sacrament

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I cannot decide what to do for a living. I just cannot do it. My enormous ego is preventing me from really committing myself to any field. For example: I thought internal medicine was fairly enjoyable. Had a pretty good time, liked thinking problems though, liked making the differential diagnosis, etc. Then a patient comes in with a maybe-acute-abdomen, so surgery consult comes and carts them off. HOLD ON, I wanna open ‘em up... oh wait, we’re the medicine team, we don’t know how to do that. Oh, but wait, same thing can happen to the surgeons! During esophagectomy, patient gets tear in the descending thoracic aorta—in comes the cardiothoracic guys! General surgery attending gets pushed to the back of the room where he stands pouting, arms crossed, because in this situation he doesn’t know what the f*** he’s doing. A patient on the neurosurg ward gets bizarre unexplained anemia and weird-looking peripheral smear and gotta call in the heme consult cause we don’t know anything about heme anymore. I have picked a career where I am doomed to be perpetually unsatisfied because nobody can do everything anymore. It’s become super-subspecialized to the point of absurdity... I mean, I went into med school thinking I wanted to be a trauma surgeon, only to find out that trauma surgeons are ICU docs now and the actual surgery routinely gets parceled out to ortho, vascular, and plastics as necessary. No field of medicine seems satisfying to me at this point. I thought maybe path because path docs have an opportunity to learn a tremendous amount about all fields of medicine, but they’re diagnosticians and don’t actually do anything. Because again, after I diagnosed the mucoepidermoid carcinoma from the slide I’d kind of like to be the one to cut the bastard out. Oh, and I can’t believe the number of people who say: “Oh, you want to do everything, be a family doc!” Are you kidding? This is the opposite of being good at everything, this is like being a professional referral service.

I’m just ranting because my tentative fourth year schedule is due tomorrow, and I’m burning a hole in my stomach with a stress ulcer right now. A year from now I’ll be matching into something and I feel like no matter what it is, I’m going to be miserable with the decision.
 

Elysium

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I think you sound like an OB kind of guy.

;)
 

DrDawg

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Go surgery. If you practice in a rural setting there will be no one else to call in.
 

Winged Scapula

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Sac...

Please give either Trauma or General Surgery a second, third, and forth thought.

While it is true that the operative management of many traumas is parcelled out to specialists and that many traumas are managed non-operatively, there is still a great deal of room to care for trauma patients both medically and surgically.

Now I am no great supporter of Trauma/CC (even though my BF is currently a fellow); I hate the stuff. But I have observed the training which allows the general surgery trained fellow to increase his medical management of patients (while some surgeons may consult out the whazzoo, it is not true that we don't manage their diabetes, hypertension, nutrition, acute renal failure, etc.) - a good critical care fellowship will train you to manage a patient's respiratory status, cardiovascular issues and write for hemodialysis n addition to many other skills. It is a valuable skill to be able to know when you need to defer to others, but the limit of your practice (within reason) will depend on how much you learn and feel comfortable with. With a few exceptions and dependent upon the hospital in which you choose to practice, you WILL be able to do most vascular cases as a Trauma surgeon. There are rural surgery fellowships (usually 6 months to 1 year) which will give you some basic skills in Ortho, Plastics and other more specialized fields.

Do I want a trauma surgeon diagnosing and managing my cancer treatment? Of course not. But the field can be more wide-reaching than perhaps you suspect. Choose a fellowship which has a high degree of penetrating trauma (allowing you to operate more) and significant critical care exposure and you'll be the man more than you expected. "Last of a dying breed", as my BF says. :rolleyes:
 

cytoborg

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sacrament said:
I thought maybe path because path docs have an opportunity to learn a tremendous amount about all fields of medicine, but they’re diagnosticians and don’t actually do anything. Because again, after I diagnosed the mucoepidermoid carcinoma from the slide I’d kind of like to be the one to cut the bastard out. Oh, and I can’t believe the number of people who say: “Oh, you want to do everything, be a family doc!” Are you kidding? This is the opposite of being good at everything, this is like being a professional referral service.
I can definitely relate! I wanted to know everything and do everything in medicine and loved pretty much every rotation. I also really wanted to "fix" people and make a big impact in their treatment, so I started to be drawn toward surgery and away from chronic disease management. I was frustrated when it came time to make my 4th year schedule because no specialty seemed perfect for me. It came down to surgery or path. I agonized for quite a while but eventually I chose path because it is so broad, I find the underlying reasons for disease fascinating, and it's awesome to make such a profound impact on treatment decisions. Also, I felt a good personality fit with the pathologists I rotated with (laid-back, kinda nerdy and fascinated by little things, very curious, many interests outside medicine). A little part of me will always miss cutting (live patients, that is ;) ) but I finally realized that there is no perfect specialty where I will truly get to do everything, and I just have to pick the one that comes closest! It also helped that I know a pathologist who was a general surgeon and switched fields. I guess the moral of the story is that there is no perfect specialty for someone who wants to do it all, so you will have to sacrifice something...it's a matter of deciding what features are relatively more important to you.
 

CambieMD

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Hi sacrament,

I had a problem deciding on what specialty to go into. I actually ended up switching specialties. I will be starting anesthesia in July. anesthesia gives you a little taste of a few different areas and you have your own special bag of tricks.

Forget the notion of doing everything yourself. Medicine is way too complex for one doc to do everything. I am in the process of closing down my fp practice to return to residency. Believe me, you do not want to be responsible for all of a patients' care.

Again, my advice is for you to look at GS,Gas or Ortho. Do not let concerns over life style and free time weigh too heavily in your decision.

I have been out in the "real" world. Most of what you think about the way things work came from your experience in med school. That does not represent what actually happens when you get out there.

Obviously, what I said is not the gospel. It reprevents my views based on my experiences.

Good luck with your search.

CambieMD
 

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I think you are mixing many things together: what you'd LIKE to do, you are CAPABLE of doing, and what is POSSIBLE to do in the situation.

If you are a slow person, who like phylosophical thinking for ages, any kind of surgery, ICU and anesthesia are definitely not for you. You'll be a bad MD+miserable person. What is your enegry level like? As former ICU phisician, I'll tell you, people burn out. It's like sitting on a bomb for 24 hours. It might seem like fun at first but it'll kill you eventually. It's definitily helpful to know all this stuff but it doesn't mean you should do it for living. As a "surgeon running ICU" goes - give me a break, there is no comparison in level of expertise between anesthesia-ICU specialist with his knowledge of pathophysiology and a surgeon. There is a reason why whole Europe has ICU-anesthesia specialty running their ICUs. I didn't mean to offend anybody, just my opinion.

As results of your work go - come on, don't you really think you can make any real difference in ADULT medicine? Pediatrics - yes (all right, there are exceptions but in general you have more chances to reverse the process). How do you feel treating 65 y.o obese drinking IVDU? I just cannot make myself compassionate enough because the patient doesn't really want to help himself at all. They say there 3 of you in the ward: the pt, you and the disease. If your pt is fighting against you, you lost before you even begin. To be honest, there are only 3 areas of modern official medicine that can really help (even adults): surgery, infectious diseases and endocrinology. Anything else is just a palliative approach.

As pathology goes, make your mind clear if you really want to treat people or you want to get away from them.

During my last year of med.school I rotated in my free time with different MDs just to check myself out. Some things which seemed exciting at first, I found boring after a while. There is no other way of choosing but try it all.
 

Winged Scapula

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Marusya said:
As a "surgeon running ICU" goes - give me a break, there is no comparison in level of expertise between anesthesia-ICU specialist with his knowledge of pathophysiology and a surgeon. There is a reason why whole Europe has ICU-anesthesia specialty running their ICUs. I didn't mean to offend anybody, just my opinion.
In case you were referring to my post above, I think you might be suprised to find that many ICUs in the US are staffed with surgeons. And in addition, especially at Level 1 Trauma centers, these surgeons have additional qualifications in Critical Care. Therefore, while Surgeons and Anesthesiologists may come from different fields, once they've both completed additional Critical Care training I find little difference in their level of expertise in running an ICU (coming from someone who has worked with both). The situation may be different in Europe and there are certainly exceptions to every rule, but please remember that I was speaking of, and advising Sacrament to do a General Surgery residency (to solve his desire to operate) and a Critical Care fellowship (to solve his desire to further medically manage his patients). He will be just as much an expert and efficient at running an ICU as an Anesthesiologist with CC training with the addition of being able to operate on his patients.

Each one brings his own expertise to the field. I would trust both a surgeon and an anesthesiologist to intubate me, run my ventilator and place an IJ line. I would prefer the surgeon place any other line below the diaphragm simply because of his experience and I would prefer the anesthesiologist to place an epidural or blood patch. Different skills but on the whole their critical care training will be the same.

But I can appreciate we are coming from different vantage points: a surgery resident who has trained in the US and someone who is coming from outside the US and applying to Anesthesiology. We have likely had different experiences.
 

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OB is a great option if you want to be able to do a lot. It has not been put in a box like general surgery or medicine. We do both. You've got to like delivering babies in order to do it. Don't let the current medical-legal environment force you to make a short sighted decision about OB. In the 80's, OB was one of the most competitive specialties and the highest earning with General OB's averaging 600-700k. AND, don't pick Anesthesia or Radiology because the environment looks great for that field right now. By the time we finish residency...it will be a different world. I gave OB a chance and feel like I'm making out like a bandit with great residency options.
 

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One other option

International medicine....go to Africa and be the man! Do it all by yourself...everything you can imagine you can do. I've done it and it rocks.
 

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sacrament, you overcame the biggest hurdle: acknowledging that you have an enormous ego (don't know if this is true or not- I'm just quoting you).

And dudeob,

dudeob said:
One other option
International medicine....go to Africa and be the man! Do it all by yourself...everything you can imagine you can do. I've done it and it rocks.
Could you elaborate?
 

DrMom

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Sac, how could you possibly have anything other than an enormous ego? ;)


From your initial monologue, it seems like you're better suited for surgery. But what do I know...I'm gonna be one of those stupid EM docs. :D

I can't believe that they make you do your MS4 schedule already. The only MS4 rotations I have scheduled yet are the 4 months of required ones that the school set up for me.
 

superdevil

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why not just get an MBA and make some coin off of all these uber-limited docs? ;)

actually, i second DrDawg's notion of doing surgery/trauma surg and then practicing in a rural place where you do a wider variety of the work.
 

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Dude. Do Ophthalmology. I felt the same way. With Ophthalmology, you take care of every part of everything you see if you want to. You can diagnose a tumor and remove it. You can do botox, read orbital CT scans, prescribe glasses, do Lasix, see kids, do oculopathology. You can tailor your career to do whatever it is you want to do. You can specialize in just glaucoma if you want, or be a comprehensive ophthalmologist and take care of everything. Anyways, give that a try for a month. At worst, you'll know more ophthalmology than most people in your class if you decide to do something else.
 

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There are some FP programs that specialize in wilderness FP. Graduates are FP docs but they are able to do some general surgery. Drawback is these programs are really designed for someone who wants to be a country doctor hundreds of miles from anywhere, so you would be the only option. These docs probably can not get OR privileges in most hospitals.
 

Wednesday

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I would agree that you sound like a surgeon.

What about pediatric surgery? From my experience they seem to be the superstar surgeons and they do just about every type of surgery. They are truely general surgeons.
 
OP
sacrament

sacrament

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I appreciate everybody's feedback. After considerable thought and purchase of two boxes of Prilosec OTC, I'm actually now trying to arrange a meeting with our department chairman of surgery--who I had very good rapport with during my rotation with him--to discuss these very issues. The question still rattles around in my head though: would I end up going this route because I'm actually passionate about surgery, or just because I need validation? Did I not get hugged enough? (And would I actually enjoy performing surgical procedures? Beats the hell out of me, since being a student on a miminally invasive service means doing a whole lot of jack-sh1t and staring glassy-eyed at a monitor. It looked fun, from where I was standing in the back, shifting from foot to foot.) I had this exact problem when applying to medical school. Originally there was no doubt in my mind: I was going the MD/PhD route. Of course, I mean... that's what "people like me" do. "People like me" chose their major in college based solely on the popular notion on the campus that it was the most difficult major offered by the university. Of course, I was borderline miserable throughout school because I didn't have any intrinsic desire to master second-order differential equations and all that horsesh1t. Which somehow didn't stop me from getting a masters in said degree, also just because it seemed like a rigorous thing to do. Oh, yeah, and I'll do it in one year, just because. It was, in fact, the most rigorous, most grueling, most horrific year of my life. Sure was worth that piece of paper! (Yeah, I don't really enjoy either math nor chemistry and yet I hold an advanced degree in chemical engineering. Makes as much sense as an utter misanthrope going into medicine... oh hey, that's me too!) Anyway, I finally sat myself down and had a long internal monologue about the fact that I didn't actually want a PhD, that I didn't really enjoy research, and that going MD/PhD solely for the extra letters was a folly that even I should not endulge myself in. And so I was reasonable, and yet... and yet even today it bugs the holy sh1t out of me that I didn't get a PhD. As reasonable a decision as it was, it will bug me until the day I die. So I don't know, is reasonable always right? What would make me more miserable, doing a job I don't have a total passion for, or spending an entire career lamenting my shortcomings? I'm not even shooting for "happy" at this point, just not "terminally regretful." Why am I such a dipsh1t? I listen to myself bitch about this and I sound like sombody I'd like to kick in the ass, but there you have it.
 

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I believe that we all feel this way to some degree and that we all know true happiness cannot come from our job. I also believe that you are a dipsh1t and that I am a dipsh1t and that everyone is a dipsh1t in great need. I am amazed that you are so in tune with your dipsh1tness. Way to go dude, you're almost there.
 

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How about terminally regretting the fact that you missed out on living your life because you spent the whole time studying and working for the sake of studying and working? You obviously didn't enjoy doing ChemE for 5 years, and it sounds like you're actually considering going into a field that you may not give a crap about just because you're smart and have potential to be a badass and you want to prove that to yourself. Screw that, my friend. Pick a field where you might have some free time to regain some of the time you've already lost and time to spend the money you're going to be making. Even if you end up reading films in a dark room all day and nobody notices, or you put people to sleep all day and nobody notices, or you freeze funny growths off people's skin all day and nobody notices, who cares? You know you could have been the next DeBakey or Blalock or Cooley if you wanted to, but living your life was more important and screw anyone who thinks you're squandering your talent because you didn't re-invent heart surgery. I think when you're old and dying, you might regret not having had a little more fun more than you'll regret not having a PhD. Just my two cents. :)
 

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I think sublimazerules hit the nail on the head...

Sacrament... the fact that you realized these things about yourself testifies that you have more insight than many. Now you just have to LISTEN to your inner voice. :D In today's climate of medicine, you're either a generalist or a specialist to a certain extent... you can't have it both ways. Stop trying to find the specialty that is perfect for you, because it WON'T happen. Whether you choose to believe this or not, it's true. Instead, find a specialty with lots of things you like about it, and not too many things you dislike. Find what makes you happy, or identify the reasons why a specialty makes you happy. Don't do something because it drives your ego to be the best... that's one of the best ways to make yourself miserable when you're sixty. Don't become a crotchety old man/woman...
 

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Sacrament, you're going to burn out big time sooner or later. I had a good friend actually drop out of med school because he kicked his own @$$ so bad as an undergrad to graduate in 3 years with top honors, then burned out and flunked everything. He ultimately realized he was only doing med school to please his parents.

Even worse, you may end up an alcoholic or drug addict...that happens to MD's far more often than anyone wants to admit.

As for me, I realized that I like the "cerebral" aspects of medicine and yet still love doing procedures. Moreover, I despise 90% of surgeons, so surgery was a "hell no". My compromise was to go into medicine and then specialize in cardiology, and most likely cardiac EP.
 

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This might not help much, but have you taken any of the aptitude tests - there are two posted on a thread in Allopathic:

http://forums.studentdoctor.net/showthread.php?t=184449

Also, the Careers in Medicine website has some useful information (http://www.aamc.org/students/cim/). Obviously these profiles can't make your decisions for you, but might be helpful. But, I think you're getting a lot of useful information - hopefully it's not overwhelming you, and hopefully your meeting with the surg prof will help. I agree with one of the previous posters, though - it sounds like you have some good insights into yourself and your situation.
 

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So you are a type Uber A +++ personality. First think about what you know makes you miserable and what you absolutely do not want to do. It sounds like you have done that already. Now where are you happy? What rotations have you found yourself occasionally staying awake during grand rounds? Which group of attendings are most like you? Are there any areas in medicine where you actually look things up on your own becasue you are curious?

You need to find the thing you can do for the rest of your life. No matter what you do, there will be repititive parts of the job, and you need to find the career where you are able to appreciate the individual variation in even the repetitive parts of yor job.
 

DrDawg

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It seems to me that 90% of the thrill for you is the challenge. Would you be happy if you weren't trying to reinvent wheel or cardiac surgery? All these people telling you to slow down or you'll burn out is more likely to push you to go harder than to ease up. My suggestion if you still want to consider a career in surgery is do a surgery sub I first thing fourth year. If you school system is like mine you can beat the new interns into hospital by two weeks. Thats two weeks of you getting in to OR with maybe just an attending or an attending and a senior. Talk to them before hand and maybe they will let you do a little bit more than usual. That first four weeks of fourth year is the key, afterwards the hospital will be loaded with 3rd students and new interns. On call nights take trauma calls to see and do something different. Round in the SICU, its where the sickest patients are. Scrub on plastics, ent, ortho, and whatever other cases you have time. Use those four weeks to plan the rest of your life. If you leave the hospital after a 12hour shift without a break for more than a candy bar and a red bull, and you feel pumped because you saved a life, removed a cancer or source of infection than surgery is for you. If you get the same rush from adjusting lasix and dig doses than maybe medicine is better choice. Plan you year out with two or three pathways that branch from this one elective and if you step on some toes because you had to cancel an elective... screwem its your future.

Also its fourth year get a hobbie. I would suggest running it gives you time to reflect on life or you can zone out and just abuse your body for a few miles. Grab a bear with some friends who really know you and ask what they see you doing. Best of luck
 

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Hey Sacrament -
I tried this once before and got flamed like you wouldn't believe (by someone who didn't know crap about rad onc, but that's a different story) - but I'll give it another shot: have you thought about radiation oncology? You would get to treat every organ system - from a brain tumor to a sarcoma in the foot, and most things in between, so you eliminate the problem of "Oh I can't work on this it's in the lung" (or the brain, or whatever). Also, you have the satisfaction of an actual physical intervention. There are definitely OR procedures (brachytherapy) if that's your thing, yet you're involved in treatment plans and procedures from the very beginning of your residency, not just holding a retractor and doing scutwork on the floors for the first 2 years. As far as diagnosis and management, yes it's true that most if not all your patients will come to you with a diagnosis, but there is a great deal of careful thought and management involved in making sure the pt has been worked up correctly, dealing with complications of treatment, working with the surgeons and the medical oncologists, etc. It also requires you to draw on a broad range of knowledge - physics, radiology, pathology, cancer/cell biology, as well as general physical exam skills, and it's a technology heavy field so it might appeal to you as an engineer. Also, while treating cancer patients is challenging (an aspect that you seem to want), it's not true that all radiation treatments are palliative - 30-50% of treatment plans at most centers are curative intent. Anyway, these are just some thoughts I had about the field and why it might appeal to someone in your situation - take them at their $0.02 face value and good luck in whatever you choose.
 

JAMMAN

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Have you ever heard this song???

I hear you on the radio
You permeate my screen, its' unkind but
If I met you in a scissor fight
I'd cut off both your wings on principle alone
On principle alone

Hey megalomaniac
You're no Jesus
Yeah, you're no f**king Elvis
Special, as you know yourself
Baby, just step down, step down

If I were your appendages
I'd hold open your eyes
So you would see
That all of us are heaven sent
There was never meant to be only one
To be only one

Hey megalomaniac
You're no Jesus
Yeah, you're no f**king Elvis
Special, as you know yourself
Baby, just step down, step down

Yeah
You're no Jesus
You're no Elvis
...
You're no answer

Hey megalomaniac
You're no Jesus
Yeah, you're no f**king Elvis
Special, as you know yourself
Just step down

:D :D
 

PrettyDoctor

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Sacrament, you're going to burn out big time sooner or later. I had a good friend actually drop out of med school because he kicked his own @$$ so bad as an undergrad to graduate in 3 years with top honors, then burned out and flunked everything. He ultimately realized he was only doing med school to please his parents.
Oh god story of my life...so what is this person doing now?
 

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Of course, I mean... that's what "people like me" do. "People like me" chose their major in college based solely on the popular notion on the campus that it was the most difficult major offered by the university.
By "people like you" you mean "mindless tool" right?




What would make me more miserable, doing a job I don't have a total passion for, or spending an entire career lamenting my shortcomings?
Don't worry you'll end up doing both for sure.

Why am I such a dipsh1t? I listen to myself bitch about this and I sound like sombody I'd like to kick in the ass, but there you have it.
Yeah, that's how everyone else feels when they have the misfortune to accidentally waste a few minutes of their life on your miserable droning. You probably need some prozac or something.
 

Miami_med

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By "people like you" you mean "mindless tool" right?



Don't worry you'll end up doing both for sure.


Yeah, that's how everyone else feels when they have the misfortune to accidentally waste a few minutes of their life on your miserable droning. You probably need some prozac or something.
Dude,

What's wrong with him venting? He's just trying to figure his stuff out. He's working hard and doesn't want to make a mistake. That's why these forums exist in the first place.
 

FACS

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By "people like you" you mean "mindless tool" right?






Don't worry you'll end up doing both for sure.



Yeah, that's how everyone else feels when they have the misfortune to accidentally waste a few minutes of their life on your miserable droning. You probably need some prozac or something.

What do you think you're doing? This is incredibly rude. Many of us feel that way about Sacrament, but just saying it outright is not at all polite. Grow up. Work on your tolerance.
 

DebDynamite

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Sacrament,
I'm a Buddhist so you have made my day with your ego insight. What did the Dalai Lama say to the hot dog vendor? "Make me one with everything!"

Seriously though, have you considered gyn-onc? I thought it was pretty cool for surgery because after you get through with the fellowship (which is 4 years after obgyn) you will be THE man/woman in your field wherever you go. Same for peds surgery and trauma in a smaller city of course. If I entertained the notion of clinical medicine (I'm interested in path & psych), I'd do gyn-onc. There are a bazillion surgeries, you manage their medicine, you see them in clinic, etc...
 

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By "people like you" you mean "mindless tool" right?

Don't worry you'll end up doing both for sure.

Yeah, that's how everyone else feels when they have the misfortune to accidentally waste a few minutes of their life on your miserable droning. You probably need some prozac or something.
You're responding in a rather toolish manner to a post that is a year and a half old.

I think you missed the point and the ball.
 

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You're responding in a rather toolish manner to a post that is a year and a half old.

I think you missed the point and the ball.

Well said. A year and a half is a bit late for a cutting reply.:rolleyes:

And this dude is totally missing the point. Sac is the first one to admit what a tool he is. That's what makes his posts amusing.


In any case, let's play nice here kids.
 

JoBlo

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The OP dilema is why I decided to do Internal medicine. It has the most direct and boardest responsibility IMHO. Consults are annoying because you don't really have any hard decision making in what happens at lot of the time, the IM team will take your advice and most of the time follow it, sometimes they don't... but the patient is d/c'd whenever they feel they should be d/c'd.

The most impressvie all-around physician I've ever met is a Nephrologist at my school that runs the inpatient renal ward. Most of his patients have general IM problems, but they go to him if they also have undelying renal disease as well. He runs it like a IM ward in which the patients just happen to have ESRD, CRI, etc and rarely consults, makes all the decisions, he's his own specialist/consult primary team. I once saw him deferr a patient with multiple/myeloma to his clinic (because for fanancial reasons heme/onc wouldn't treat him) and was as competant and comfortable administering his chemo as they probably would have been. But he can do that because, he is probably the smartest and most competant physician in our entire hospital network (with 100% agreement by the faculty/residents/students).

Anyway IM may be a happy mediium. And their is always OB/Gyn
 

ilovehedgehogs

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I know I haven't been posting much, but I didn't think people would have to dig quite this far back to find something to bitch about.

BTW, everything turned out fine.
So, sac...how exactly did it turn out? Im just curious.
 

CaptKirk

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I appreciate everybody's feedback. After considerable thought and purchase of two boxes of Prilosec OTC, I'm actually now trying to arrange a meeting with our department chairman of surgery--who I had very good rapport with during my rotation with him--to discuss these very issues. The question still rattles around in my head though: would I end up going this route because I'm actually passionate about surgery, or just because I need validation? Did I not get hugged enough? (And would I actually enjoy performing surgical procedures? Beats the hell out of me, since being a student on a miminally invasive service means doing a whole lot of jack-sh1t and staring glassy-eyed at a monitor. It looked fun, from where I was standing in the back, shifting from foot to foot.) I had this exact problem when applying to medical school. Originally there was no doubt in my mind: I was going the MD/PhD route. Of course, I mean... that's what "people like me" do. "People like me" chose their major in college based solely on the popular notion on the campus that it was the most difficult major offered by the university. Of course, I was borderline miserable throughout school because I didn't have any intrinsic desire to master second-order differential equations and all that horsesh1t. Which somehow didn't stop me from getting a masters in said degree, also just because it seemed like a rigorous thing to do. Oh, yeah, and I'll do it in one year, just because. It was, in fact, the most rigorous, most grueling, most horrific year of my life. Sure was worth that piece of paper! (Yeah, I don't really enjoy either math nor chemistry and yet I hold an advanced degree in chemical engineering. Makes as much sense as an utter misanthrope going into medicine... oh hey, that's me too!) Anyway, I finally sat myself down and had a long internal monologue about the fact that I didn't actually want a PhD, that I didn't really enjoy research, and that going MD/PhD solely for the extra letters was a folly that even I should not endulge myself in. And so I was reasonable, and yet... and yet even today it bugs the holy sh1t out of me that I didn't get a PhD. As reasonable a decision as it was, it will bug me until the day I die. So I don't know, is reasonable always right? What would make me more miserable, doing a job I don't have a total passion for, or spending an entire career lamenting my shortcomings? I'm not even shooting for "happy" at this point, just not "terminally regretful." Why am I such a dipsh1t? I listen to myself bitch about this and I sound like sombody I'd like to kick in the ass, but there you have it.
Dude... become an artist.
 

Faebinder

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Winged Scapula

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Why scared? Or do you not think several months of critical care during residency would enable one to manage typical post-operative medical problems?

Having rarely seen a medical subspecialist outside of nephrology and neurology inside a SICU, I can assure you that at many academic medical centers, the surgeons and critical care physicians are more than competent at managing these things.

Surely Faebinder realizes that The Todd is a character and not a real surgeon (who, especially in the critical care setting, titrates blood sugars more tightly than most internists).

Anyway, I'm sure every speciality looks down on others for not knowing the things they know...so go ahead and laugh at surgeons who ask about controlling glucose or hypertension (even I would laugh) while I do the same for the consults for abdominal distention in patients without an AXR or even a NGT, or abdominal pain with an obvious hernia.
 

erichaj

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I cannot decide what to do for a living. I just cannot do it. My enormous ego is preventing me from really committing myself to any field. For example: I thought internal medicine was fairly enjoyable. Had a pretty good time, liked thinking problems though, liked making the differential diagnosis, etc. Then a patient comes in with a maybe-acute-abdomen, so surgery consult comes and carts them off. HOLD ON, I wanna open ‘em up... oh wait, we’re the medicine team, we don’t know how to do that. Oh, but wait, same thing can happen to the surgeons! During esophagectomy, patient gets tear in the descending thoracic aorta—in comes the cardiothoracic guys! General surgery attending gets pushed to the back of the room where he stands pouting, arms crossed, because in this situation he doesn’t know what the f*** he’s doing. A patient on the neurosurg ward gets bizarre unexplained anemia and weird-looking peripheral smear and gotta call in the heme consult cause we don’t know anything about heme anymore. I have picked a career where I am doomed to be perpetually unsatisfied because nobody can do everything anymore. It’s become super-subspecialized to the point of absurdity... I mean, I went into med school thinking I wanted to be a trauma surgeon, only to find out that trauma surgeons are ICU docs now and the actual surgery routinely gets parceled out to ortho, vascular, and plastics as necessary. No field of medicine seems satisfying to me at this point. I thought maybe path because path docs have an opportunity to learn a tremendous amount about all fields of medicine, but they’re diagnosticians and don’t actually do anything. Because again, after I diagnosed the mucoepidermoid carcinoma from the slide I’d kind of like to be the one to cut the bastard out. Oh, and I can’t believe the number of people who say: “Oh, you want to do everything, be a family doc!” Are you kidding? This is the opposite of being good at everything, this is like being a professional referral service.

I’m just ranting because my tentative fourth year schedule is due tomorrow, and I’m burning a hole in my stomach with a stress ulcer right now. A year from now I’ll be matching into something and I feel like no matter what it is, I’m going to be miserable with the decision.

It has a good lifestyle and you have the final word. The surgeon is done with what they have done or the trauma is over and its time to recover. That is where you come in and you word on recovery is final. Your in charge.

Your patients are motivated.