There's less of it, but what we do get is 1,000,000 x better in anesthesia.
When we rarely (very rarely) diagnose some showstopping problem preop, we cancel the case and someone else does the tuneup legwork. If a problem occurs acutely, or the situation changes abruptly mid-surgery, you diagnose and immediately treat problems yourself. This is uniquely satisfying to me.
H&P + diagnosis + treatment in an outpatient clinic is a lot of [common chronic medical problem] + start a drug + wait 3 months to see the patient again + find out the patient never filled the rx + try again and wait 3 months + patient no-shows + finally see the patient and make an incremental adjustment + another 3 month followup on and on and on ... all in the context of a 15-30 minute clinic appointment hamster wheel grind.
As you might have guessed, I generally disliked or even hated outpatient primary care work, but there were still days when everything came together, the diagnoses flowed, the patients were friendly and grateful, the nurses didn't abuse me, I wasn't 50 minutes behind by 11 AM ... and I thought I could almost see myself doing that specialty. Then reality would rear its ugly head and I'd be miserable again. For me anesthesia had by far the fewest ugly head-rearing episodes, so here I am.
No one can tell you what specialty you'll be happiest in, unless it's a cash-only dermatology practice. I will tell you I know a lot more unhappy FP and IM docs than anesthesiologists though.
It's like public speaking. Everyone is uncomfortably bad at first. Experience and a growing knowledge / technical skill base will make all the difference in the world.
It's a rare MS4 who can smoothly and confidently handle even the simplest ACLS-directed crisis. You're probably normal. So unless you're convinced you're really, truly, pathologically bad at thinking on your feet or handling the unexpected (think anxiety disorder level super bad) don't let your current weak crisis-fu dissuade you from anesthesia. 4 years of residency will get you there.
Pgg, great thread. Thanks.
To the OP, I've made the decision to do anesthesiology and will start CBY in just over 2 months
😱😱
Anyhow, I too liked primary diagnisis. But, it was mostly hospital based stuff that I liked such as inpatient medicine. I just finished a month of MICU and it was also very cool. At times, I could have seen doing outpatient IM or even FP (though I just contradicted myself).
However, what I realized was that while anesthesiologists don't do a lot of primary, chronic disease type Dx (as pgg has stated), they DO NEED TO KNOW MEDICINE. And well, in my opinion. I think that once I realized how sick patients were, undergoing all sorts of procedures that required some kind of anesthesia, it put me at ease. Patient histories, which ofcourse you'll need to understand, are only going to get more complex, medically, as our patient population ages and grows in size....
On the interview trail, one of the staff was taking up Harrison's as a "hobby". Frankly, I thought that was cool and can only enhance one's professional value, albeit in perhaps an unquantifiable way.
And, when you see these guys come rushing into a code or an emergent intubation and completely take charge of the situation, it's pretty darn cool (not so scare you about the acuity concerns you eluded to, as I agree with pgg on that issue as well). I've seen this personally in the MICU when the fellow couldn't tube the patient and had to call "anesthesia".
There was a former post from JPP (I think) which brought up the point that when, in an ICU setting, even the medicine trained CC guys are mostly comfortable ordering this medication or that. While the aneshesiology trained docs will either have the drugs ON THEM or draw them up themselves, and more often than not will push the meds themselves. Seeing this is just really cool. I'm not comparing Pulm/CC dudes to Anes/CC people, but just reiterating an observation that others have made in the past w/r/t emergent situations.....
cf
