The Honeymoon Phase is Over

[TheBigCat04]

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Hey everyone,

I decided to post here because I wanted to see if any one else feels the way I do. I searched on previous forums about similar emotions but I thought itd be cool to get some support/criticism/everything from my current colleagues.

I am now roughy 4-5 months into my internship at a Transitional Year program. I'm over it all. THE HONEY MOON PHASE IS OVER! I'm done with the glory of being a doctor, the congratulations from friends and family, the respect from outsiders, the announcement that I matched, the making of new friends in residency, the freshness of being a resident now and getting to wear longer coats. I just don't care anymore. I'm starting to become jaded and look at sick patients as just more work. I try to read and study for step 3 and can't stop thinking about how I don't care. I don't find any of it interesting. Its all just rote memorizing and spitting out facts. Sounds nuts but I find medicine to be so mentally unstimulating. No room for creative thought process just memorize protocol, factoids, associative memory usage.....and PAPERWORK. So boring.

To be clear I never liked medical school either. I was always an above average student especially in the maths, sciences, economics throughout my life. I always had trouble memorizing and thus struggled in courses in foreign language and even biology. Thus medschool was super challenging. All these people I went to undergraduate with were suddenly kicking my ass. People who I used to destroy in undergrad courses were doing better than me. I thought I was a fluke and I just somehow made it through the education system my whole life without actually being that smart. I worked my tail off during rotations and the STEP exams and somehow made it past those barriers.

I thought things would get better in residency, but it hasnt. Its only emphasized how much I just don't like being a typical doctor. Sure, superficially its really cool but I can't stand how boring I've become. Its hard for me to conversate with other people on other topics. I can't explore hobbies. All my friends pursuing other careers are loving their 20's. I find myself searching for "non-clinical jobs for MDs" a whole lot.

Anyways I just hate going to work everyday. I don't know if its just intern blues or if its the fact that I'm sick and tired of feeling stupid every day since 3rd year medical school. Every single day Im worried that Ill be caught as a fraud. And its not that I'm dumb, or so I don't think, but I just have trouble memorizing things! Thats what I loved about math physics and economics. It wasnt memorizing at all really. It was more so understanding a system and hten playing around within certain fundamental theories. It was beautiful. Now it seems intelligence is determined by meer fact memorizing and reciting some study.

Any ways I was wondering if anyone else has the intern blues and/or if anyone else has actually felt this way before and just switched into something else more chill so they could enjoy life. I like the thought of switching to something like family med but again its all protocol driven and fact memorizing and way too generalized. PMR might be cool but they don't make enough and honestly I want to make good money after going through this ish.

I still make plans about what I'm going to be when I grow up. I just dont see myself doing this rest of my life and want to pursue something else, more creative and bigger picture oriented. But Im too scared to leave the clinical path due to the certainty and salary it will provide. I sometimes think that I'd be a huge disappointment to everyone because I'm often viewed with such pride by friends and family but at this point I don't really care.

Im probably just weak minded but this is my vent. Feel free to agree/disagree/make fun of me!!!

 

[natashana]

Pretty much everyone starts to hate work and life in general at some point during intern year. It doesn't matter that work hours are more regulated, or there are no calls, or whatever else has been done to try to make intern's lives easier. You work most of the time at a job you, frankly, are not good at. You are reminded of this daily. You, for the first time, really have to experience the brunt of dealing with sick, angry, or frustrated people--both patients and coworkers. You have to learn to navigate an inefficient system efficiently, with high stakes outcomes.

Anyways, let's not dwell on the downside--everyone has felt like you at some point. It gets SO SO SO much better second year. If you can try your hardest to look on the bright side, ignore the haters (KEY), have fun outside of work, and rely on some sort of support system to vent, you will make it through with the least amount of pain possible. Second year you will feel exceptionally smart compared to the new interns, will have one level of removal from the angry patients/coworkers and paperwork, and generally work less. These things are amazing, and it's worth it to get through, because at that point, difficult situations will just roll off your back like water.

 

[cjw0918]

I am sorry you feel this way. I felt so down in the dumps at various points in my training and questioned my decision to enter medicine as well. The only thing I can say is that the actual practice of medicine is much different from how it is in training. Training is such a beat down. When you're doing the real thing, it's so much better and more rewarding. (Of course, I am not in primary care. Many of my friends and colleagues in primary care seem to have never ending frustration and dissatisfaction.) I will say that I am in my third year post training and I LOVE my job. I hope you stick it out a bit longer and find your niche.

 

[Target2]

I felt the same way you did during medical school and intern year. I felt that I never got to enjoy my 20's because life was consumed by medicine. Like you, my friends in other careers were out partying, dating, travelling, doing all the things I couldn't. I never got to experience anything outside of medicine, so I felt cheated and always wondered what else was out there because I was bored of medicine. I did end up leaving medicine and pursued another career and started living life. It was extremely hard and scary at first b/c of the uncertainty and lack of training in another field. But eventually things fell into place b/c I became passionate about other things. I am really glad I did take a break, but it's not for everyone....you really have to the guts to leave the comfort and job security of medicine.

Fast forward, my experiences have made me realize certain facts about life that I wouldn't have learned if I didn't leave: 1. every job will get boring at some point or another. 2. you can choose to live life now or later in life (after you become a practicing physician, you can start to live your life, spend money, travel, whatever you want b/c you are financially stable). 3. your friends in other careers will go through the ups and downs of job insecurity, being laid off, not having as much flexibility to live or work wherever they want, not making enough money to support a growing family. 4. medicine is definitely the best job out there and if you doubt it, then go try something else even if its just for a few months....I promise you will appreciate medicine so much more 🙂

 

[residentdoc8]

I felt the same way you did during medical school and intern year. I felt that I never got to enjoy my 20's because life was consumed by medicine. Like you, my friends in other careers were out partying, dating, travelling, doing all the things I couldn't. I never got to experience anything outside of medicine, so I felt cheated and always wondered what else was out there because I was bored of medicine. I did end up leaving medicine and pursued another career and started living life. It was extremely hard and scary at first b/c of the uncertainty and lack of training in another field. But eventually things fell into place b/c I became passionate about other things. I am really glad I did take a break, but it's not for everyone....you really have to the guts to leave the comfort and job security of medicine.

Fast forward, my experiences have made me realize certain facts about life that I wouldn't have learned if I didn't leave: 1. every job will get boring at some point or another. 2. you can choose to live life now or later in life (after you become a practicing physician, you can start to live your life, spend money, travel, whatever you want b/c you are financially stable). 3. your friends in other careers will go through the ups and downs of job insecurity, being laid off, not having as much flexibility to live or work wherever they want, not making enough money to support a growing family. 4. medicine is definitely the best job out there and if you doubt it, then go try something else even if its just for a few months....I promise you will appreciate medicine so much more 🙂

Target2 (and everyone else who has posted)-- I have to say- THANK YOU SO MUCH for such a CANDID NON-MALIGNANT SUPPORTIVE response to this posting!!! This is by far the best thread in this entire forum! I've wanted to QUIT medicine SO MANY TIMES....i've been beaten down and gotten back up more often than not...and the only thing that had kept me going for a long time were my enormous student loans over my shoulders...but, if you think about it, there really isn't another field out there with so much job security (regardless of the economy). Once training is over, you will have the ability and flexibility to shape the career that you want (even in primary care...you could CHOOSE to set up your own practice and do botox or issue medical marijuana cards all day if your heart so desires!)....and in the end, if you had chosen an alternative career path, you may have ended up in the same exact position as you are now (as mentioned before, you could have possibly been laid off from a job, or been in just as much debt, or had a ceiling on your own earning potential no matter much you've worked or put in your hours in)-- in the very end, medicine is really the best field out there in the long run and it's secure....so try and push through this difficult period knowing that for the rest of your life you will have the ability to make money, have some sort of job satisfaction, and have more freedom in your future. Your degree allows you to do whatever you want (teach, pharmaceutical industry, set up your own business, research, etc.) Just wanted to thank everyone else who has posted-- what a great thread!

 

[Perrotfish]

We're right there with you. Hopefully it will get better after Intern year. If it helps it seems like all the other Interns are miserable, only some of the residents are, and very few of the attendings are. That gives me a lot of hope there's a light at the end of the tunnel. 8.5 rotations to go. You'll get there. And if you still want to change careers then you'll know you left rather than running away.

 

[MDpride]

I feel the same, but don't know what i would do if i were to quit medicine now.
Its been 5 months into residency, but feels like ever.
Its mainly long work hours bothering me.
I can practice medicine as long as i get weekend off when events are happening.
Looking back, should have done more digging before enlisting.
Its cool to read about pathophsyio of disease but now i wonder how much of it is even useful in daily practice of medicine.

 

[TheBigCat04]

I totally agree. I just hate not having weekends ever and I hate how pathophysiology isn't even worth reading. Sounds cliche but I really wish I just did Dentistry. It seems much more reasonable lifestyle, creative thought process, procedure based, outpatient....basically everything id like out of a medical specialty..... oh well.

Thanks for all the kind responses by the way, really appreciate it.

To Target2, what career did you end up going into? Do you regret your decision at all? What kinds of steps did you take to actually muster up the courage and just leave?

Thanks

 

[Law2Doc]

We're right there with you. Hopefully it will get better after Intern year. If it helps it seems like all the other Interns are miserable, only some of the residents are, and very few of the attendings are. That gives me a lot of hope there's a light at the end of the tunnel. 8.5 rotations to go. You'll get there. And if you still want to change careers then you'll know you left rather than running away.

The winter of intern year is rough. By spring you will see the light at the end of the tunnel, and will be adequately efficient and knowledgable regarding the daily grind and attendings expectations that you can start to streamline tasks and get some semblance of control over your daily life. In retrospect it won't seem like that big of an ordeal.

 

[Dr. USMLE]

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[nancysinatra]

Hey, hang in there. I'm a fourth year and I felt exactly like you, at many times. There were many subjects I loved in college and none of them involved the ridiculous memorizing that is at the heart of medicine. I thought intern year and some parts of second year were a complete drag.

Still, it does get better. When you get more efficient then you find that you can think more about what's going on. The hours get better, and there's less scutwork.

I don't know what specialty you're in, but as you get farther along, you might find a subspecialty that appeals to your interests. At this point that probably isn't too comforting, but when you're a couple years into training you can actually start to see huge differences in the various practice options that are available, and in the different subspecialties of your field.

 

[45408]

PMR might be cool but they don't make enough and honestly I want to make good money after going through this ish.

It's not all about money. Hating your life in order to get a big paycheck is not going to be worth it.

But PM&R pays fairly well anyways 😀

It's also quite normal to feel the way you're feeling.

 

[Arcan57]

I feel the same, but don't know what i would do if i were to quit medicine now.
Its been 5 months into residency, but feels like ever.
Its mainly long work hours bothering me.
I can practice medicine as long as i get weekend off when events are happening.
Looking back, should have done more digging before enlisting.
Its cool to read about pathophsyio of disease but now i wonder how much of it is even useful in daily practice of medicine.

Pathophys is useful in that it makes it seem like medicine is a coherent system of diseases that can be wrestled to the ground with enough thought. It's not, of course, but this model has proven more useful then those it replaced and probably isn't going away barring a complete collapse of the first world. It also gives us a framework to hang the clinical knowledge we learn in residency, which makes the less socially adept of us sound more convincing when talking to strangers about life-altering decisions.

 

[Dral]

Give it time. No one likes intern year (well, pretty much no one). The no weekends wears on you for sure. It sounds like you're going into an advanced residency, so give it a chance.

Residency is not easy, period. I loathed my life during ICU...missed so many good things, really disliked the work, rough hours, felt like a COMPLETE idiot, etc.

I still feel like an idiot now that I'm in my advanced spot, but I'm loving what I'm doing and what I'm learning about (Derm). I truly do love it, btw...not in it just for the 'perks'....and it actually is A LOT of work.

My advice would be to hold off on any final decisions until you've given your advanced spot a good chance.

 

[PistolPete]

For us, 2nd year is much worse than intern year because we can actually take 24 hour calls, and work the brunt of weekends. It sucks, intern year is only a bit better.

I too think about if I should have chosen dentistry... man, what a sweet gig. No call, no weekends, 9-5, and they still make 200k.

Another 3.5 years of residency to go...

 

[StevenRF]

Man, I could have written the exact same post intern year. This is coming from someone who is working actively to get out of a medicine but not there yet so take it with a grain of salt...

Figure out what you don't like. Healthcare, medical science, and practicing as a physician are not the same thing. Even if you like the science, seeing patients may not give you some innate joy. Being an attending isn't going to change that, you'll be seeing twice as many patients with your butt on the line and your heart not in it. Find a career and financial plan to get out and go for it. Worst case you fail, and end up like most americans, working a job they hate to earn a paycheck, which is where we already are.

 

[Sarcoidosis]

Hey everyone,

Anyways I just hate going to work everyday. I don't know if its just intern blues or if its the fact that I'm sick and tired of feeling stupid every day since 3rd year medical school. Every single day Im worried that Ill be caught as a fraud. And its not that I'm dumb, or so I don't think, but I just have trouble memorizing things! Thats what I loved about math physics and economics. It wasnt memorizing at all really. It was more so understanding a system and hten playing around within certain fundamental theories. It was beautiful. Now it seems intelligence is determined by meer fact memorizing and reciting some study.

Im probably just weak minded but this is my vent. Feel free to agree/disagree/make fun of me!!!

This is very true... after 3rd year it seems like downhill in terms of knowledge. However, what I realized is that the most important aspect of our medical knowledge is the foundation. Once we forget the foundation we are doomed to memorization!

The first 2 years of medical school teaches you foundation of medicine that if you revise will make everything else a lot easier to remember. Because it dealt with concepts and off course memorization.

Our clinical textbooks have cases that rarely tie the fundamentals to clinical practice. I believe we should have chapters and headings in books that state the pathophysiology of a bunch of diseases rather than having the name of each disease, their clinical findings and so on...
Most of the review books focus on what is important for that period in ones training, summarizing a large textbook, however, the whole story(logic) behind the important points is left out and so when we study/read this we are left to memorization.

I dont' know if I am making any sense and I can't think of a good example at this time.

As well, in your case or any intern in a similar situation you have to realize that this may just be Adjustment disorder and time heals everything!

 

[MDpride]

This is very true... after 3rd year it seems like downhill in terms of knowledge. However, what I realized is that the most important aspect of our medical knowledge is the foundation. Once we forget the foundation we are doomed to memorization!

The first 2 years of medical school teaches you foundation of medicine that if you revise will make everything else a lot easier to remember. Because it dealt with concepts and off course memorization.

Our clinical textbooks have cases that rarely tie the fundamentals to clinical practice. I believe we should have chapters and headings in books that state the pathophysiology of a bunch of diseases rather than having the name of each disease, their clinical findings and so on...
Most of the review books focus on what is important for that period in ones training, summarizing a large textbook, however, the whole story(logic) behind the important points is left out and so when we study/read this we are left to memorization.

I dont' know if I am making any sense and I can't think of a good example at this time.

As well, in your case or any intern in a similar situation you have to realize that this may just be Adjustment disorder and time heals everything!

what book/resource would u recommend for that fundamentals for interns who don't have much time to read

 

[88845]

I totally agree. I just hate not having weekends ever and I hate how pathophysiology isn't even worth reading. Sounds cliche but I really wish I just did Dentistry. It seems much more reasonable lifestyle, creative thought process, procedure based, outpatient....basically everything id like out of a medical specialty..... oh well.

Thanks for all the kind responses by the way, really appreciate it.

To Target2, what career did you end up going into? Do you regret your decision at all? What kinds of steps did you take to actually muster up the courage and just leave?

Thanks

For us, 2nd year is much worse than intern year because we can actually take 24 hour calls, and work the brunt of weekends. It sucks, intern year is only a bit better.

I too think about if I should have chosen dentistry... man, what a sweet gig. No call, no weekends, 9-5, and they still make 200k.

Another 3.5 years of residency to go...

This is why I've encouraged many of my peers to look into dentistry as an option. Dentists never have to step foot in a hospital if they don't want to and aren't subjected to the endless hoops required to jump through that medicine requires. It's a decent career with favorable life-work balance and comes with the satisfaction of being able to control your own private practice. If I were to pursue medicine I would probably go for family medicine as it seems to me that one could setup a practice environment which allows for flexibility (e.g. outpatient, weekends off, regular hours, etc) with the ability to be outpatient only. Both of your sentiments serve as cautionary tales to anyone who is on the fence about whether to pursue medicine or dentistry.

 

[Sarcoidosis]

what book/resource would u recommend for that fundamentals for interns who don't have much time to read

Tell you the truth, I don't have a great resource to recommend.

Or I haven't found one anyway.

But being in a similar boat as many are... I realized my frustration with the material stemmed from having passive reading/studying and slow deterioration of basic medical knowledge...

For instance... it is so much harder to remember the different vasculitis/arthritic conditions their names/clinical symptoms/management and I would read them and forget constantly...

What I realised was, my understanding of basic immunology had deteriorated that was my problem..... it sucks to memorise these things over and over without a big concept...

However, it may be easier to simply understand the anatomy of the body well and try to figure out what happens when different tissues/organs in our body are attacked by our own immune system. Think about what happens when a particular tissue is attacked, then think about a logical management for the condition.

I don't have a good and quick resource for you, you will have to open up the big textbooks I believe... because the short and sweet review books are for those that have photographic memories.

One thing I can recommend is get in a group and talk out the material out loud, you will learn more when you are trying to teach.

I know all this is easier said than done especially when you only get 5 hours/night to sleep.

 

[Mattchiavelli]

quit studying for step three. Seriously. Just take it like a month after intern year when you've had an entire year of clinical work done and you won't have to study much. I don't agree witht he whole "two months, to weeks, two pencils" adage ad you likely haven't done a lot of outpatient which step three has a lot of, but regarding the adult inpatient stuff you'll be fine. That should free up some time to be a real person

 

[natashana]

Pathophys is useful in that it makes it seem like medicine is a coherent system of diseases that can be wrestled to the ground with enough thought. It's not, of course, but this model has proven more useful then those it replaced and probably isn't going away barring a complete collapse of the first world. It also gives us a framework to hang the clinical knowledge we learn in residency, which makes the less socially adept of us sound more convincing when talking to strangers about life-altering decisions.

Post of the day/week/whatever!! 👍👍👍

 

[RubberToes]

I can relate to you on many points: I excelled in math (top1 or 2 in high school) and sciences, as well as accounting that we studied in school (IGCSEs - Cambridge examinations - British system). In medicine, everyone just memorize stuff which often, but not always, doesn't require in-depth thought, and people whom you outperformed with little effort earlier can kick your ass.

To boot, I am an IMG, who lost motivation during medschool, didn't do USMLEs either. And btw, my twin bro works in investment banking and landed a 100K+ job at the age of 22. My elder bro was doing MBA and Wharton and there was a doctor with him who was doing management because there's a lot more money there. I started to feel really demotivated.

But now I feel different though, because I've found a part of medicine that I love. I want to devote myself and excel in it, and take pride in my work. It's rekindled the love I had for medicine as a child, watching my dad give medical advice to people (psychiatrist) that disappeared with the lectures in medschool.

Anyway, my advice to you is keep going, and think hard about a part of medicine that you really love, maybe something with not too much general knowledge, but more specialized. If not, then perhaps like hospital administration or something, where your medical expertise can still help.

Good luck.

 

[deleted263296]

I ponder leaving medicine every day. The needy, ungrateful patients just piss me off and this healthcare system is FUBAR.

 

[Slowpoke]

As an M1 reading these replies, I am taking everything you guys say to heart and am going to try to not let this process beat me down.

Is there anything that you would say to your M1 self, if you could?

 

[anonperson]

I still make plans about what I'm going to be when I grow up. I just dont see myself doing this rest of my life and want to pursue something else, more creative and bigger picture oriented. But Im too scared to leave the clinical path due to the certainty and salary it will provide. I sometimes think that I'd be a huge disappointment to everyone because I'm often viewed with such pride by friends and family but at this point I don't really care.

What did you really expect out of intern year? Did you not gain anything from your third and fourth year medical school rotations to see that intern year, regardless of specialty, is a process in which you learn to take crap from anyone and everyone in the hospital capable of forming a thought.

You should have easily picked that up in the middle of third year. If you didn't, I'm not sure how one could be so unaware.

What you are feeling is normal though. It should get better. Especially in your case since this is just a transitional year and you likely have rads/ophtho/derm waiting in the future. Don't make any stupid decisions based on what is supposed to be a tough year of training.

Also, how does dentistry fulfill a creative aspect of anything? It's a procedural profession with regular hours and good pay. Derm has that, ENT has that, ophtho has that along with others.

What you probably want is a low stress profession where you can work with your hands a bit, make some good coin, get called Dr, and not get called in the middle of the night. Find the specialty/subspecialty that can accommodate this in medicine if you absolutely do NOT want to leave medicine. Otherwise you'll have to put your head down and grind through the rest of the year.

It gets better though. Slowly. By the end, you'll wonder where all the time went.

 

[HLxDrummer]

I am an MS1 as well and can totally see this being me in a few years. I hate memorizing stuff blindly. I liked chemistry in college because it required you to think (I actually liked P. Chem the most!) and figure things out instead of memorizing.

I'm worried I'll be bored to death and that I'll be a bad doctor. How the hell do you guys remember every detail you learn during your first two years for step 1, let alone the rest of your life when your not using it a lot?

On top of it I had no life in undergrad and not much of one now (combination of school and other factors). It is rough seeing friends make "good" money, living life, etc the past few years and know I still have a long ways to go before I can buy myself something besides a loaf of bread and books.

Even now it would be extremely hard for me to back out (not that I want to do this, but makes it scary)...

Sorry your feeling this way though, OP. Hope it gets better for you!

 

[Winged Scapula]

I am an MS1 as well...

Your status says Pre-Med. You might consider changing that because users do really look at that stuff here.

How the hell do you guys remember every detail you learn during your first two years for step 1, let alone the rest of your life when your not using it a lot?

😆 We don't. There's a reason why they say 3rd year medical students are the smartest; they remember all the basic science minutiae at that point. We don't. You only retain what you use on a day to day basis.

 

[HLxDrummer]

Your status says Pre-Med. You might consider changing that because users do really look at that stuff here.

Thanks for the heads up, not on here too often!

😆 We don't. There's a reason why they say 3rd year medical students are the smartest; they remember all the basic science minutiae at that point. We don't. You only retain what you use on a day to day basis.

Well that is a relief! Most jobs I can accept being "decent" and not doing an amazing job but I would feel really unethical being a physician if I'm not at least up there with everyone else, you know? Good to know I didn't accidentally slip through the cracks in the admission process, lol! Thanks for the info!

 

[Top Gun]

I'm worried I'll be bored to death and that I'll be a bad doctor. How the hell do you guys remember every detail you learn during your first two years for step 1, let alone the rest of your life when your not using it a lot?

You don't. You remember the principles that you use the most. And that changes as you go from med student to resident to fellow to attending. Certain ones become more applicable in whichever field you go into, and those are the ones you remember. Do you honestly think any of us remember all the steps of gluconeogenesis, for instance?

It gets better once you get into the clinical years and into practice. There, you actually have to think and apply what you've learned to come up with a diagnosis and a management plan, particularly when you get a patient with vague complaints.

 

[dragonfly99]

What did you really expect out of intern year? Did you not gain anything from your third and fourth year medical school rotations to see that intern year, regardless of specialty, is a process in which you learn to take crap from anyone and everyone in the hospital capable of forming a thought.

You should have easily picked that up in the middle of third year. If you didn't, I'm not sure how one could be so unaware.

What you are feeling is normal though. It should get better. Especially in your case since this is just a transitional year and you likely have rads/ophtho/derm waiting in the future. Don't make any stupid decisions based on what is supposed to be a tough year of training.
.

I agree with this.
I think that some medical students did not go to a very malignant medical school, so they get surprised by how crappy things can actually be...

 

[Doctorama]

I think you feel the way many of us did a couple months into residency. We thought "what did I get myself into!?"

Good news: residency goes by pretty fast each year gets better as you know the system.

Bad news: obamacare

My advice, stick with it. What else will you do? Even if you worked serving pina coladas on the beach, you'd end up hating the sand.

 

[GOINGDUMB]

.

 

[fyfanatic]

How the hell do you guys remember every detail you learn during your first two years for step 1, let alone the rest of your life when your not using it a lot?

Like others have said, you really don't need to memorize that much now that you have wikipedia and uptodate at your disposal. For example, today I had a patient with neutropenic fevers and I did not remember at what point someone is considered neutropenic. So I looked on uptodate which said the definition was ANC <1500. Then I googled ANC calculator, plugged in the numbers, and got the ANC. Took me about 2 minutes.

To be honest, the most important thing about being an intern is not having memorized everything from medical school. It's about being efficient, managing your time well, following orders from your residents and attendings, knowing when to escalate to your seniors when a patient starts crashing, being nice to the nurses, communicating to consults, case managers and anyone else who is needed to get your patients discharged, and giving a good sign-out to nightfloat. You could be the smartest person in the world and know everything about pathophysiology, but if you aren't good at those things, you will not succeed as an intern. Unfortunately, med school doesn't really teach you that.

 

[gutonc]

Like others have said, you really don't need to memorize that much now that you have wikipedia and uptodate at your disposal. For example, today I had a patient with neutropenic fevers and I did not remember at what point someone is considered neutropenic. So I looked on uptodate which said the definition was ANC <1500. Then I googled ANC calculator, plugged in the numbers, and got the ANC. Took me about 2 minutes.

Srsly? UpToDate needs some fixing then. And WBC x Neutrophil % = ANC...you don't generally need to use a calculator for that (and most labs report the ANC separately anyway).

But now I'm just being pedantic...this was mostly about UTD being wrong...a bit of a cautionary tale.

 

[LucidSplash]

Srsly? UpToDate needs some fixing then. And WBC x Neutrophil % = ANC...you don't generally need to use a calculator for that (and most labs report the ANC separately anyway).

But now I'm just being pedantic...this was mostly about UTD being wrong...a bit of a cautionary tale.

<1500-1000 counts as mild neutropenia but does not meet criteria for neutropenic fever (must be severe neutropenia ie <500). UTD likely correct, fyfanatic just gets only half credit for not looking for the right detail.

 

[MrBeauregard]

And shouldn't ANC = WBC x (%PMN + %bands/segs)?

 

[gutonc]

<1500-1000 counts as mild neutropenia but does not meet criteria for neutropenic fever (must be severe neutropenia ie <500). UTD likely correct, fyfanatic just gets only half credit for not looking for the right detail.

IDSA defines neutropenia as ANC <= 500 or <=1000 with expectation that it will continue to decrease. Severe (they actually call it profound, but whatever) neutropenia is ANC < 100. But now I'm being truly pedantic and will stop.

And shouldn't ANC = WBC x (%PMN + %bands/segs)?

Touche' good sir.

 

[SeekerOfTheTree]

Wow. I haven't even started residency and I already resonate with this. Dude if you find a way outta this game let me know because I'm looking too.

Dudes it's the same out there. Unless your job title is preceded by theoretical or researcher you will be doing same day to day stuff without anything really challenging your mind. Your love for economics will turn into looking at spreadsheets all day and your love for physics will turn into calculating how far you need to have the guy stand to get the right kind of money shot. It's not that awesome out there. When I feel I am not intellectually challenged I like to go home and build robots. You gotta find your hobby that challenges you because a job sure wont.

 

[SeekerOfTheTree]

As an M1 reading these replies, I am taking everything you guys say to heart and am going to try to not let this process beat me down.

Is there anything that you would say to your M1 self, if you could?

Chase more tail during first year and study less.

 

[45408]

You gotta find your hobby that challenges you because a job sure wont.

There's plenty of things in medicine that can continue to challenge you. Unless you're John Cameron, and you've done 2000 Whipples, there's probably some surgical procedures out there that will test you to some extent for much of your career.

 

[SeekerOfTheTree]

I was trying to direct him on how to satisfy his thirst for intellectual curiosity. Learning a new procedure would be like telling an electrician who wants to test his knowledge of signal encoding and processing to learn how to fix Radios. It's not the same thing. Jobs that aren't in research typically have you apply learned knowledge and you are paid based on how good you are at applying that knowledge. They don't really care for you to be a Maverick.

 

[SeekerOfTheTree]

That didn't come out right. I was trying to say every job will just become a job where you do a task you are good at or a set of tasks over and over again and thats why you get paid. We in medicine idealize almost every other profession as being the nirvana we missed out on.

 

[45408]

I was trying to direct him on how to satisfy his thirst for intellectual curiosity. Learning a new procedure would be like telling an electrician who wants to test his knowledge of signal encoding and processing to learn how to fix Radios. It's not the same thing. Jobs that aren't in research typically have you apply learned knowledge and you are paid based on how good you are at applying that knowledge. They don't really care for you to be a Maverick.

That didn't come out right. I was trying to say every job will just become a job where you do a task you are good at or a set of tasks over and over again and thats why you get paid. We in medicine idealize almost every other profession as being the nirvana we missed out on.

I suppose it depends what exactly something thinks that something "new" has to be. Very, very few people are going to come up with something completely new. In that sense, I agree, almost no physician at all does that.

However, there are quite a few situations (not infrequently encountered during M&M), when we discuss a complicated scenario in which a patient has 5 problems and 500 ways to go about fixing them. Your approach won't be truly unique, but it will require problem-solving and insight to come up with the best approach.

Personally, I really hope that I will be able to do a task that I am good at, and do it repeatedly and make decent money for it. I have little desire to be "out on my own."

 

[DD214_DOC]

And shouldn't ANC = WBC x (%PMN + %bands/segs)?

I have no idea. I have always seen ANC reported in the differential.

 

[LucidSplash]

IDSA defines neutropenia as ANC <= 500 or <=1000 with expectation that it will continue to decrease. Severe (they actually call it profound, but whatever) neutropenia is ANC < 100. But now I'm being truly pedantic and will stop.

I get that we're discussing semantics. I understand the IDSA definition of neutropenia specifically with regard to treatment for neutropenic fever. My point was that most would consider an ANC 1500-8000 as WNL, and <1500 is considered the threshold for neutropenia in adults for practical purposes in most hematology resources. So again, fyfanatic got the practical definition but not the one that mattered for the clinical problem he was addressing (half credit). 😉

 

[SeekerOfTheTree]

Personally, I really hope that I will be able to do a task that I am good at, and do it repeatedly and make decent money for it. I have little desire to be "out on my own."

I would be completely happy with this as well.

 

[Sarcoidosis]

To be honest, the most important thing about being an intern is not having memorized everything from medical school. It's about being efficient, managing your time well, following orders from your residents and attendings, knowing when to escalate to your seniors when a patient starts crashing, being nice to the nurses, communicating to consults, case managers and anyone else who is needed to get your patients discharged, and giving a good sign-out to nightfloat. You could be the smartest person in the world and know everything about pathophysiology, but if you aren't good at those things, you will not succeed as an intern. Unfortunately, med school doesn't really teach you that.

👍