Really for the attention impaired?

[Rockhouse]

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I am sure this post won't last long, and partly it is an M1 primary care rant. But I spent my first afternoon with my FP preceptor, and I respect his work, its all good, but in ten patients i saw 6 diabetes and 4 sore throats. Yawn. I know there is a lot of yawning in EM as well, lots of not fun stuff, but can it really keep an ADD kid interested for a career? And are their any others you fellow ADDer's have considered that might work if EM doesn't pan out?

 

[Miami_med]

I am sure this post won't last long, and partly it is an M1 primary care rant. But I spent my first afternoon with my FP preceptor, and I respect his work, its all good, but in ten patients i saw 6 diabetes and 4 sore throats. Yawn. I know there is a lot of yawning in EM as well, lots of not fun stuff, but can it really keep an ADD kid interested for a career? And are their any others you fellow ADDer's have considered that might work if EM doesn't pan out?

As a fellow ADD person, I also noticed this. However, after changing preceptors for my MS2 year, I did learn that primary care doesn't have to be that dull. It is really what you make of it. I had a preceptor that did lots of minor procedures, saw lots of interesting pathology (Hypotonic Bowel with obstruction due to inflammation in the hospital for the 3rd time with double acid base disorder, etc...), and rounded on patients in 5 different hospitals. I was actually not bored. I think that some primary docs prefer a relatively laid back practice. This is really not an exciting notion to you or me, but some people enjoy having basic outpatient work. That being said, it doesn't have to be that way.

All of that being said, I'd say my specialty rank list would be as follows:
1. EM-Obviously
2. Trauma Surgery- I guess because I like trauma and a lot of the work is urgent and fast.
3. Family Medicine- Because I like the broad scope of practice. I could re-invent myself if I ever got really bored.
4. Hematology/Oncology- As a last choice, if I can't run around like crazy, I can atleast be a complete nerd with minimal call.

 

[Paws]

Hey Miami, I like your list. It's like mine except I am not sure about the trauma surgery only because that would mean doing a surgery residency. Altho, I liked the trauma surgery residents I met on my rotation. Otherwise, same list, same reasons. Decisions, decisions ...

But I agree with the op, ten million patients with uncontrolled diabetes, a hundred thousand sore throats. Could get ugly after a while and I might just freak out with a similar ADD boredom.

 

[trkd]

Most of my EM patients have diabetes. A large portion of my peds EM patients have a cough or sore throat. Just a thought. But I do like the variety in EM. But I also thought FP had variety. My FP doc rocked though. Maybe that is what you need.

 

[Hard24Get]

I am sure this post won't last long, and partly it is an M1 primary care rant. But I spent my first afternoon with my FP preceptor, and I respect his work, its all good, but in ten patients i saw 6 diabetes and 4 sore throats. Yawn. I know there is a lot of yawning in EM as well, lots of not fun stuff, but can it really keep an ADD kid interested for a career? And are their any others you fellow ADDer's have considered that might work if EM doesn't pan out?

From my perspective, there is a huge difference between FP and EM primary care. Dealing with an acute exacerbation (or just perceived exacerbation) of chronic illness is pretty cool to me. What I don't like is doing their prevention screen thereafter (last weight/cholesterol/pap/colonoscopy, etc). But to be a good FP these sort of boring things have to happen. Even a cold in EM can be dealt with more efficiently because of this. And frankly, a few minutes of anything can be entertaining (new personality, etc), not to mention the sicker people we get to interact with.

What else to do? 😕 Maybe IM or anesthesiology with subspecialization in surgical critical care? Can't imagine doing a surgery residency....

 

[iatrosB]

What else to do? 😕 Maybe IM or anesthesiology with subspecialization in surgical critical care? Can't imagine doing a surgery residency....

IM? I thought that was pretty much the opposite of EM!? Rounding 24-7, extensive work ups including kitchen sink, obsessing over PO4 levels and what not...😕

 

[Hard24Get]

IM? I thought that was pretty much the opposite of EM!? Rounding 24-7, extensive work ups including kitchen sink, obsessing over PO4 levels and what not...😕

No, no - IM (but preferably anesthesiology) to get to critical care, which is at least broader and, well, critical). Obviously an IM residency would be horrible, but at least not as long as surgery. Much to my dismay, both IM and surgery round like the Dickens. This is why I hope to do well on my EM rotation - what else is there?

 

[AmoryBlaine]

I am sure this post won't last long, and partly it is an M1 primary care rant. But I spent my first afternoon with my FP preceptor, and I respect his work, its all good, but in ten patients i saw 6 diabetes and 4 sore throats. Yawn. I know there is a lot of yawning in EM as well, lots of not fun stuff, but can it really keep an ADD kid interested for a career? And are their any others you fellow ADDer's have considered that might work if EM doesn't pan out?

Medicine is not for the "attention impaired."

 

[BKN]

Medicine is not for the "attention impaired."

Here, here. And I'll say it again, a person with true ADHD (rather than the overdiagnosed or self-diagnosed) makes a particularly bad EP. We have to be able to filter much conflicting input and prioritize carefully. This is precisely what ADHD individuals have problems with, they keep getting distracted by the next stimulus whether important or not.

And you're right Amory. true ADHD types don't often get through medical school.

This is all different from what truly draws people to EM - adrenalin love.😍 😍 😍

 

[Hard24Get]

Oh, I think you two are taking things too seriously. The vast majority of people going around saying they're "ADD" or "ADHD" are really just finding a tongue-in-cheek way to say that they want something that keeps things varied and interesting (better to be self-effacing than arrogant). I think the OP is just trying to figure out whther EM will be varied enough for him/her and figure out what other similar options there are.

Here, here. And I'll say it again, a person with true ADHD (rather than the overdiagnosed or self-diagnosed) makes a particularly bad EP. We have to be able to filter much conflicting input and prioritize carefully. This is precisely what ADHD individuals have problems with, they keep getting distracted by the next stimulus whether important or not.

And you're right Amory. true ADHD types don't often get through medical school.

This is all different from what truly draws people to EM - adrenalin love.😍 😍 😍

 

[Rockhouse]

You guys got me, the next question I was going to ask was where I can get some more ritalin to make it through to my next exam. Hard24 has me spot on. It's (i am sure like many) not that I can't pay attention, its just that there are a lot of things that tend not to hold my attention. Maybe I will be a complacent doc, I hope not, but who knows. While I am here waisting my Saturday night, I just thought I would get what some of you veterans think about the stereotype, and what other self-diagnosed "adrenaline junkies" find interesting besides EM.

 

[GeneralVeers]

You guys got me, the next question I was going to ask was where I can get some more ritalin to make it through to my next exam. Hard24 has me spot on. It's (i am sure like many) not that I can't pay attention, its just that there are a lot of things that tend not to hold my attention. Maybe I will be a complacent doc, I hope not, but who knows. While I am here waisting my Saturday night, I just thought I would get what some of you veterans think about the stereotype, and what other self-diagnosed "adrenaline junkies" find interesting besides EM.

Coffee is my ritalin. I have about 3 cups in a twelve hour shift. Without my coffee I cannot function.

 

[BKN]

Oh, I think you two are taking things too seriously. The vast majority of people going around saying they're "ADD" or "ADHD" are really just finding a tongue-in-cheek way to say that they want something that keeps things varied and interesting (better to be self-effacing than arrogant). I think the OP is just trying to figure out whther EM will be varied enough for him/her and figure out what other similar options there are.

I think you're right. . .Oh, what did you say?

 

[AmoryBlaine]

Oh, I think you two are taking things too seriously. The vast majority of people going around saying they're "ADD" or "ADHD" are really just finding a tongue-in-cheek way to say that they want something that keeps things varied and interesting (better to be self-effacing than arrogant). I think the OP is just trying to figure out whther EM will be varied enough for him/her and figure out what other similar options there are.

We probably are taking it too seriously .

But you have to admit "I'm ADD" is probably one of the top 5 reasons the average med student puts forth when asked "why EM?" by their friends.

I also think (and I will brace for flames) that there are med students who secretly think that EM, with its shift work and ability to refer patients to consultants, is a field in which they will not have to work hard.

 

[iatrosB]

We probably are taking it too seriously .

But you have to admit "I'm ADD" is probably one of the top 5 reasons the average med student puts forth when asked "why EM?" by their friends.

I also think (and I will brace for flames) that there are med students who secretly think that EM, with its shift work and ability to refer patients to consultants, is a field in which they will not have to work hard.

Those are the ones that burn out...in for a rude awakening.

 

[Hard24Get]

We probably are taking it too seriously .

But you have to admit "I'm ADD" is probably one of the top 5 reasons the average med student puts forth when asked "why EM?" by their friends.

I also think (and I will brace for flames) that there are med students who secretly think that EM, with its shift work and ability to refer patients to consultants, is a field in which they will not have to work hard.

It's true that many use this excuse, but I maintain that most are not really being serious. The only reason I don't use it as an contraeuphenism (neologism?) is to avoid propagating psych stereotypes that aren't true.

I've never gotten the impression that the average EM shift, especially in the middle of the night and weekends would be very chill, considering not only when you have to be there, but what you're doing while you're there. Your argument seems more true for primary care, where you can work Mon-Fri 8-5 or so, courtesy of EM and consultants.

That being said, I think different things are easier for different personalities, and every field of medicine is important to keep stocked with good people. So why worry about the motivations of others? This thread is about the career options for people of like-mind and heart.

 

[AmoryBlaine]

So why worry about the motivations of others? This thread is about the career options for people of like-mind and heart.

Not really worried about the motivations of others, just adding fuel to the discussion.

 

[Jeff698]

I also think (and I will brace for flames) that there are med students who secretly think that EM, with its shift work and ability to refer patients to consultants, is a field in which they will not have to work hard.

I'm sure there are. Of course, there are still those naive folks who think there is something sexy about medicine. Certainly ain't all the rectals and pelvics we do. Nor the many cases of toxic sock. Nor....

Take care,
Jeff

 

[DropkickMurphy]

Here, here. And I'll say it again, a person with true ADHD (rather than the overdiagnosed or self-diagnosed) makes a particularly bad EP. We have to be able to filter much conflicting input and prioritize carefully. This is precisely what ADHD individuals have problems with, they keep getting distracted by the next stimulus whether important or not.

And you're right Amory. true ADHD types don't often get through medical school.

This is all different from what truly draws people to EM - adrenalin love.😍 😍 😍

Huh? What were you saying? I got distracted by a shiny object....

What about those ADHD patients who function well on medication?

 

[AmoryBlaine]

I'm sure there are. Of course, there are still those naive folks who think there is something sexy about medicine. Certainly ain't all the rectals and pelvics we do. Nor the many cases of toxic sock. Nor....

Take care,
Jeff

It's amazing how a rectal on a *ahem* less-than-hygenic patient can knock the sexy right off of the MD degree isn't it?

 

[Hard24Get]

It's amazing how a rectal on a *ahem* less-than-hygenic patient can knock the sexy right off of the MD degree isn't it?

Yeah, but stinkies can add excitement to an otherwise dull day. Seriously, one shift in an ED and people should know better than to think it's sexy!

 

[AmoryBlaine]

Yeah, but stinkies can add excitement to an otherwise dull day. Seriously, one shift in an ED and people should know better than to think it's sexy!

Ha ha, I appreciate the enthusiasm but I don't think that body odor does much to excite me!

 

[SoCuteMD]

I also think (and I will brace for flames) that there are med students who secretly think that EM, with its shift work and ability to refer patients to consultants, is a field in which they will not have to work hard.

I'm a 2nd year med student and I have to say that those I've encountered who are interested in EM at this point tend to be the "hit it hard and get it done" types. I wanna work like a DOG until my shift is over, and then I wanna go home and play with my dog, go rockclimbing, go sailing, ski, run, sleep, read, etc.

 

[Febrifuge]

Exactly. I'm a non-trad, and I like to tell people "I've spent enough time sitting in a chair and waiting; for the next thing to happen, for somebody else to finish their part of the work so I can do mine, or for what I did yesterday to turn into something I need to do today."

Give me four things to do, let me figure out which order to do them in, and when I'm done with two of them, throw two more things on the pile. Oh, and feel free to interrupt the whole process, if it's for something cool and interesting. I'll be happy like that for 8 or 10 or 12 hours. Apparently, people who are not destined for EM hate the sound of that.

 

[USCDiver]

IM? I thought that was pretty much the opposite of EM!? Rounding 24-7, extensive work ups including kitchen sink, obsessing over PO4 levels and what not...😕

I think your confusion is common. The real world is not residency. When was the last time you saw a private practice Internist rounding all day. They can't make money that way. They're either in and out of the hospital running like mad and on call all the time; or they use a hospitalist service and don't do anything but sign PA/NP notes all day in the clinic. At least that's the way it is around here.

 

[GeneralVeers]

I think your confusion is common. The real world is not residency. When was the last time you saw a private practice Internist rounding all day. They can't make money that way. They're either in and out of the hospital running like mad and on call all the time; or they use a hospitalist service and don't do anything but sign PA/NP notes all day in the clinic. At least that's the way it is around here.

The PMDs spend the rest of their time in clinic, listening to patients ramble about their personal lives, and mentally masturbating over 2nd line therapy for diabetes and hypertension. At least in EM you can tell the patient to stop talking if he's not saying anything productive after 1 minute.

 

[Jeff698]

At least in EM you can tell the patient to stop talking if he's not saying anything productive after 1 minute.

As much as I'd like to do just that (and often after only 30 seconds) down that road lies very poor Press-Ganey scores. Turns out that, at least in hospitals with paying patients, those things matter.

I give my patients a good 5 minutes (during which time I'm frequently thinking about what I'll have for dinner) of listening with attentive and compassionate head nodding and chin scratching before I start cutting them off. Assuming their not truly sick, of course.

Hardest damn 5 minutes I can imagine. Often downright painful.

Take care,
Jeff