Stress and Specialties: PM&R, Pathology, Psychiatry

[Darkskies]

Hello,
I am a recently graduated pre-med and I have been seriously pondering whether I should commit to pursuing medicine as a profession. My main fear is learning to step up to the plate and contend with the high stress and responsibility of making life or death decisions, and the potential for having my botched mistakes cause irreparable damage/death to patients. As one progresses through medical school and residency, is he taught how to deal with the responsibility? Were you slowly eased into the high stress and responsibility of an attending as you went through all the hoops?

Regarding myself, I have a solid academic record but in practical situations I feel that I can be absentminded and make careless errors. In college, I was very slow at labs and made stupid mistakes. A rather far-fetched case in point would be from my independent research stint. I was supposed to bring over several test tubes and I didn't notice the test tube rack straight in front of me so I put the test tubes down on the absorbent pad the graduate student was doing his dissection on. This wasn't a huge mistake because I placed them in the test tube rack after he told me to(when I noticed it) but small things like this could have bigger consequences. I know my example is sort of vague but I hope you kind of understand my gist. I am planning on taking two years off to obtain real work experience/lab experience so that I can feel more confident about my practical skills/work ability before committing to medical school.

Based on my research, I've narrowed down to the bare minimum of specialties where the sort of stressors I'm fearing are somewhat lessened are PM&R, Psychiatry and Pathology. I would like to be able to be in a specialty where I won't have to make quick decisions(unless I were absolutely sure my decision was adequate) and where I could bounce off questions with colleagues or seniors if I am unsure of what recourse to take in a given situation. I just want to ensure that I never make a mistake that has severe negative consequences(or at least more of those mistakes than the average attending).

Are my fears overblown? During residency are the residents conditioned to learn the material so that by the time they are an attending mistakes are rare/minimized? I would appreciate any responses and especially if attendings/residents in the three specialties named before could offer me more insight into their respective fields. I was also interested in FM/IM/Peds and was wondering whether those fields still fit my ideal career.

Before I commit to medical school I just want to be certain that there will be a specialty that befits me and despite what everyone says I know that I can never be sure at this stage if medicine is the correct path for me unless I go through with it and see for myself.

Many Thanks in advance,
Darkskies

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[smq123]

I am a recently graduated pre-med and I have been seriously pondering whether I should commit to pursuing medicine as a profession.

This makes it more of a pre-allo topic, and will therefore be moved to that forum.

As one progresses through medical school and residency, is he taught how to deal with the responsibility?

Yes.

Based on my research, I've narrowed down to the bare minimum of specialties where the sort of stressors I'm fearing are somewhat lessened are PM&R, Psychiatry and Pathology. I would like to be able to be in a specialty where I won't have to make quick decisions(unless I were absolutely sure my decision was adequate) and where I could bounce off questions with colleagues or seniors if I am unsure of what recourse to take in a given situation. I just want to ensure that I never make a mistake that has severe negative consequences(or at least more of those mistakes than the average attending).

Are my fears overblown? During residency are the residents conditioned to learn the material so that by the time they are an attending mistakes are rare/minimized?

- Attendings make mistakes, and mistakes on the attending level are not all that uncommon. Patients are human, and human bodies can sometimes be very unpredictable. It can be hard to judge, exactly, which patients will do well and which ones will not.

- Even in path, you may have to make a quick judgement on the spur of a moment (i.e. when reading frozen sections). In psychiatry, where patients can be *very* unpredictable, you may also have to make quick judgements. Finally, in all specialties, even when you have colleagues to "bounce questions off of," they still will not make decisions for you....ultimately, when it is YOUR patient, YOU are responsible for making the final decision. Furthermore, you may be in a situation where you are all alone and help is far away or a long time in coming....what will you do? Stand there, frozen, like a deer in headlights until someone finally comes to rescue you?

- If you are in medicine, you have to be willing to live with a fair amount of uncertainty. If you can't, becoming a physician may not be a good choice for you.

I just want to ensure that I never make a mistake that has severe negative consequences(or at least more of those mistakes than the average attending).

You can't ensure this. You can do your best to avoid it, but you can't guarantee that it will never happen.

I was also interested in FM/IM/Peds and was wondering whether those fields still fit my ideal career.

These would be terrible choices for someone who is terrified of making a mistake. As a generalist, you see all comers for all types of diseases - it is a tremendous amount of information to cover. Plus, if you do outpatient medicine, you have to live with a high degree of uncertainty - did you diagnose Mr. Smith correctly before he went home? Was that the right medication for Mrs. Jones? Etc.

 

[ArkansasRanger]

I think you just need some substantial leadership experience. Making decisions that can have sweeping impacts on people or entire populations will get you over it. Trust yourself. Have plenty of self-confidence. If others can do the job you can too. It's not unlike anything else.

 

[Giemsa]

I'm a practicing pathologist . . . here's my input.

My main fear is learning to step up to the plate and contend with the high stress and responsibility of making life or death decisions

Pathology tends to be low stress with the "life and death" decisions. Typically one doesn't have to make snap decisions based on incomplete information (frozen sections & blood banking being the obvious exceptions). In my experience, one has time to assess the case fully and completely and render a diagnosis.

However, mistakes in pathology are fundamental: if you give the surgeon the wrong diagnosis, pretty much everything that is done to the patient stemming from that diagnosis subsequently is going to be incorrect. ("Yes, that's cancer, do go ahead and cut off that young man's leg" or "No, that mole isn't cancerous, don't worry about it, leave it alone, she'll be fine").

I can be absentminded and make careless errors.

In pathology, time may be on your side. I typically am not so rushed that I can't, if I feel unsure, put a case aside and take a look at it with fresh eyes. Or show it to a colleague. However, you can't do that with every case. Typically, nobody's checking your results. The other physicians, nurses, etc. will usually accept your diagnosis (unless it is in stark contrast to their clinical sense of the situation) and mistakes can go undetected until the patient is beyond salvage.

I would like to be able to be in a specialty where I won't have to make quick decisions(unless I were absolutely sure my decision was adequate)

generally yes in pathology

and where I could bounce off questions with colleagues or seniors if I am unsure of what recourse to take in a given situation.

generally yes in pathology

I just want to ensure that I never make a mistake that has severe negative consequences(or at least more of those mistakes than the average attending).

In terms of not making more mistakes than the average, you might want to investigate (during medical school) whether you have any aptitude for pathology. There is a certain natural talent that some people bring to pathology: they call it "the eye". Some people are just better pathologists than others because they have "the eye".

You might want to consider epidemiology or research.

 

[morning]

There's also genetics, occupational med, allergy/immunology and diagnostic radiology.

There are people who go through medical school and realize they really don't like the responsibility or patient care at all. They often find something in medicine they enjoy doing, but it does seem like a huge waste of 4-8 years of your life.

 

[Abby_Normal]

I think you just need some substantial leadership experience. Making decisions that can have sweeping impacts on people or entire populations will get you over it. Trust yourself. Have plenty of self-confidence. If others can do the job you can too. It's not unlike anything else.

This sounds like good advise. Obviously, if the idea of medical-type responsibility bothers you too much, you might want to rethink medicine. However, if you are seriously interested otherwise, you really should do some more self-exploration before you write it off.

I obviously can't speak specifically to your case, but fear, ability to handle responsibility, etc can be very situational. For example, I tend to be horribly shy, but have never had a problem talking to/interacting with people when when tutoring or last summer when I was an ER volunteer.

 

[Darkskies]

Thanks for all the replies! I guess I have a lot more to think about. In pathology, although you'll have to make decisions on your own by the time someone becomes an attending is he/she quite competent with just about any case?

Secondly, I don't really see how my thread should be in the pre-allo forums simply because I am a pre-med. I was under the impression that my questions would be better addressed by practicing attendings or residents. I am not trying to be contentious, I just thought that the pre-allo forums mainly deal with how to get into medical school, college grades/classes,etc. Perhaps the General Residency forum was not the appropriate place for my thread but couldn't it be moved to somewhere more residents or attendings would see it? Please let me know. Thanks,
Darkskies

 

[smq123]

Secondly, I don't really see how my thread should be in the pre-allo forums simply because I am a pre-med. I was under the impression that my questions would be better addressed by practicing attendings or residents. I am not trying to be contentious, I just thought that the pre-allo forums mainly deal with how to get into medical school, college grades/classes,etc. Perhaps the General Residency forum was not the appropriate place for my thread but couldn't it be moved to somewhere more residents or attendings would see it? Please let me know. Thanks,
Darkskies

The gen res forums are meant for issues of interest to current residents right now. They're not meant to advise pre-meds on whether or not they should pursue medicine.

Your question seems, to me, whether or not you should even pursue medicine in the first place - which is a question that, really, only pre-meds ask themselves.

Finally, lots of residents and attendings *do* read pre-allo, and as such will see your thread. You might not even get many replies in the gen res forum, since most of the residents read that forum to read threads about issues of interest to them at this stage in their career, not necessarily to advise pre-meds.

 

[avatarftw]

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[Darkskies]

Okay, I understand perfectly now. Thanks. How do you learn to live with a fair amount of uncertainty in medicine? I thought that the years of residency produced physicians who are competent with just about any situation in their field.

The gen res forums are meant for issues of interest to current residents right now. They're not meant to advise pre-meds on whether or not they should pursue medicine.

Your question seems, to me, whether or not you should even pursue medicine in the first place - which is a question that, really, only pre-meds ask themselves.

Finally, lots of residents and attendings *do* read pre-allo, and as such will see your thread. You might not even get many replies in the gen res forum, since most of the residents read that forum to read threads about issues of interest to them at this stage in their career, not necessarily to advise pre-meds.

 

[smq123]

How do you learn to live with a fair amount of uncertainty in medicine? I thought that the years of residency produced physicians who are competent with just about any situation in their field.

You'll never encounter every possible situation as a resident. Residency is only 3-7 years long, and you will spend the rest of your career learning.

 

[Darkskies]

You'll never encounter every possible situation as a resident. Residency is only 3-7 years long, and you will spend the rest of your career learning.

Well I guess I thought that even if you never encounter every possible situation as a resident, you are trained to handle just about every major situation. I also thought that for rarer situations you've never been exposed to before, you would still know how to begin the workup. Is this not the case? How do you go about learning while trying to make sure you don't jeopardize your patient as you have never seen the particular presentation?

 

[Darkskies]

You'll never encounter every possible situation as a resident. Residency is only 3-7 years long, and you will spend the rest of your career learning.

Well I guess I thought that even if you never encounter every possible situation as a resident, you are trained to handle just about every major situation. I also thought that for rarer situations you've never been exposed to before, you would still know how to begin the workup. Is this not the case? How do you go about learning while trying to make sure you don't jeopardize your patient as you have never seen the particular presentation?

 

[nlax30]

Well I guess I thought that even if you never encounter every possible situation as a resident, you are trained to handle just about every major situation.

Well yea, there's more or less a standard "body of knowledge" that you learn in some form or another during residency, but the patients are still human, and thus each case can be slightly different. You may learn the textbook presentation of a disease but that's not how you all you patients are going to present.

I also thought that for rarer situations you've never been exposed to before, you would still know how to begin the workup. Is this not the case? How do you go about learning while trying to make sure you don't jeopardize your patient as you have never seen the particular presentation?

Well, yeah, you'll read and learn about the rare diseases and whether or not you actually see them is another story. Just because you haven't come across something before doesn't mean that you are pretty that patient's live in danger when you first see it and diagnose and treat. I think you're kind of over thinking things here about how medicine is actually practiced and learned. You will be constant learning but that doesn't mean you are constantly starting from scratch when presented with a new or rare disease.

I don't really know how to explain it besides to say that I think this is more of a philosophical question/discussion than one that you should focus on at this point to decide whether or not you are meant for medicine.

 

[Darkskies]

I don't really know how to explain it besides to say that I think this is more of a philosophical question/discussion than one that you should focus on at this point to decide whether or not you are meant for medicine.

So what should I be focusing on to determine whether I'm meant for medicine or not? Grades, MCAT, desire to help people? The last comment isn't meant to come off as a retort. I'm really trying to figure this out..

 

[nlax30]

So what should I be focusing on to determine whether I'm meant for medicine or not? Grades, MCAT, desire to help people? The last comment isn't meant to come off as a retort. I'm really trying to figure this out..

Just sent you a PM but can repeat some of it here. Main point is that having some fear/concern over learning what you need to learn in order to safely treat patients, at least in mind, is kind of a natural concern. I'm sure most have had similar concerns at varying points during their career. We are still human, will never be perfect, and can will never be able to know everything. If having that kind of concern meant that medicine wasn't right for someone then I think there would be a lot less people in medicine.

If you're truly just trying to decide if medicine is right for you....
Does medicine in general interest you?
Have you done enough shadowing, talking with physicians, had enough clinical experience to get a better idea of how medicine is actually practiced in various fields and what a typical day is like for a doc?
Do you think you'd enjoy having the sort of responsibility a physician has? Are you comfortable putting in the amount of years of training involved?
Are their family concerns or roadblocks?
Is there any other career you could see yourself doing and being happy with longterm?
And so on... in my opinion those are some of the questions I had to work through.

 

[ArkansasRanger]

Thanks for all the replies! I guess I have a lot more to think about. In pathology, although you'll have to make decisions on your own by the time someone becomes an attending is he/she quite competent with just about any case?

Secondly, I don't really see how my thread should be in the pre-allo forums simply because I am a pre-med. I was under the impression that my questions would be better addressed by practicing attendings or residents. I am not trying to be contentious, I just thought that the pre-allo forums mainly deal with how to get into medical school, college grades/classes,etc. Perhaps the General Residency forum was not the appropriate place for my thread but couldn't it be moved to somewhere more residents or attendings would see it? Please let me know. Thanks,
Darkskies

Anybody with life experience can answer your questions - not just doctors.

Everyone has some measure of responsibility.

Will a soldier be able to go into combat without running? Can a plumber join copper tubing knowing it won't leak gas and blow some family up in their house? Will a paramedic know how to run the code on someone in ventricular fibrillation? Can a police officer make the observation needed to save a life? Will an electrician be able to splice the wiring and not burn down an entire apartment building? Can a kid at the quick lube be certain he put the plug back so all the customer's oil doesn't drain out and burn the car up? Will a firefighter not back out of a burning house and leave his partner lost somewhere inside in the darkness? Can a small business owner be certain his merchandise will keep his store open and keep his family fed?

Those are all examples of everyday people doing everyday parts of their jobs, making decisions that are going impact more people than just themselves, and millions of us do it everyday.

 

[Darkskies]

Anybody with life experience can answer your questions - not just doctors.

Everyone has some measure of responsibility.

Will a soldier be able to go into combat without running? Can a plumber join copper tubing knowing it won't leak gas and blow some family up in their house? Will a paramedic know how to run the code on someone in ventricular fibrillation? Can a police officer make the observation needed to save a life? Will an electrician be able to splice the wiring and not burn down an entire apartment building? Can a kid at the quick lube be certain he put the plug back so all the customer's oil doesn't drain out and burn the car up? Will a firefighter not back out of a burning house and leave his partner lost somewhere inside in the darkness? Can a small business owner be certain his merchandise will keep his store open and keep his family fed?

Those are all examples of everyday people doing everyday parts of their jobs, making decisions that are going impact more people than just themselves, and millions of us do it everyday.

All of what you say is true. I guess I'm wondering if I would be competent in making such decisions or whether I'd do a lot worse than the average resident and end up getting terminated(God Forbid!). Does academic success correlate with success in the clinic/actual practice? I feel like my issues are not really academic, and more to do with my personality/absentmindedness. I know I'm thinking too far out and that there's no way for anyone to tell unless I go through with it...If only there weren't so many loans so you could get out scotch free if it turns out that you're not a fit for the profession.

 

[radiodoc99]

Keep in mind as technology improves, fields like path will get easier and accuracy will improve.

 

[ArkansasRanger]

All of what you say is true. I guess I'm wondering if I would be competent in making such decisions or whether I'd do a lot worse than the average resident and end up getting terminated(God Forbid!). Does academic success correlate with success in the clinic/actual practice? I feel like my issues are not really academic, and more to do with my personality/absentmindedness. I know I'm thinking too far out and that there's no way for anyone to tell unless I go through with it...If only there weren't so many loans so you could get out scotch free if it turns out that you're not a fit for the profession.

I can't guage your success as a physician based on what you do in medical school because I've never been there. That said, I know some very stupid people who are more than successful at their jobs which to me says they do their jobs effectively.

Your concerns are seriously the farthest thing from my mind. I'm more concerned about what I'm giving up in order to apply to med school and go, etc. since I'm nontraditional. I don't want to sacrafice my life really, but it's the job I most want to be doing that I can do so it's where I'll direct my efforts.

 

[Darkskies]

I can't guage your success as a physician based on what you do in medical school because I've never been there. That said, I know some very stupid people who are more than successful at their jobs which to me says they do their jobs effectively.

That's exactly what I mean. I feel that I lack some common sense and can be slow at practical tasks even though academically I am above average. I'm wondering if this would be a hindrance in medical training. I guess if worst comes to worst I can always be on the income based repayment plan which would ease the burden of loans if for some reason I have to exit medicine,correct?

I just recently graduated college and I'm planing on taking 1-2 years off to get some work and life experience underneath my belt to hopefully allay these concerns since the issues I might have to deal with, I'd have to confront in any job. I suppose the consequences would be more severe in medicine. Good luck with all of your endeavors and I'm sure you already know that many other people in medical school will be nontraditionals like yourself.

 

[Law2Doc]

You'll never encounter every possible situation as a resident. Residency is only 3-7 years long, and you will spend the rest of your career learning.

Agreed. You will never know everything you need, or have seen everything you need, and will never get to the point where you are unflappable and don't make at least a few errors, some costlier than others. The best all do.

First, I'm not sure I agree that you will get "eased in" to the process, the way the OP seems to mean it. The major steps are: you learn the basic sciences the first two years of med school, then you spend time doing clinical rotations the latter two years where you are there working under residents and tend to have little personal responsibility for the patient. At some point in 4th year you probably will be made to do a sub-I or two where you will have a bit more responsibility, but still will answer to residents throughout the day on your patients -- you won't be working without a net.

But then you graduate and become an intern, and you kind of get thrown into it. You have seniors you can call if you don't know what you are doing or are over your head, which will be frequent in the beginning. The learning curve is very steep, and you will realize that you have come out of med school learning but a mere fraction of what you need to know. Most of your seniors will be very patient with you and your inane questions for a few weeks. But after about a month the senior isn't going to want to hear that you are having trouble controlling the patient's hypertension or blood sugar or that you aren't sure how much pain control is too much for a 90 year old with bad kidneys. So you are pretty much on your own. You have a list of people you can call if the patient goes south -- the senior on call, the chief, even the attending. But it's up to you not to let it get to that point, and if it does, it's up to you to recognize it and take the appropriate steps. You start out awful at this, and get better as you go. Which is why you should tell your relatives never to go to the hospital for elective stuff in July-August.

There are no specialties that are free from pressure. Path, radiology and other consult fields are ones where other clinicians are going to rely on your reports and if you are wrong, the patient may very well die and you will get sued. Clinicians (as opposed to consults) have a more direct role in killing their patients with bad decisions. Fields like PM&R are a bit less on the front line, but that's a field where you have to do a preliminary year (internship) in medicine before you start, and will definitely be on the front line during that year. Even after, you will be prescribing drugs and treatments that if wrong can hurt your patients, many of whom are old and have had strokes and other major insults to their health before you get them (they work with some of the more fragile of patients). With psych, the drugs all work via mysterious and poorly understood processes, and most have very significant side effects, and many patients are a risk to themselves and others, so you can't exactly be cavalier about treating patients in that field either.

It is very common to kill a patient during your training. Most do. Heck, they even made a Scrubs episode about it, it's so common. So yeah, there's a lot of pressure. You don't do this to dabble, you are either committed to being the best clinician you can be, or you are going to be a walking disaster.

 

[Darkskies]

So yeah, there's a lot of pressure. You don't do this to dabble, you are either committed to being the best clinician you can be, or you are going to be a walking disaster.

Oh, I wouldn't be intent on doing this just to dabble. I'm pondering whether my best will be enough.

 

[Longshanks]

Oh, I wouldn't be intent on doing this just to dabble. I'm pondering whether my best will be enough.

If you're having these questions or doubts, some of which are natural, I am under the impression you haven't had enough experience with health care. See if you can volunteer in a local health care setting, shadow a physician, or get an entry-level job in health care. Then you'll see the interactions of different professionals with patients, and have the chance to observe and converse with physicians.