Weird Factor in Specialty Selection

[Smokemont]

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Thank you for proving my point.

 

[jerseytrash]

Okay, really want to know now if I'm wrong:

My impression is that the kind of person that goes through a good chunk of their lives w/o getting regular medical care are the ones that do not have insurance, at least not the kind that doesn't require a PCP to act as gatekeeper. Therefore, they usually go to the ED when something bad happens, in which case, the EP misdiagnosed.

Who among those that have the kind of insurance that allows direct specialty care goes without care for so long that they don't discover that they have diabetes or stable angina or hypertension until they exhibit severe symptoms?

You can't automatically assume someone who doesn't get regular medical care doesn't have insurance. The VA is a prime example of that where veterans will not see doctors for years and years until they need their legs chopped off by a vascular surgeon for bad diabetic gangrene. But they are almost ALL covered by the VA system depending on their degree of service connection.

Also yes a lot of people use the ED as their primary care of sorts. ED physicians hate it. It's a waste of money and hospital resources. Their job is not to manage long term chronic medical care.

You have yet to experience this sort of stuff as a med student or a physician so I will just say you will be biting your tongue in a few years when you think about this

 

[punkedoutriffs]

Thank you for proving my point.

To whom? Certainly not me. If I'm wrong, tell me where I'm wrong. If you think it's frustrating to listen to a guy talk about what he doesn't know, it's more frustrating to listen to a guy telling him he doesn't know what he's talking about, and then just justifying by fiat.

 

[punkedoutriffs]

You can't automatically assume someone who doesn't get regular medical care doesn't have insurance. The VA is a prime example of that where veterans will not see doctors for years and years until they need their legs chopped off by a vascular surgeon for bad diabetic gangrene. But they are almost ALL covered by the VA system depending on their degree of service connection.

Also yes a lot of people use the ED as their primary care of sorts. ED physicians hate it. It's a waste of money and hospital resources. Their job is not to manage long term chronic medical care.

You have yet to experience this sort of stuff as a med student or a physician so I will just say you will be biting your tongue in a few years when you think about this

Okay, cool. Didn't know about VA ppl not getting care despite having insurance. But don't they still have to see an EP before they get triaged to surgery?

 

[operaman]

OP: A few thoughts, free advice being worth what you pay for it and all.....

1) Is your desire to know what to do in those situations driven by a deep desire to help the patient or more by a deep desire to be the hero? It's a minor distinction, but perhaps an important one to consider. I know I definitely like being the one to save the day, to feel needed and valuable, and such thoughts definitely play into what I think will make me happy long term. Those rare moments where you might be called on are few and may never happen at all. The day-in and day-out life of a certain field, however, may speak to whatever desire is fueling your original question. Maybe a trauma surgeon if you want to save the day; perhaps a generalist with additional work in public health if it's more about helping as many people as possible. I know the trauma surgeon helps too - this is just about whatever motivates you on the inside. If long term relationship with your patients really matter, then trauma is probably not your thing. Thinking about whatever is driving you to ask these questions may lead you to better answers than simply looking for the specialty that would give you the broadest knowledge possible.

2) Not sure what year you are, but medicine is really good at showing what you DONT want to do, so that may help you out as time goes by. There are a few specialties that rank below "leave medicine entirely" for me thanks to some time spent on them. I have the utmost respect for people who do them, but they just aren't for me. This effect may help you trim your list.

3) Medicine is too damn vast and complex for anyone to really know all there is to know about everything. Maybe in the days when all you had to know was which leeches to place on which wound, but not now.

 

[CDI]

I make no sense because I'm not yet in med school.

FTFY.

This should be a disclaimer.

 

[Kal EI]

Thank you for proving my point.

I would ignore pre-meds. It's hard to explain things to them because they have a superficial understanding of real world medicine. Most specialists I know have ruins of respect for their colleagues in FM or any primary care.

 

[tco]

Why would the OP ignore it if it's important to him/her? Glad to hear you are truly happy with your specialty choice. Also, obviously no one can treat everything but I'm not so sure you can argue against FPs being able to treat the most. I'm not bashing specialists but perhaps this quality is important to some.

You were saying that only a few people were making quality comments, or something along those lines, because only a few people were agreeing with what you were saying. I was suggesting that you were stating that the OP should basically ignore everyone that doesn't support his thought process, not that they should ignore the issue. I just think the situations he described are a terrible thing to use to make any impact on your career decision. With that said, to contribute to the discussion...

I am fairly confident that I, as a fourth year medical student, could at least contribute *something* to the hypothetical situations that the OP posed. If I came across a car accident, I could administer first aid, or BLS. If my kid got sick, I can give him a dose of amoxicillin and if he didn't get better, I could realize that I'm not a pediatrician enough to take him to a bloody pediatrician. If my *whoever* had a rash, I could refer them to a dermatologist. All things that a radiologist, pathologist, surgeon, or general PCP (to include family medicine - who are the most general of generalists) could do. Family medicine's specialty is, quite literally, not having a specialty. They're broad enough to know how to treat many things, but don't have enough knowledge to treat anything too complicated. They sure as heck could manage that chronic hypertension emergency on an airplane, though.

Don't get me wrong, every specialty in medicine is necessary. If it wasn't, it wouldn't exist. Many people have suggested that my chosen specialty become annexed by other specialties...However, to suggest that the OP's line of thought isn't irrational just because it's important to them is, in itself, irrational.

 

[JP2740]

why do ED physicians have to go to residency? I think they get dumber

 

[prometheus09]

Who do you think explains what the specialist did and/or said because the patient was too scared/worried/nervous to comprehend the visit? So an FP has intimate knowledge of specialty services/procedures now? Plus, how often does a patient consent to and undergo a procedure without understanding it at least to a lay degree, especially if it's impactful enough to cause fear and worry? "Okay, I don't understand what we're doing here, but I'm so scared and nervous that it doesn't matter." Huh?
This was interesting to read... actually patients do procedures they don't understand a lot more than you imagine. They just don't understand due to complex explanations, too much information at once, being too scared to understand/comprehend completely, or a variety of reasons ("the doctor must know what's best, who am I to question it?"). Family medicine physicians usually will see that patient more often than the specialist, have more time to explain, be a familiar face in a time of difficulty, can boil down complex terms to the patient's individual knowledge level... doesn't mean they "have intimate knowledge" of a procedure, but they know the gist and main points that patients should know and present it in a way the patient understands.


Who do you think determines whether or not the patient should routinely f/u with the specialist or it was a one time visit? The specialist can do that.
"Hey doc, do I really need to see Dr. Specialist for this problem again? I feel better now, do I need to keep paying to see this guy again?" - a question I have encountered a lot, actually.

Who do you think the patient asks advice from when the specialist suggests a treatment? Another specialist. Why would you ask an FP about something out of his scope of practice?
"Hey doc, Dr. Specialist recommended this procedure, do you think it's a good idea? Should I get a second opinion?"


You're really downplaying the doctor-patient relationship, however cheesy you think that sounds... it's real, and it makes a difference.

 

[tco]

I would ignore pre-meds. It's hard to explain things to them because they have a superficial understanding of real world medicine. Most specialists I know have ruins of respect for their colleagues in FM or any primary care.

Absolutely 100% respect from me (I know I'm not even a resident yet, but pretty much all of my colleagues have chosen their specialties by now) to all branches of medicine.

The original statement was a series of hypothetical situations that one might encounter where a specialist may not know the answer, not about respect for PCPs. Let me rant a bit, because that's what I'm good at...In a few of those, a PCP's management will be "referral," further strengthening what I've already stated about not being able to know everything in medicine. If the OP is dreading these situations and wants to make a career decision because of them, my advise is to simply, "Get over it." If the OP thinks that they want to encounter these situations daily and be employed to manage them, my advice is to do family medicine...You can even do some kind of fellowship after to do C-sections if that fits your fancy. However, you'll still never be able to treat everything. You'll make referrals for your entire career. I will never make a referral after my intern year. That's a fundamental difference in personality types and job descriptions, not a ranking of value in medicine. Both are extremely valuable.

 

[Smokemont]

To whom? Certainly not me. If I'm wrong, tell me where I'm wrong. If you think it's frustrating to listen to a guy talk about what he doesn't know, it's more frustrating to listen to a guy telling him he doesn't know what he's talking about, and then just justifying by fiat.

Here you go, I fixed everything for you.

Where do you think the patient goes after seeing the specialist? The FP. Who do you think explains what the specialist did and/or said because the patient was too scared/worried/nervous to comprehend the visit? The FP. Who do you think determines whether or not the patient should routinely f/u with the specialist or it was a one time visit? The FP. Who do you think the patient asks advice from when the specialist suggests a treatment? The FP.

 

[Coffee Machine]

OP, I think what it comes down to is that you want to go into a field with more breadth and less depth (like IM, FM, EM, peds, etc.) rather than hyperspecializing (something like IVF). I don't know how this became a two page bicker fest. This is a question plenty of medical students consider. I don't think it's weird at all that you don't want to be a dermatopathologist or a retina specialist.

 

[Trastuz]

1) Is your desire to know what to do in those situations driven by a deep desire to help the patient or more by a deep desire to be the hero? It's a minor distinction, but perhaps an important one to consider. I know I definitely like being the one to save the day, to feel needed and valuable, and such thoughts definitely play into what I think will make me happy long term. Those rare moments where you might be called on are few and may never happen at all. The day-in and day-out life of a certain field, however, may speak to whatever desire is fueling your original question. Maybe a trauma surgeon if you want to save the day; perhaps a generalist with additional work in public health if it's more about helping as many people as possible. I know the trauma surgeon helps too - this is just about whatever motivates you on the inside. If long term relationship with your patients really matter, then trauma is probably not your thing. Thinking about whatever is driving you to ask these questions may lead you to better answers than simply looking for the specialty that would give you the broadest knowledge possible.

This is sage advice IMO.

My 2 cents: I matched in rads. One of the reasons I chose it is because I am a back-of-the-classroom sort of guy. I have no need to be recognized. In fact, I'd say over 50% of the time radiology comes up in casual conversation people say "oh I have a friend who does that too. They just finished at x community college last month."

My attendings constantly denigrate radiologists for not being "real doctors" (family folks aren't the only ones who get little love). Despite their lack of confidence, however, I am only one month into my TY and feel confident I could manage most medical emergencies long enough for the patient to be transferred somewhere for advanced care. Maybe some ED docs with advanced wilderness training can do a cric with a pen lid like MacGyver, but unless there is a miller, a tube and a vent on the plane, most docs bag the same way an EMT does. Same story catching a baby, managing a seizure or most other scenarios I can imagine. If I forget that penicillin is used to treat strep throat in 15 years, I'm sure I can find the answer online in about 3 mins.

Most medical professionals have the knowledge base to manage an emergency (your urology story sounds like an anomaly to me), but most don't have the opportunity to demonstrate that knowledge regularly and be recognized for it.