Weird Factor in Specialty Selection

[FulfilledDeer]

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Okay, so I've been back and forth about this a lot in my mind and I want to get some outside, and perhaps wiser, perspective.

When I'm thinking about choosing a specialty, one sticking point that always surfaces is wanting to feel like a doctor OUTSIDE OF WORK. I feel the need to emphasize that point, since I'm not denigrating any specialty. At work, even the non-clinical specialties feel like being a doctor to me - sometimes more so. It's definitely different for each specialty, but there's always that sense remaining. But outside of those duties, I can't shake the sense of future...unpreparedness as a radiologist (for example). Do you really want a radiologist on the plane when someone needs a doctor? If my nephew gets sick with strep (?) would a pathologist be any help at all? Maybe the dermatologist should just drive right by a car accident.

I'm just wondering if anybody else feels this way? Or even understands it, I guess. I'm pulled towards EM in particular because it sort of fulfills desire this to a T, but there are other aspects to consider too (but I have an easier time wading through those).

 

[JP2740]

Aren't we a little old for fantasies like this

 

[Textbookversion]

Aren't we a little old for fantasies like this

👍

 

[muddyduck7]

While on vacation in a rural place, that thought definitely crossed my mind... So you are not alone 😳

 

[WaylonS]

Okay, so I've been back and forth about this a lot in my mind and I want to get some outside, and perhaps wiser, perspective.

When I'm thinking about choosing a specialty, one sticking point that always surfaces is wanting to feel like a doctor OUTSIDE OF WORK. I feel the need to emphasize that point, since I'm not denigrating any specialty. At work, even the non-clinical specialties feel like being a doctor to me - sometimes more so. It's definitely different for each specialty, but there's always that sense remaining. But outside of those duties, I can't shake the sense of future...unpreparedness as a radiologist (for example). Do you really want a radiologist on the plane when someone needs a doctor? If my nephew gets sick with strep (?) would a pathologist be any help at all? Maybe the dermatologist should just drive right by a car accident.

I'm just wondering if anybody else feels this way? Or even understands it, I guess. I'm pulled towards EM in particular because it sort of fulfills desire this to a T, but there are other aspects to consider too (but I have an easier time wading through those).

Dermatologists are not allowed to know ACLS, radiologists are not allowed to diagnose MIs, and pathologists, who receive residency training in microbiology, are not supposed to know how to treat strep throat.

 

[FulfilledDeer]

Aren't we a little old for fantasies like this

I'm suggesting anyone save the day. Just be able to deal with something like a family member's cold-like symptoms without feeling completely out of your depth. The other examples were more to demonstrate the point than to indulge in hero fantasy fulfillment.

Dermatologists are not allowed to know ACLS, radiologists are not allowed to diagnose MIs, and pathologists, who receive residency training in microbiology, are not supposed to know how to treat it.

Not sure where you're going with this (i.e. sarcasm?). But a story: I was with a urologist who had been practicing for 20-ish years. We had a patient in front of us talking about a previous history of pyleo and the attending was trying to look something up on the EMR. The guy (who looked really sick) seized out while the attending was on the computer and when I calmly pointed out that maybe the EMR was not the most important thing at this point he sort of panicked and called for a nurse and a wheelchair. Everything ended up fine, but since the attending's practice had been office-based for the past 10 years, he seemed very unprepared if anything else had gone wrong.

 

[KinesiologyNerd]

I'm suggesting anyone save the day. Just be able to deal with something like a family member's cold-like symptoms without feeling completely out of your depth. The other examples were more to demonstrate the point than to indulge in hero fantasy fulfillment.



Not sure where you're going with this (i.e. sarcasm?). But a story: I was with a urologist who had been practicing for 20-ish years. We had a patient in front of us talking about a previous history of pyleo and the attending was trying to look something up on the EMR. The guy (who looked really sick) seized out while the attending was on the computer and when I calmly pointed out that maybe the EMR was not the most important thing at this point he sort of panicked and called for a nurse and a wheelchair. Everything ended up fine, but since the attending's practice had been office-based for the past 10 years, he seemed very unprepared if anything else had gone wrong.

It takes a medical degree to manage a cold? Also, that urologist just sounds like a terrible doctor.

 

[DrBowtie]

I'm suggesting anyone save the day. Just be able to deal with something like a family member's cold-like symptoms without feeling completely out of your depth. The other examples were more to demonstrate the point than to indulge in hero fantasy fulfillment.



Not sure where you're going with this (i.e. sarcasm?). But a story: I was with a urologist who had been practicing for 20-ish years. We had a patient in front of us talking about a previous history of pyleo and the attending was trying to look something up on the EMR. The guy (who looked really sick) seized out while the attending was on the computer and when I calmly pointed out that maybe the EMR was not the most important thing at this point he sort of panicked and called for a nurse and a wheelchair. Everything ended up fine, but since the attending's practice had been office-based for the past 10 years, he seemed very unprepared if anything else had gone wrong.

Truthfully though, for a seizure in an office based setting, what else was he going to do?

 

[FulfilledDeer]

It takes a medical degree to manage a cold? Also, that urologist just sounds like a terrible doctor.

Truthfully though, for a seizure in an office based setting, what else was he going to do?

Okay, I guess I'm either not very articulate on this subject, or I've posted the wrong thing. I'm hoping people are just not giving me the most favorable interpretation of my intention and meaning, otherwise I'm so off base I can't even recognize it. And that would be slightly depressing.


As for the urologist, I definitely didn't convey the point I intended to. I mean, he absolutely did what he could. It was just the panic I felt from him, the sense that if the patient hadn't come round in a couple of minutes that he would have been out of his depth. That if there was not an ED just downstairs that the patient's care would have (and should have probably) transferred to EMS.

I don't know that I'm really communicating well here. Does anybody know what I'm getting at? It's not about specifics...just about the ability to function as a "doctor" that everyone imagines. Being unable to even field those questions your extended family starts pestering you with once you're in medical school as a full M.D. because you've narrowed your focus down so much as to only be dealing with knee replacements feels like a loss to me.

Edit: And I'm not saying it's right that is feels like a loss. Just trying to articulate.

 

[Arbor Vitae]

Personally, I'd enjoy not having to work on my days off.

 

[CDI]

Truthfully though, for a seizure in an office based setting, what else was he going to do?

More like ANY setting which isn't a hospital.

 

[CDI]

Oddly enough, I kind of understand what OP is getting at. Can't knock em for it either.

I don't just consider this a career, but rather a lifestyle choice. For me its most likely a result of being the son of an internist. Got used to everyone and their mom coming over or calling the house all hrs of the day for medical opinions and advice. When we go visit our grandparents place abroad, patients line up outside the home to see my dad. Now if he was a derm or rads...doubt any of that would happen.

 

[dmitrinyr]

Okay, I guess I'm either not very articulate on this subject, or I've posted the wrong thing. I'm hoping people are just not giving me the most favorable interpretation of my intention and meaning, otherwise I'm so off base I can't even recognize it. And that would be slightly depressing.


As for the urologist, I definitely didn't convey the point I intended to. I mean, he absolutely did what he could. It was just the panic I felt from him, the sense that if the patient hadn't come round in a couple of minutes that he would have been out of his depth. That if there was not an ED just downstairs that the patient's care would have (and should have probably) transferred to EMS.

I don't know that I'm really communicating well here. Does anybody know what I'm getting at? It's not about specifics...just about the ability to function as a "doctor" that everyone imagines. Being unable to even field those questions your extended family starts pestering you with once you're in medical school as a full M.D. because you've narrowed your focus down so much as to only be dealing with knee replacements feels like a loss to me.

Edit: And I'm not saying it's right that is feels like a loss. Just trying to articulate.

FulfilledDeer,

I understand what you're trying to get at, but I think that you're going about it in the wrong way. As a medical student, you should choose the specialty that you can picture yourself doing and actually enjoying in 10, 20 years. You shouldn't pick a specialty based on whether you can answer your extended family member's question during dinner at a future event about a mole that they found or their kid's cold, etc. If you like EM and can see yourself doing EM and enjoying coming to work everyday, then go for it.

I'll use my own story as an example... I finished a residency in IM and currently am working as a hospitalist while applying for a fellowship in pulmonary/critical care. Yes, IM residency prepares you for many situations which include inpatient and outpatient care. With that said, my pediatric and OB knowledge is what I remember from USMLE and/or my peds/OBGYN MS-3 rotation and so if someone asks me about their new baby and what they should do in X situation (non-emergent) or some advice for their pregnant wife (non-emergent), I am ok with saying that it's not my specialty and that they should probably talk to their pediatrician or OB. My dad asks me about specific details regarding his kidney stone stent placement and surgery and post-op recommendation and the best I can do is an educated guess, but tell him that he should talk to his doc if he wants to know the exact thing to do.

Yes, this is even more extreme if you're a radiologist or psychiatrist or pathologist and really don't see medical patients, but I know people that are radiologists and pathologists and they are just fine with the fact that they don't know exactly the antibiotic that they should use for strep throat or advise their parents on their post op plan from hip surgery. They have one thing going for them though... they really enjoy their jobs and are experts in their field and provide an expert service that makes the totality of any one's patient possible.

Just my 2 cents.

 

[Anastomoses]

i get it. I'm having a slightly different yet similar issue with even less of a solution. i got into medicine because i thought if i was really adept, it would be like having a superpower. i struggle with the idea of being forced to choose one specialty instead of getting to do vascular surgery, a colonoscopy, relieving leg compartments, and detecting/prescribing treatment for auto immune diseases. Such is life.


"specialization is for insects" - Heinlein

 

[punkedoutriffs]

I would find it super annoying to have ppl pull me to the side & ask advice. I'd love to just tell them, "I'm a radiologist. Unless you have a CT scan on you, let's just go back to the party."

If a true emergency happens on a plane/in a restaurant, there's not much to do other than perform CPR & and wait for the ambulance. Anybody could do that.

"specialization is for insects" - Heinlein

“As Gregor Samsa awoke one morning from uneasy dreams he found himself transformed in his bed into a gigantic insect.”
― Franz Kafka 🙂

 

[TooMuchResearch]

I would find it super annoying to have ppl pull me to the side & ask advice. I'd love to just tell them, "I'm a radiologist. Unless you have a CT scan on you, let's just go back to the party."

If a true emergency happens on a plane/in a restaurant, there's not much to do other than perform CPR & and wait for the ambulance. Anybody could do that.



“As Gregor Samsa awoke one morning from uneasy dreams he found himself transformed in his bed into a gigantic insect.”
Franz Kafka 🙂

If an emergency happens on a plane, there is a med kit with acls and some other core drugs available.

 

[punkedoutriffs]

If an emergency happens on a plane, there is a med kit with acls and some other core drugs available.

Oh yea, good point. There's bound to be someone trained to use it on board too. I doubt they just installed the kit with the notion of hoping that an EM physician would just happen to be around during a medical crisis.

 

[dsoz]

Are you even in med school yet?

I have the feeling that once you do a few months of rotations that you will find your place. Do something that interests you.

I am starting medical school classes in a week. I am going in with an open mind. I have a couple of areas that I THINK that I would be interested in, but I would like to experience different rotations before making a decision. All that I know is limited to what I shadowed (family medicine) and volunteered (emergency medicine). Until I see some of the other specialties I won't tell people what I want to do "when I grow up." Most people change their major a few times in college. Why should med school be any different?

My advice to you is to relax. Your specialty will come to you in time. Also, get the same sort of statement for when people ask you what kind of doctor you want to become. "I want to experience some of the different fields before making a decision. At some point I will figure it out."

Also, I responded seriously, but the OP sounds almost like a troll.

 

[FulfilledDeer]

Are you even in med school yet?

Also, I responded seriously, but the OP sounds almost like a troll.

Yes I am. And I appreciate that you have a bunch more posts than me under your belt, but your Trolldar is either way off, or you're super quick to pull that trigger. Either way, relax.

FulfilledDeer,

I understand what you're trying to get at, but I think that you're going about it in the wrong way. As a medical student, you should choose the specialty that you can picture yourself doing and actually enjoying in 10, 20 years. You shouldn't pick a specialty based on whether you can answer your extended family member's question during dinner at a future event about a mole that they found or their kid's cold, etc. If you like EM and can see yourself doing EM and enjoying coming to work everyday, then go for it.

I'll use my own story as an example... I finished a residency in IM and currently am working as a hospitalist while applying for a fellowship in pulmonary/critical care. Yes, IM residency prepares you for many situations which include inpatient and outpatient care. With that said, my pediatric and OB knowledge is what I remember from USMLE and/or my peds/OBGYN MS-3 rotation and so if someone asks me about their new baby and what they should do in X situation (non-emergent) or some advice for their pregnant wife (non-emergent), I am ok with saying that it's not my specialty and that they should probably talk to their pediatrician or OB. My dad asks me about specific details regarding his kidney stone stent placement and surgery and post-op recommendation and the best I can do is an educated guess, but tell him that he should talk to his doc if he wants to know the exact thing to do.

Yes, this is even more extreme if you're a radiologist or psychiatrist or pathologist and really don't see medical patients, but I know people that are radiologists and pathologists and they are just fine with the fact that they don't know exactly the antibiotic that they should use for strep throat or advise their parents on their post op plan from hip surgery. They have one thing going for them though... they really enjoy their jobs and are experts in their field and provide an expert service that makes the totality of any one's patient possible.

Just my 2 cents.

This is fantastic, thank you! I'm not trying to base my choice of specialty on one thing. It's a huge combination of factors I'm thinking about (not least of which is if I can stand the day in and day out), but this particular idea is just nagging and illogical, so it bugs me more than most. I'm more just trying to figure out whether it even should be a factor.

 

[FulfilledDeer]

Oh yea, good point. There's bound to be someone trained to use it on board too. I doubt they just installed the kit with the notion of hoping that an EM physician would just happen to be around during a medical crisis.

Actually, there was an article in the NEJM a couple weeks (months?) back that was talking about in-air emergencies. I don't recall most of it, but I certainly got the impression there was a lot of "optional" stuff that the crew was not explicitly trained to use. I could be wrong though.

 

[CDI]

Actually, there was an article in the NEJM a couple weeks (months?) back that was talking about in-air emergencies. I don't recall most of it, but I certainly got the impression there was a lot of "optional" stuff that the crew was not explicitly trained to use. I could be wrong though.

In-air is only 3 scenarios...stable keep flying to destination, land ASAP, keep flying theyre dead. That's a call I hope I never have to deal with.

I'm curious what they have on board though, and if it's stuff for procedures/rx or diagnostic (to help decide whether landing is the right call).

Further no doctor in their right mind will do anything heroic in-air, and they'll naturally do the most conservative thing.

 

[jdh71]

In-air is only 3 scenarios...stable keep flying to destination, land ASAP, keep flying theyre dead. That's a call I hope I never have to deal with.

I'm curious what they have on board though, and if it's stuff for procedures/rx or diagnostic (to help decide whether landing is the right call).

Further no doctor in their right mind will do anything heroic in-air, and they'll naturally do the most conservative thing.

If someone asks for a doc on a plane, order a drink. Heh.

We're trained to work with all the bells and whistles in the hospital, so any kind of work-up will be rather limited. Med kids on planes contain stuff to deal with acute MI (nitro and ASA), anaphylaxis (epi and benedryl) and asthma exacerbation (albuterol inhaler), that's about it, probably because they are usually pretty obvious. They have stuff for basic BLS including masks and AEDs. You can also start an IV, and give a bag of saline (but they may have to ask for a nurse on a plane to get that started. heh)

 

[TooMuchResearch]

In-air is only 3 scenarios...stable keep flying to destination, land ASAP, keep flying theyre dead. That's a call I hope I never have to deal with.

I'm curious what they have on board though, and if it's stuff for procedures/rx or diagnostic (to help decide whether landing is the right call).

Further no doctor in their right mind will do anything heroic in-air, and they'll naturally do the most conservative thing.

A google search pulled this for me:

http://www.minnesotamedicine.com/tabid/3773/Default.aspx

It has a section about what should be available.

Yes, the most conservative thing should be done. If the most appropriate thing to do with the available resources is ACLS, a cric, etc., then that is what you should do.

 

[jdh71]

A google search pulled this for me:

http://www.minnesotamedicine.com/tabid/3773/Default.aspx

It has a section about what should be available.

Yes, the most conservative thing should be done. If the most appropriate thing to do with the available resources is ACLS, a cric, etc., then that is what you should do.

You can't run ACLS on a plane.

 

[VenturaResident]

Okay, so I've been back and forth about this a lot in my mind and I want to get some outside, and perhaps wiser, perspective.

When I'm thinking about choosing a specialty, one sticking point that always surfaces is wanting to feel like a doctor OUTSIDE OF WORK. I feel the need to emphasize that point, since I'm not denigrating any specialty. At work, even the non-clinical specialties feel like being a doctor to me - sometimes more so. It's definitely different for each specialty, but there's always that sense remaining. But outside of those duties, I can't shake the sense of future...unpreparedness as a radiologist (for example). Do you really want a radiologist on the plane when someone needs a doctor? If my nephew gets sick with strep (?) would a pathologist be any help at all? Maybe the dermatologist should just drive right by a car accident.

I'm just wondering if anybody else feels this way? Or even understands it, I guess. I'm pulled towards EM in particular because it sort of fulfills desire this to a T, but there are other aspects to consider too (but I have an easier time wading through those).

This doesn't sound weird to me at all. What it actually sounds like is that you should strongly consider Family Medicine as well as EM. I think lots of students are walking around with an idea, conscious or not, of what "a real doctor" is. And there are different versions of that - some people's "real doctor" is the one in the OR taking out a tumor. Another person's is the highly specialized very academic expert in a certain tiny field. But for other people the "real doctor" has more to do with being prepared to handle a wide variety of medical situations for a wide variety of people in the community. That's certainly my vision of a real doctor - not something that I decided on specifically and consciously, and not any more objectively right than anyone else's idea, but just what happens to be my personal classic image of a doctor. And that was one of the driving forces for my specialty choice - all other fields, anything narrower than family medicine, felt tiny and limited and a little fake. I couldn't imagine being the derm person who couldn't respond to an emergency. Or the internist who couldn't deliver a baby. Or, frankly, the ER person who could respond to an immediate situation but wasn't really skilled in preventing it in the first place.

Your version of "a real doctor" inside and outside the official working day *matters*. It's not illogical, and it's certainly not unimportant in terms of specialty choice.Depending on what your version of real is, that could lead you in a lot of different directions, but it's absolutely important for finding your direction in the future. It seems to me that you are getting a lot of ridiculous push back in this thread from people who apparently don't have much of anything to contribute (but, what are you going to do, it's SDN, that's often par for the course.) Ignore what's not useful there (including my post if you feel like it!) but hold on to the importance of this factor as you make choices about the future. Good luck to you!

 

[CDI]

If someone asks for a doc on a plane, order a drink. Heh.

Have an uncle (heme/onc) who volunteered once. Turned out the air hostess was just having a panic attack. He got 2 bottles of scotch out of it and bumped to First the rest of the way. He tried to refuse (or so he claims) but they handed it to him as he deboarded as duty-free.

Another time had a relative flying, where another doctor pronounced the passenger dead. They kept on flying to the destination with the body wrapped in blankets up in First Class. Slightly uncomfortable I imagine for the passengers...

 

[tco]

I look at what you're saying as an added bonus. "Oh, yeah, sorry aunt Grace, I don't know what your rash is if I can't look at it in my angio suite."

As for the problems on a plane, etc. What will a surgeon do that a normal doc can't do? Is he going to use the plastic butter knife to perform an emergent trach on someone with angioedema? Give me a break.

As someone else said, aren't we a little old and mature to have fantasies like this?

 

[tco]

This doesn't sound weird to me at all. What it actually sounds like is that you should strongly consider Family Medicine as well as EM. I think lots of students are walking around with an idea, conscious or not, of what "a real doctor" is. And there are different versions of that - some people's "real doctor" is the one in the OR taking out a tumor. Another person's is the highly specialized very academic expert in a certain tiny field. But for other people the "real doctor" has more to do with being prepared to handle a wide variety of medical situations for a wide variety of people in the community. That's certainly my vision of a real doctor - not something that I decided on specifically and consciously, and not any more objectively right than anyone else's idea, but just what happens to be my personal classic image of a doctor. And that was one of the driving forces for my specialty choice - all other fields, anything narrower than family medicine, felt tiny and limited and a little fake. I couldn't imagine being the derm person who couldn't respond to an emergency. Or the internist who couldn't deliver a baby. Or, frankly, the ER person who could respond to an immediate situation but wasn't really skilled in preventing it in the first place.

Your version of "a real doctor" inside and outside the official working day *matters*. It's not illogical, and it's certainly not unimportant in terms of specialty choice.Depending on what your version of real is, that could lead you in a lot of different directions, but it's absolutely important for finding your direction in the future. It seems to me that you are getting a lot of ridiculous push back in this thread from people who apparently don't have much of anything to contribute (but, what are you going to do, it's SDN, that's often par for the course.) Ignore what's not useful there (including my post if you feel like it!) but hold on to the importance of this factor as you make choices about the future. Good luck to you!

Yeah, that's exactly what he should do... Ignore differing opinions and only listen to people that support irrational decision making. I would look objectively at your potential specialty choices and ignore your idea of a "true doctor." I kind of felt that way for a while, but became truly happy with my specialty choice when I realized that no one can treat everything, despite what the family medicine doc wants you to think...

 

[punkedoutriffs]

Yeah, that's exactly what he should do... Ignore differing opinions and only listen to people that support irrational decision making. I would look objectively at your potential specialty choices and ignore your idea of a "true doctor." I kind of felt that way for a while, but became truly happy with my specialty choice when I realized that no one can treat everything, despite what the family medicine doc wants you to think...

Specialists refer to FM's during a plane emergency (.000x%). FMs refer to specialists for every other medical context (1 - .000x%). I'd reach for the lower hanging fruit.

 

[Anastomoses]

If someone asks for a doc on a plane, order a drink. Heh.

We're trained to work with all the bells and whistles in the hospital, so any kind of work-up will be rather limited. Med kids on planes contain stuff to deal with acute MI (nitro and ASA), anaphylaxis (epi and benedryl) and asthma exacerbation (albuterol inhaler), that's about it, probably because they are usually pretty obvious. They have stuff for basic BLS including masks and AEDs. You can also start an IV, and give a bag of saline (but they may have to ask for a nurse on a plane to get that started. heh)

I think that's what House did on their airplane emergency episode.

 

[FulfilledDeer]

As someone else said, aren't we a little old and mature to have fantasies like this?

Okay, I surrender. I feel like I'm being stuffed with straw as we speak (a man....full of straw....okay, you get it), and aside from a couple of helpful responses I'm not feeling like this is charitable interpretation land.

 

[Kahreek]

probably any trained physician, a general practicioner without any speciality (do those exist anymore), is able to handle most situations. without the right equipment you can only do so much, and the right knowledge skills and attitude arises, like a dormant beast inside you.

Now seriously, it is more about knowing first aid specifically, than what specialty you are in.

 

[Anastomoses]

Okay, I surrender. I feel like I'm being stuffed with straw as we speak (a man....full of straw....okay, you get it), and aside from a couple of helpful responses I'm not feeling like this is charitable interpretation land.

C'mon...this is SDN. Grin and laugh. I think it's a cute issue you have - not to be belittling or anything.

 

[FulfilledDeer]

C'mon...this is SDN. Grin and laugh. I think it's a cute issue you have - not to be belittling or anything.

I ummm....uhh....thanks. I think. I'm not upset or anything, just realizing that this is potentially a dead end.

 

[Smokemont]

This doesn't sound weird to me at all. What it actually sounds like is that you should strongly consider Family Medicine as well as EM. I think lots of students are walking around with an idea, conscious or not, of what "a real doctor" is. And there are different versions of that - some people's "real doctor" is the one in the OR taking out a tumor. Another person's is the highly specialized very academic expert in a certain tiny field. But for other people the "real doctor" has more to do with being prepared to handle a wide variety of medical situations for a wide variety of people in the community. That's certainly my vision of a real doctor - not something that I decided on specifically and consciously, and not any more objectively right than anyone else's idea, but just what happens to be my personal classic image of a doctor. And that was one of the driving forces for my specialty choice - all other fields, anything narrower than family medicine, felt tiny and limited and a little fake. I couldn't imagine being the derm person who couldn't respond to an emergency. Or the internist who couldn't deliver a baby. Or, frankly, the ER person who could respond to an immediate situation but wasn't really skilled in preventing it in the first place.

Your version of "a real doctor" inside and outside the official working day *matters*. It's not illogical, and it's certainly not unimportant in terms of specialty choice.Depending on what your version of real is, that could lead you in a lot of different directions, but it's absolutely important for finding your direction in the future. It seems to me that you are getting a lot of ridiculous push back in this thread from people who apparently don't have much of anything to contribute (but, what are you going to do, it's SDN, that's often par for the course.) Ignore what's not useful there (including my post if you feel like it!) but hold on to the importance of this factor as you make choices about the future. Good luck to you!

This. OP, it is not an illogical issue if you think about it all the time and expect it to affect your happiness in life. I think about this quite a bit also which is probably why I am interested in more rural FM while caring for my patients in the hospital and picking up some ED shifts. Don't know yet if reimbursement/malpractice will let me do OB but I'm still pumped to learn the skills.

Yeah, that's exactly what he should do... Ignore differing opinions and only listen to people that support irrational decision making. I would look objectively at your potential specialty choices and ignore your idea of a "true doctor." I kind of felt that way for a while, but became truly happy with my specialty choice when I realized that no one can treat everything, despite what the family medicine doc wants you to think...

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.

Specialists refer to FM's during a plane emergency (.000x%). FMs refer to specialists for every other medical context (1 - .000x%). I'd reach for the lower hanging fruit.

You make no sense. I'm only a 2nd year and acknowledge my lack of experience and suggest you do the same. It's quite obvious you have none but something tells me you have been told this in the past 🙄

 

[punkedoutriffs]

You make no sense. I'm only a 2nd year and acknowledge my lack of experience and suggest you do the same. It's quite obvious you have none but something tells me you have been told this in the past 🙄

I make no sense because I'm not yet in med school? What if I said the same thing but was a resident or attending? Lack of ethos doesn't automatically break an argument. What I said was basic knowledge that even lay people know.

I'll kow tow if it's called for, but you're just groveling. Keep it up and you'll start claiming not to know how to tie your shoes until you get further down the training track.

 

[Kal EI]

Okay, so I've been back and forth about this a lot in my mind and I want to get some outside, and perhaps wiser, perspective.

When I'm thinking about choosing a specialty, one sticking point that always surfaces is wanting to feel like a doctor OUTSIDE OF WORK. I feel the need to emphasize that point, since I'm not denigrating any specialty. At work, even the non-clinical specialties feel like being a doctor to me - sometimes more so. It's definitely different for each specialty, but there's always that sense remaining. But outside of those duties, I can't shake the sense of future...unpreparedness as a radiologist (for example). Do you really want a radiologist on the plane when someone needs a doctor? If my nephew gets sick with strep (?) would a pathologist be any help at all? Maybe the dermatologist should just drive right by a car accident.

I'm just wondering if anybody else feels this way? Or even understands it, I guess. I'm pulled towards EM in particular because it sort of fulfills desire this to a T, but there are other aspects to consider too (but I have an easier time wading through those).

I'm not quite sure what you would do as an EM doc outside the hospital.

When your nephew gets strep, what are you going to do? Give him some abx? Woohoo!

I make no sense because I'm not yet in med school? What if I said the same thing but was a resident or attending? Lack of ethos doesn't automatically break an argument. What I said was basic knowledge that even lay people know.

I'll kow tow if it's called for, but you're just groveling.

I agree it's lame to pull rank, but any M3 or M4 will tell you that everything changes when you get more experience. Residents will tell that to M3s/M4s. Attendings will tell that to residents.

It's not fair but 99% of the time the added perspective truly does matter. You'll understand this after you take Step 1 and pre-meds are yapping about their ultimate Step 1 study plan before med school has even started.

 

[jerseytrash]

Yeah, that's exactly what he should do... Ignore differing opinions and only listen to people that support irrational decision making. I would look objectively at your potential specialty choices and ignore your idea of a "true doctor." I kind of felt that way for a while, but became truly happy with my specialty choice when I realized that no one can treat everything, despite what the family medicine doc wants you to think...

😕 Since when do family docs claim they can treat everything?

I think it's not unreasonable to have a BASIC knowledge of most fields - even as a radiologist for example you should have some working clinical knowledge so that you can correlate your CT findings to a ddx for what that inflamed mass in the belly might be. A surgeon should have some basic understanding of how to diurese someone who's volume overloaded post-op (which I've heard derisively referred to as a "medicine thing" despite it being quite the contrary).

I do agree otherwise though that the practice model is for people to specialize, and that sometimes involves chucking out the extraneous stuff that's not immediately relevant to your field. And there ain't nothing wrong with that (as long as you don't take it to, say, the extreme of ortho 😀 )

 

[jerseytrash]

I'm not quite sure what you would do as an EM doc outside the hospital.

When your nephew gets strep, what are you going to do? Give him some abx? Woohoo!

I think he's saying that at least in theory EM knows "every" field albeit at a superficial level so if they run into a situation they can act on it - which is probably true for EM, IM, and general surgery to some extent. But stabilizing someone and shipping them to the nearest hospital for further management is IMO something EVERY physician should know.

Long gone are the days where people knew everything about everything in medicine

 

[Smokemont]

I make no sense because I'm not yet in med school? What if I said the same thing but was a resident or attending? Lack of ethos doesn't automatically break an argument. What I said was basic knowledge that even lay people know.

I'll kow tow if it's called for, but you're just groveling.

No, but it significantly weakens your argument, especially in this case. Your lack of any experience at all is apparent in your preconceived idea of how and why medicine is practiced the way it is. I suggest you spend some time in a FPs practice away from the resources of a big city and enjoy the view as your eyes open.

 

[punkedoutriffs]

No, but it significantly weakens your argument, especially in this case. Your lack of any experience at all is apparent in your preconceived idea of how and why medicine is practiced the way it is. I suggest you spend some time in a FPs practice away from the resources of a big city and enjoy the view as your eyes open.

Maybe you should have paid more attention to what I was actually saying, cuz this doesn't change it. I'm well aware that rural FP practices refer less. But guess what? They still refer. How often does a specialist refer a patient to an FP? The river might flow fast or it might flow slow, but it sure as hell doesn't flow backwards.

(And yes, I'm aware there might be exceptions where the specialist is incompetent or something, but that's an anomaly to the system.)

 

[jerseytrash]

Maybe you should have paid more attention to what I was actually saying, cuz this doesn't change it. I'm well aware that rural FP practices refer less. But guess what? They still refer. How often does a specialist refer a patient to an FP? The river might flow fast or it might flow slow, but it sure as hell doesn't flow backwards.

I've had multiple patients on subspecialty services who needed to be hooked up with primary care appointments because they were admitted to GI for a GI bleed and it turned out, whoops, they have diabetes or HTN

 

[punkedoutriffs]

I've had multiple patients on subspecialty services who needed to be hooked up with primary care appointments because they were admitted to GI for a GI bleed and it turned out, whoops, they have diabetes or HTN

You'd consider that a referral in the same nature as most FM to specialist referrals? Sounds more like a mistaken initial diagnosis and subsequent bounce.

 

[Smokemont]

Maybe you should have paid more attention to what I was actually saying, cuz this doesn't change it. I'm well aware that rural FP practices refer less. But guess what? They still refer. How often does a specialist refer a patient to an FP? The river might flow fast or it might flow slow, but it sure as hell doesn't flow backwards.

(And yes, I'm aware there might be exceptions where the specialist is incompetent or something, but that's an anomaly to the system.)

Where do you think the patient goes after seeing the specialist? Who do you think explains what the specialist did and/or said because the patient was too scared/worried/nervous to comprehend the visit? Who do you think determines whether or not the patient should routinely f/u with the specialist or it was a one time visit? Who do you think the patient asks advice from when the specialist suggests a treatment? Your patronizing view of the concept of referral just makes you ignorance shine. That was a nice analogy though 🙄

 

[jerseytrash]

You'd consider that a referral in the same nature as most FM to specialist referrals? Sounds more like a mistaken initial diagnosis and subsequent bounce.

Uh no it's not. Many people go through a good chunk of their lives without getting regular medical care and end up only discovering they have diabetes or stable angina or hypertension when something bad happens. If that means the gastroenterologist who admitted them discovered the diagnosis, it's still a primary care referral because in the real world that's who treats these things.

 

[jerseytrash]

Where do you think the patient goes after seeing the specialist? Who do you think explains what the specialist did and/or said because the patient was too scared/worried/nervous to comprehend the visit? Who do you think determines whether or not the patient should routinely f/u with the specialist or it was a one time visit? Who do you think the patient asks advice from when the specialist suggests a treatment? Your patronizing view of the concept of referral just makes you ignorance shine. That was a nice analogy though 🙄

👍 speaking as someone who wants to be a specialist, you pretty much hit the nail on the head as to why primary care is such an important aspect of medicine

 

[punkedoutriffs]

Where do you think the patient goes after seeing the specialist? Home, unless another health problem comes up, then the triage starts again w/ the FP or EP. 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?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.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?Your patronizing view of the concept of referral just makes you ignorance shine. That was a nice analogy though 🙄

.

 

[punkedoutriffs]

Uh no it's not. Many people go through a good chunk of their lives without getting regular medical care and end up only discovering they have diabetes or stable angina or hypertension when something bad happens. If that means the gastroenterologist who admitted them discovered the diagnosis, it's still a primary care referral because in the real world that's who treats these things.

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?

 

[jerseytrash]

I just can't

You really just are showing how severe your lack of understanding of medical practice in the real world is

 

[punkedoutriffs]

I just can't

You really just are showing how severe your lack of understanding of medical practice in the real world is

No, please, I'm not being glib about it. I want to know. Here's me kow-towing.