling on (or kicking the down horse again), it's like dim sum and is all about choosing the "one from column A, two from column B" on the menu that best fits your day to day and long term interests (two different but v. important considerations).

I'll miss patient contact a ton, and even went so far as to interview in a clinical field as well. The interesting thing was that doing the interviews made it clear that I was that much more interested in Path, and knew it was where I belonged (so withdrew from others).

Are there parts (some of them LARGE) about direct patient contact that couldn't be worse, at least for me? Sure. But there are aspects that I really enjoyed (hard to believe, but I loved most of my rotations). For long term interest, though, Path has it over the others FOR ME.

Gotta pick a field where you like the majority of what you do, not every little piece. If I could do that, there would be some flying and fly-fishing as part of my rock-star attending position.

P

 

[fun8stuff]

Meanwhile, by this point, buttons for all of the floors have been pressed.

******* of the day: I was parking my car this morning and an dingus was riding my tail (because apparently we should all be going 40 mph in a garage where you can't see around the corner and there is two way traffic in every part). After I pulled into my spot, he accelerated quite a bit, then tore around the corner and pulled into a spot that was a fraction closer to the door into the hospital. At this point, he proceeded to sit in his car and not get out. Good thing he was in such a hurry. People here do this all the time - they get to the garage early, I guess to get a good parking spot, and then sit in the car for quite some time (some people even pull in and then sleep for a bit). WTF?

same thing happens where i am at...... heaven forbid they walk an extra 10-20 feet on their 500+ feet walk to the hospital!