would an anesthesiologist be comfortable with int med probs?

[ThinkFast007]

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I do not mean to be condescending or anything, I'm just in the midst of trying to figure out what I want to do ( i'm a third year). so...

I was just wondering. Since, an anesthesiologist is an MD I know they SHOULD know the regular thinks like how to tx the oh i dont know..rhinitis, pneumonia, etc. However, how comfortable are you all in this? I know that if one wants to go into anes one must complete a prelim year in medicine, but will that make one 'competent' in regular med stuff. I know 'competent' here is a very loose term.

The reason is this. Invariably, since you're an MD and are at a common gatherings family members, friends, whoever may have 'medical' q's about something (like a cough, or fever, or some diarrhea, pneumonia,etc). I thinkwhen people have a q about something and we're like "i dont know" (all the time) we could be perceieved as being an idiot (yah i know perception of others should not be the driving force, etc..) The thing is also after residency I would like to go to some third world country and do some pro-bono work,etc where I assume internal medicine knowledge is what is of most importance (unless of course there are surgeries and you obviously need the services of anest).

thanks again for your opinions. 👍

 

[kungfufishing]

pro bono anesthesia in the jungle? "here, bite down on this....you boys hold him down, Ill cut it off"

 

[wangstar]

I do not mean to be condescending or anything, I'm just in the midst of trying to figure out what I want to do ( i'm a third year). so...

I was just wondering. Since, an anesthesiologist is an MD I know they SHOULD know the regular thinks like how to tx the oh i dont know..rhinitis, pneumonia, etc. However, how comfortable are you all in this? I know that if one wants to go into anes one must complete a prelim year in medicine, but will that make one 'competent' in regular med stuff. I know 'competent' here is a very loose term.

you will be very competent at dealing with problems dealing with heart (if you do cardiac you will basically be a cardiologist), and lung (ventilators, ICU stuff), heme, renal, pain management, etc. you may not be able to make a diarrhea or strange rash diagnosis but i think you will find that if thats what you are looking for you really aren't going to have any skills better than what an NP or PA could do, thus you won't get paid and you will have a lot of competition going against you. i think if somebody you knew coded right in front of you, you would be far more competent to handle it than an IM doc.

 

[Tenesma]

thinkfast007.... i understand where you are coming from...

When i first got my MD and my temporary license, I was very excited about treating my family members and friends and distant friends... My parents saw it as my MD education finally paying off, my friends and distant friends were impressed with my power to yield a prescription pad.... But trust me, this excitement quickly disappears as you get more and more calls for help, your family reunions are spent diagnosing ALL of your family and friends, your friends get upset because you forgot to call in a prescription for their girlfriend's UTI.... So i learned the hard way: "DON'T treat your FAMILY and FRIENDS". I refuse to write prescriptions, I refuse to look at rashes for more than 1 minute before saying: "You should take this to a dermatologist"...

Bottomline, as an anesthesiologist you will know more about most drugs than anyone else - as an anesthesiologist you will know more about physiology than most - as an anesthesiologist you will know more about critical care than most.... but do you really want to be involved with everybody's little illnesses!? NO!!!

about pro-bono work in the third world... internal medicine won't serve much good - because the problems of the third world aren't the same as ours, and even if they were you wouldn't have the drugs to prescribe. In the third world, i would argue that surgery and anesthesia are far more essential because you are able to alter somebody's life right then and there... Only tropical infectious disease medicine will help otherwise... Prescribing glyburide and atenolol won't last long in the third world 🙂

 

[UTSouthwestern]

If you are truly bent on doing both anesthesiology and primary care, why not do an IM residency and anesthesiology? 6 years but board certified in both fields. I did and still do feel very comfortable treating various IM pathology, although my physical exam skills are rusty in some areas.

Also, doing work with Doctors Without Borders or various religious organizations does not entail a tremendous amount of knowledge. As Tenesma stated, surgical care is of greater impact as most third world people suffer from a lack of facilities and health care professionals and not from overeating, high cholesterol, high sugar diets and their sequelae. I have done several medical missions to the hills of South America and the majority of patients I saw required surgical correction of a variety of defects or fractures, while the majority of medical illnesses were limited to tropical pathology. Yes, I did see the occasional celiac sprue, a variety of other nuitritional intolerances, and a very occasional cardiac patient, but very rarely.

Incidentally, my friends in private practice who double boarded in IM and anesthesiology (and I know quite a few) have NEVER put their IM training to use in terms of moonlighting as an internist or doing any type of non-anesthesiology related work.

 

[ThinkFast007]

If you are truly bent on doing both anesthesiology and primary care, why not do an IM residency and anesthesiology? 6 years but board certified in both fields. I did and still do feel very comfortable treating various IM pathology, although my physical exam skills are rusty in some areas.

Also, doing work with Doctors Without Borders or various religious organizations does not entail a tremendous amount of knowledge. As Tenesma stated, surgical care is of greater impact as most third world people suffer from a lack of facilities and health care professionals and not from overeating, high cholesterol, high sugar diets and their sequelae. I have done several medical missions to the hills of South America and the majority of patients I saw required surgical correction of a variety of defects or fractures, while the majority of medical illnesses were limited to tropical pathology. Yes, I did see the occasional celiac sprue, a variety of other nuitritional intolerances, and a very occasional cardiac patient, but very rarely.

Incidentally, my friends in private practice who double boarded in IM and anesthesiology (and I know quite a few) have NEVER put their IM training to use in terms of moonlighting as an internist or doing any type of non-anesthesiology related work.

Thanks q one who replied. all the points you all made make sense. And as one of you pointed out, the anesthesiologist would probably be the best one to have around if someone crashed. It's like this. Last week when I was in church this old later fainted, there was a cardiologist in the church who was able to attend to her (it's true all that ended up happening was the EMS took her to the hosp). But at that moment I was thinking to myself. IF that had happened and I was an anesthesiologist (and the congregtion would know i'm a doc most likely) people would want me to do something. I just didnt want to be the one in the future to just stand there and be scratching my head and be like 😕 😕

But it's true you all (anesth) are prolly the best for something like this if it were to occur.

thanks guys

 

[Tenesma]

actually this is going to sound weird... but if something were to happen in the field (ie: church), no matter how much you know - there is little you can do without monitors, devices and drugs.... in fact, the only thing you can truly hope for is EMS w/ their truck. In fact, as a former paramedic I would be useless at a church without the accoutrements of a well-stacked ambulance 🙂

 

[VentdependenT]

If I have to treat any outpatient medical problems chronically as an anesthesiologist then I'll go nuts. As far as "run of the mill" medical issues are concerned you'll be working with everything from diabetes to asthma to cervical arthritis perioperativaly.

As UT stated, if your looking to give your family advice on ED or birth control then anesthesiology will fall severly short of your needs

 

[UTSouthwestern]

You'd be suprised at how your training kicks in when those situations occur. I have had the misfortune to be around when:

1. Mom brought her son in to the health food store I was shopping in to treat her son who was obviously having a grand mal seizure
2. Off duty police officer lost control of her car going 90 mph and crossed over into oncoming traffic
3. Neighbor had an MI
4. Neighbor had a major CVA (get the picture, don't be my neighbor)
5. Passenger on a flight started choking on airline peanuts

many others I don't care to recall.

In each situation, my training put me into motion covering the AB's (not C's), calling 911, assessing the situation, and treating with whatever modality was available.

You will develop that confidence, especially with anesthesiology, where you will learn to treat immediately when an adverse event occurs.

You must decide if you are truly committed to becoming an anesthesiologist or want to lean toward primary care. You can do the latter while training in the former (I still moonlight as an ER physician and cover internists' practices for up to a week at a time for a significant amount of coin).

 

[manixter]

I do not mean to be condescending or anything, I'm just in the midst of trying to figure out what I want to do ( i'm a third year). so...

I was just wondering. Since, an anesthesiologist is an MD I know they SHOULD know the regular thinks like how to tx the oh i dont know..rhinitis, pneumonia, etc. However, how comfortable are you all in this? I know that if one wants to go into anes one must complete a prelim year in medicine, but will that make one 'competent' in regular med stuff. I know 'competent' here is a very loose term.

The reason is this. Invariably, since you're an MD and are at a common gatherings family members, friends, whoever may have 'medical' q's about something (like a cough, or fever, or some diarrhea, pneumonia,etc). I thinkwhen people have a q about something and we're like "i dont know" (all the time) we could be perceieved as being an idiot (yah i know perception of others should not be the driving force, etc..) The thing is also after residency I would like to go to some third world country and do some pro-bono work,etc where I assume internal medicine knowledge is what is of most importance (unless of course there are surgeries and you obviously need the services of anest).

thanks again for your opinions. 👍

As an anesthesiologist, you are uniquely enabled to deal with the ABCs. You are able to recognize respiratory distress (something that many of my internal medicine colleagues have trouble with), you can intubate, ventilate, put in lines, titrate pressors. You've done four years of medical school, and one year of internship. Anything else, you have time to look it up.
In my opinion, it's easier to make an anesthesiologist think like an internist than vice versa.
--mir

 

[Lefty]

Hey 007,

I have a lot of similar concerns. I have already decided not to treat family or friends, however. That just opens the door for trouble. I am more interested in proper medical training for medical service in foreign countries. I think a good, well-structured internship before anesthesia residency may be your best option for the type of training it sounds like you want. Besides, once you're in a foreign country you may have to adapt to using the only available supplies. For example, some of my friends that went to help out in a service clinic in Mexico were treating little kids who had strep throat. They decided on the appropriate antibiotic treatment only to find that the only thing available was chloramphenicol b/c it was dirt cheap and that's what everyone there used for most infections. It is a different world entirely, as hinted at by above comments.

Also, I understand the idea of not wanting to be somewhere isolated (like on a plane, or in the middle of nowhere) when someone has a medical emergency and the words "is anyone here a doctor?" make me want to hide and pretend I do real estate or something. Anesthesia and ER docs are the kind of docs I want around me if I have any kind of emergency--they could probably keep someone alive the longest for prepared personnel to arrive. Now, if you're talking about delivering a baby you may be screwed as an anesthesiologist. You could easily polish your OB skills though by doing a well-structured transitional year before residency. So don't forget you have options for your internship year in terms of training options and skills to acquire.

Find what will make YOU the happiest--not your family, friends, or foreigners. There are always opportunities to serve others in more ways than medical service too. Good luck deciding on a specialty.

Lefty