Question for those interested/doing ortho or GS

[EclecticMind]

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Before I ask my question, let me just elaborate briefly where I'm coming from. I feel strongly that I do want to go into surgery... I have worked with surgeons and absolutely loved it! Initially I just assumed that I would go into gen. surgery b/c on the surface at least, the other surgical specialties didn't really appeal to me. I knew that ortho was heralded as being an awesome field, but for some reason the idea of just dealing with bones didn't seem very rewarding to me for personal reasons; a major one being b/c I assumed that an orthopedic surgeon would only be useful only if the problem delt with something musculoskeletal. I didn't like the idea of spending all of these years to become a doctor, and then one day someone in my family have a heart attack (or something medical), and I wouldn't be able to offer any kind of useful knowledge to them or anyone else... other than saying "I don't know, I just do bones." Then get the look like "after all those years of medical school, you can't tell me anything about papa's heart?" That thought just didn't resonate too well with me.

Now, I'm about to begin my 3rd year and I'm more confused than ever about what I want to do. I entered medical school thinking that I wanted to do general surgery, but almost invariably the only feedback or information you get about the field is overwhelmingly negative. Inevitably that has caused me to seriously question the idea of going into general surgery.

So what I am going to do then? I have spent so much time stressing over this issue, because as I have said before, I shine like gold when I have a specific goal... but when I don't, I'm worthless. So please don't offer me the advice "wait till you finish your 3rd year... bla... bla". I understand your point, but the whole "waiting" theory just doesn't work for me... actually it's indirectly destructive to my achievements.

Now, here's what I do know: I know that I like knowing about medicine, and I have been told by many teachers that I would be great at internal medicine b/c I am (apparently) very good with abstract thinking and putting things together that most medical students cannot. But guess what.... I don't want to do internal medicine! Actually, I think it would be boring as hell... so my hats off to anyone that does choose a career in IM.

I know that I like surgery... I know that I like fixing a problem, and I LOVE trauma (worked 4 years as an EMT); but at the same time, I also like thinking about it or figuring a problem out... I wouldn't want to do one without the other... and apparently a field in trauma surgery (which I have seriously considered) is supposedly suicide for the opportunity to have any family life, or any life outside of the hospital for that matter.

I know that I like the general medical knowledge that a general surgeon has... outside of the OR.

But I'll just tell you right now... and if this steps on any toes, my apologies. I know that I DO NOT like the idea of having to screw around with peoples dinguses!!! Sorry, but I guess if God made me with the intentions of being a general surgeon, he must have forgot to include the part of giving me the ability to withstand doing anal procedures. Sorry, but I just think it's disgusting.


I also know that there are several on this board that think ortho is the holy grail of a surgical specialty. Well, I've tried to open my mind up to it and see it from a different angle. After all, orthos don't deal with dinguses... and I have been into bodybuilding for several years... I like sports...so it just seems like that would be the field for me, right? Well here's the problem: I think that as an orthopod I would one day regret not being able to utilize hardly any of the knowledge that I had spent so much time acquiring during medical school.

So my question to those doing or wanting to do GS:

Does it just not bother you to know that you will spend a significant amount of your career working in and around someone's dingus and rectum?

And if it ever did bother you... how did you get over it... or did you?


And my question for those doing or wanting to do ortho:

Does it bother you knowing that you won't be able to utilize majority of the knowledge that you learned in medical school? Or is the field just that awesome that you become less concerned about it?


Again, I do want to apologize because I'M SURE that there some of you will read this that already have a chip on your shoulder about something I've mentioned... but I've got a chip on my shoulder too... and it's because I don't have any goal right now that I'm working toward, and b/c what I thought I wanted to do has been seriously called into question b/c of all of the discouragement I've gotten about my original plan... and it's killing me. I know what I like and what I don't, but I just can't seem to match that with a specialty choice.

I really do appreciate anything you have to say... even if you want to flame me b/c I'm sure some of you will. Nevertheless, I still would like to hear your opinion. Thank you.

 

[EclecticMind]

oh yeah, and this is another idea I've had.

I'm (again, "supposedly") very gifted at being able to take abstract concepts, and breaking them down and explaining them in a way that is easily understandable. So therefore I've been told a lot that I should go into academic medicine... so I've contemplated becoming a general surgeon, maybe do a fellowship in something like critical care or vascular, and work in a teaching hospital. If I did that, I could MAYBE somehow get through a general surgery residency and (by the grace of God) just bear having to deal with anorectal **** (no pun intended) just to get through residency.

But if I did that, my question is how much do attendings at teaching hospitals have to do anorectal procedure... because I would just assume that majority of those would be only supervised by attendings and directly dealt with by the residents. Am I wrong?

 

[RLMD]

Sounds like Emergency med would be a good fit for you. Procedures, trauma, thinks a lot like an IM doc, better hours than surgery.

 

[EclecticMind]

Sounds like Emergency med would be a good fit for you. Procedures, trauma, thinks a lot like an IM doc, better hours than surgery.

yeah, I've thought some about that too... but from my experience, it seems like ER docs are the least respected by their colleagues than any other specialty. And before you say it, no... I'm not wanting to be a doctor JUST to have respect... but I damn sure don't want to be disrespected! Plus, I would miss the OR.

 

[phillymed]

I identify with you on most accounts (although Im a lowly MS2)
spent a lot of time in the hospital this summer trying to figure out what I want to do and help motivate my self next year.
I think if you love the OR, you just have to bite the bullet. Its not that I hated what I saw of internal medicine, Its that I now Ill regret never going back to the OR.
I do think it is possible to be someone who loves the OR and be someone who loves taking care of pt's on the floor.
From friends who are residents I can summize that residency sucks nomatter what you do, so do what you really like.
So why not do a fellowship in Trauma/CC, and emphasize on the general/cc aspect in your career. This way you get the procedural aspect as well as the intensive aspect of being an internist?

 

[Winged Scapula]

You might wish to review the work habits of General Surgeons. While those in a smaller community practice may indeed do most of the local ano-rectal procedures, general surgeons in larger or more academic practices "generally" do few ano-rectal procedures. Those are largely the province of CRS.

If you truly object to those procedures, it is fairly easy to tailor your post-grad practice to exclude those types of things, although it would be a tad difficult to pass on a perirectal abscess that comes into the ED the night you're on call for General Surgery. However, if you limit your ED call and have other partners who don't mind those procedures, you can realistically avoid them. Most of the schedules ano-rectal cases here are done by the Colorectal staff, not the General Surgeons (who concentrate on abdominal procedures such as hernias, choles, pancreatic dz and limited bowel resections; breast cases, gastric bypasses, etc.).

The supervision differs from hospital to hospital, but in general residents are more supervised than ever. Don't make the mistake of assuming that ano-rectal cases are simple - even those as classically thought of as such (ie, roids). I have done cases at outside facilities with the attending looking over my shoulder (but not scrubbed) and the same case at another hospital watching the attending do it. Different hospital, different attending, different thoughts about resident autonomy. Besides, there is great potential for harming someone with ano-rectal cases and a good attending is not about to let the resident do something they are qualified or well supervised for. And if the reason is that the attending doesn't want to do "those type of cases" then he/she should not accept them.

 

[EclecticMind]

thank you K. Cox for your response. That is just the kind of information that I'm wanting/needing to obtain. Very insightful, as well as encouraging. Again, thank you.

 

[NCHoosier]

Ortho PGY-1 here. I tend to agree with all the above posts. You may be taking your view of both GS and ortho to extremes a bit. Chances are, if you do GS, the majority of your time will be spent on things other than buttholes. Similarly, if you do ortho, chances are you're still going to know what to do if someone codes on an airplane. In either specialty, residency will be grueling. IN either specialty, you'll be able to tailor your practice to fit your life, once you're an attending. Make an informed decision but also go with your gut (no pun intended). What would you really like to do most? They're both great fields, for different reasons.