So what do I want to be when I grow up?

It's October now, the weather is becoming increasingly cold, and the leaves are starting to change (though the Fall rain this season was heavy so it's not as pretty as years before). Part of why I'm doing this research year is to learn about myself and really hone in on a specialty that I find interesting. I need to figure out what I enjoy most about medicine. Medicine is no longer a career path that can be chosen simply for the money, as the upcoming changes to our healthcare system (no matter who is elected) will undoubtedly continue the downward trend in physician salaries. So I thought I'd spend some time and write an initial flow of thoughts on what I want to be when I grow up, just so I have something to which to refer as I continue to make this decision. I consciously try not to post about medicine here because frankly there are PLENTY of blogs about medicine and medical school, so let's hope this is just one of a few.

Ok, first off, I'm gonna have to LOVE what I do. I know that seems pretty obvious and very elementary, but I find it surprising how many of my peers are basing their career decisions on things other than this simple fact. I understand (and will discuss in a second) that other criteria come into play here. Things like lifestyle, desire to have family, money and prestige all can play some role in this type of decision, but honestly, how do you not start with the idea that you simply must enjoy your job? Medicine is unique in that the half life of medical knowledge is five years. That means by the time a newly minted physician finishes residency, half of the knowledge he or she gained during medical school is completely obsolete. So medicine is LIFELONG education, LIFELONG schooling. There is really no 'settling down' into a routine. So I have to pick a specialty where I enjoy reading the journals, going to the national meetings, and clicking with the other personalities of that specialty.

On that note, the question is, what did I LOVE during my third year? What were my favorite rotations? That's actually easy...I absolutely LOVED surgery. I enjoyed the fast pace of surgery. I enjoyed the fact that there was very little bullshit when it came to writing surgical notes and making decisions. I liked that decisions generally resulted in action. I also loved the fact that surgery often offered an outright cure. And I simply LOVED being in the OR. There's something relaxing about it. There's music playing (even during the very complicated surgeries), there's some joking around going on, and time simply flies by (most students would disagree with me on this). I feel like the surgeon also carries a certain respect level not afforded to some other specialties. When I was on surgery and did a consult in the ED, the ED nurses and physicians made sure the patient chart and imaging studies were ready for me to look at before I got down there. After surgery, I was on medicine, and did a medical consult in the ED, and couldn't find a single person willing to help out. It just felt different, I can't even really explain it.

Another rotation I enjoyed was OB/GYN. Ultimately, OB/GYN is a surgical field. A lot of time is spent in the OR in addition to the clinic. The pace is extremely fast and the field is very diverse. The OB/GYN does primary care, specialty care, medical diagnosis, and surgical intervention. I think that's awesome. The specialty itself also tends to be a happy one. Everyone loves babies and I can't imagine helping someone bring a child into this world ever getting old and "routine." The surgeries can be big too. The C-section is the only procedure I have seen where there is 500ml bloodloss routinely.

What about pediatrics? This was my very first rotation during medical school. I actually did excellently in this rotation. It was incredibly interesting and simply a lot of fun. I never thought that I would be good with children. But I guess having lots of little cousins helps somewhat in this department. I quickly managed to learn that a screaming kid is nothing to be afraid of (in fact, it's so much easier to examine the back of their throats when their screaming their brains out then trying to get them to open their mouths when they're quiet). At first, holding a newborn was frightening, but pretty soon, I was flipping the babies onto one hand to examine the back, doing the pediatric reflexes, finding the femoral pulses, etc. I learned how to distract 9 month olds with my school ID while I looked in their ears. Oh, and I thought I would hate working with the adolescents, but it turns out I enjoyed listening to their problems and educating them about their personal health. Pediatrics was also a great 6-week parenting course. I saw examples of some phenomenal parents, and a few examples of some terrible parents. I actually now have a pretty good idea how I would parent when the time comes (one example, I would make sure there are low-height bookshelves in EVERY room of the house PACKED with all types of books. Even in the kitchen and bathrooms. That way, the kids can reach for a book at anytime and read it or have it read to them).

I didn't enjoy my medicine rotation all that much. I just felt like a glorified secretary: arraning imaging studies, coordinating consults, making sure orders got carried out, etc. However, the subspecialty of gastroenterology really interested me. I think that's because I found it a lot like surgery. There is a significant clinical component, a lot of the pathologies are the same, and they do lots of procedures as well. If I do medicine, it will be only to do gastroenterology (which means I'll have to suffer for three years before hitting the GI fellowship).

My Winamp playlist just ran out, so that's enough for today. I'll continue this later...