Specialties that are “cerebral” but also have emergent SHTF moments?

[Maybedoc1]

MS2 in clinicals trying to figure out what I want to do with my life. One that thing I’ve found about myself is that I enjoy complex patients that require lots of thought, but I also really like the emergent, **** hitting the fan situations. Sometimes I feel like these are at odds with each other and specialties that are really cerebral don’t have the SHTF moments and vise versa. There’s obviously lots of clinical experiences and specialties that I haven’t been exposed to at this point so I’m open to suggestions

---

Members don't see this ad.

 

[MateoGM416]

Critical care? Pulm?

 

[EmbryonalCarcinoma]

Neurology... SHTF = stroke codes. The rest can be cerebral.

 

[Arsartium]

Tbh, any specialty can be as cerebral as you make it. Complexity in patient population is more a function of practice setting.

Neurosurgery. You can spend your days doing 1 level lamis or doing functional or tumor neurosurgery with all the complexity that can entail. And then of course nsgy deals with trauma and strokes.

 

[Dantes]

Neuro, psych, rheum (maybe not as many emergencies in rheum) worth checking out

 

[holdthemayo]

I'll put a vote in for anesthesia. Very cerebral. Your job is to manage patients' medical conditions through a period of inherent hemodynamic instability. If you do your job well, nonone even knows how hard you thought/worked to keep the patient stable.

You will also have the inevitable patient trying to die on you where everyone in the OR steps back and does exactly what you tell them to do.

 

[Styrene]

Psychiatry. Endless complexity in every realm from patient interview to pharmacotherapy to psychodynamics, ambiguity, unknown mechanisms, and recurrent immediate threats of danger. You can spend a lifetime focusing just on eliciting certain symptoms on interview, for example. Takes a ton of patience and can be very draining or euphoric.

The thing about psychiatry: It's very easy to be an okay psychiatrist and very difficult to be a great one.

 

[longhaul3]

Neurosurgery fits very well—many patients are very sick, neurosurgical problems are often exceedingly complex, and there are life-threatening emergencies daily

Frankly IM does too...sick patients tend to get sicker, especially when they're already in the hospital. Usually they get passed off to a separate ICU service though

I know where you're coming from. I had the same thought when I was a med student and ended up in neurosurgery. It's amazing but I will say it is exhausting when the average patient is quite sick and there are constant new emergencies on top of that. For most people it's more sustainable and lifestyle friendly to choose either complex and stable (rheumatology, oncology etc) or emergencies and critical care only (EM, CCM etc)

 

[mrbreakfast]

You are describing inpatient neurology. You see incredibly "cerebral" cases - brain tumors, autoimmune encephalitis, paraneoplastic conditions, myopathies, etc - and then run from those to strokes, hemorrhages, seizures, acute vision loss, spinal emergencies, etc, that you often need to respond to in minutes. You work with an organ system that most other physicians know nothing about.

Other than that: neurosurgery, pulm/CC, and certain branches of cardiology (as well as CT surgery) come to mind.

 

[mistafab]

Any specialty can be cerebral if you care about it.

 

[TelemarketingEnigma]

lots of specialties can be like this, but it's pretty much the definition of critical care. Pulm-CC especially since you get all the cerebral parts of IM and rounding interrupted by codes and intubations and procedures. there's other routes to the ICU though if you're more of an EM, anesthesia, neuro, or surgery minded person at heart.

 

[holdthemayo]

lots of specialties can be like this, but it's pretty much the definition of critical care. Pulm-CC especially since you get all the cerebral parts of IM and rounding interrupted by codes and intubations and procedures. there's other routes to the ICU though if you're more of an EM, anesthesia, neuro, or surgery minded person at heart.

The problem is, I'm not sure if I've ever met a happy CC doc. I've met happy versions of all of the above. Probably gas, EM, neuro, surg in order.

I get why people want to do cc, but I also don't get why anyone would do cc.

 

[TelemarketingEnigma]

The problem is, I'm not sure if I've ever met a happy CC doc. I've met happy versions of all of the above. Probably gas, EM, neuro, surg in order.

I get why people want to do cc, but I also don't get why anyone would do cc.

hey now, OP never asked to be happy!

 

[LetsDoThisThrowaway]

The problem is, I'm not sure if I've ever met a happy CC doc. I've met happy versions of all of the above. Probably gas, EM, neuro, surg in order.

I get why people want to do cc, but I also don't get why anyone would do cc.

I've met plenty of happy CC folks, it's a big world.

EM and Crit Care typically top the "burnout" charts on Medscape reports, and for good reason, but you'll meet happy people in both professions. Hell, people talk about how chill anesthesia is but the absolute difference in burnout rates, according to Medscape's surveys which have their own issues, is only like 9%. Those surveys honestly show more an issue with burnout in medicine/work as a whole than particular specialties, also those who usually top those charts only make up like 1% of respondants. But I digress.

 

[ACSurgeon]

The problem is, I'm not sure if I've ever met a happy CC doc. I've met happy versions of all of the above. Probably gas, EM, neuro, surg in order.

I get why people want to do cc, but I also don't get why anyone would do cc.

Hi nice to meet you

 

[Melchizedek]

hey now, OP never asked to be happy!

Interventional Cardiology.
If you're gonna be unhappy, make $$$ and be unhappy.


Edit to add:
But seriously. IC. If you build your practice right, could be cath lab one week with the high stress situations you're looking for, CICU week for a slow burn type of SHTF, two weeks of consults/office where you spend time assessing the heart in every which way to say "should I cath this person or nah?"

 

[bioarchaeologist]

MS2 in clinicals trying to figure out what I want to do with my life. One that thing I’ve found about myself is that I enjoy complex patients that require lots of thought, but I also really like the emergent, **** hitting the fan situations. Sometimes I feel like these are at odds with each other and specialties that are really cerebral don’t have the SHTF moments and vise versa. There’s obviously lots of clinical experiences and specialties that I haven’t been exposed to at this point so I’m open to suggestions

This is textbook ICU

 

[matchpalmedical]

Anesthesia

 

[GoSpursGo]

I’m biased, but I think oncology. Giving highly toxic drugs for a life threatening disease, and juggling the side effects and infectious risks. Even more so if you are participating in early phase clinical trials

 

[Angus Avagadro]

Gas certainly meets the cerebral and SHTF moments. Who do they call when someone is trying to die in the hospital? Anesthesia. Difficult airways( probably the scariest as how long can a patient hold their breath), pain control, high risk OB, nerve blocks for surgery and acute pain, massive blood loss, and coagulation control, cadiac echo and US for nerve blocks, plus we take critical patients from the icu and manage them in the OR.

 

[operaman]

Gas certainly meets the cerebral and SHTF moments. Who do they call when someone is trying to die in the hospital? Anesthesia. Difficult airways( probably the scariest as how long can a patient hold their breath), pain control, high risk OB, nerve blocks for surgery and acute pain, massive blood loss, and coagulation control, cadiac echo and US for nerve blocks, plus we take critical patients from the icu and manage them in the OR.

Yeah gas and cc seem to best fit this. We get a tiny bit of the difficult airway shtf in ent but but I’ve never heard us lumped in with anything “cerebral!”

I will say for the OP that SHTF situations are more fun when you’re a student. Gets much less fun when you’re the attending and your decisions determine what happens. Exciting sure, but I spend an inordinate amount of time and thought preventing the s from hitting the fan to begin with. I remember watching ED thoracotomies and slash trachs as a student and yeah it was cool and fun.

Now my idea of a great day is when everything goes according to plan and I can leave the hospital early.

 

[Esmolol]

Neurology... stay away from gas. #GunnerOfTheYear

Having done my neuro final today I can say... cerebral AF!

 

[deleted1095841]

Neurosurgery
Anesthesiology
Transplant surgery
Pulm CC
Infectious diseases

 

[TelemarketingEnigma]

Neurosurgery
Anesthesiology
Transplant surgery
Pulm CC
Infectious diseases

one of these things is EXTREMELY not like the others

i love ID but if an ID doc is the one in charge when SHTF, a lot of other people have done something incredibly wrong

 

[LucidSplash]

Really dislike this false dichotomy between "cerebral" and procedural/interventional/"action-oriented" fields. I don't think the time-sensitive procedural/interventional/"action-oriented" fields are any less cerebral than the less procedural/action-oriented. But I also don't think the hospitalists and psychiatrists and family medicine folks aren't useful when SHTF.

Look at it this way, I'm a vascular surgeon. If I had a patient in DKA and pretty sick with deranged labs etc, I'm sure I'd feel pretty uneasy managing it and call someone fast who would be like "hey that's no sweat, I do that all the time." So I try not to get annoyed when someone calls me and is clearly out of their depth trying to get help with a vascular problem. Recently, I had a patient on the vascular service have a stroke overnight while covering at a hospital where I don't know their particular pathways for getting ahold of stroke neurology, getting the stat imaging, etc. While the management is the same everywhere, the phone numbers and pathways to put that stuff in motion varies. There was no PA on call with me that weekend and it was a place without trainees who typically know the "who to call" pathways better than most attendings. I called a hospitalist for help to get my patient what they needed expeditiously and was also really greatful when they took the patient on their service. Likewise for a different patient on the hospitalist service with bilateral carotid dissections and crescendo symptoms despite appropriate initial management, I was able to help arrange transfer to a place with higher level of care by calling colleagues and expediting transfer, when the admitting service wasn't sure what, if anything, could or should be done.

You want to be the firefighter of the hospital that other services call emergently all the time when SHTF/things go wrong, consider vascular surgery or IR. I mean I kinda enjoy it, sometimes, but less so at like 4pm on a Friday or at 2am which is usually when stuff like that seems to happen. There are downsides to it and I'm usually cussing my own life choices about then, even though I'm happy in my field the majority of the time. But ALL specialties call other specialties for assistance and collaboration. We'd all be a lot better off if ego was checked at the door.

 

[InternistDO]

I agree that the distinction between "action hero" and "nerd" specialties is kind of arbitrary. I also think that people's definition of SHTF moments likely changes as you progress through training. A cardiac arrest seems very dramatic when you're a medical student--its substantially less dramatic after your 30th time resuscitating a 90 year old with terminal cancer.

If you mean "cerebral" in the sense most people use it (complex diagnosis and management and other Dr. House stuff) and "SHTF" meaning procedures, resuscitation and other thrilling heroics, then IM or its specialities is probably what people will think of--pulm/crit or cardiology are probably the closest, or maybe a hospitalist in a place with an open ICU or high acuity IMC/step down. But as others have said, cerebral and **** hitting the fan are in the eyes of the beholder. You will find both of those things in almost any specialty to a certain extent.