Tuesday, February 15, 2011
Friday, February 11, 2011
Career Choices
I noticed that exactly one year ago, I documented what I thought were my top specialty choices at that moment. You can find that post here if you're curious. Since it's been a year, I thought I would take the opportunity to reflect and see what has changed. My experience with the different fields has hardly changed (if at all), but my perceptions have changed a little and my idea of what is a good fit for me has been refined some. The list of fields that I am not at all interested in hasn't changed at all. My list of good possibilities has changed slightly, but mostly just in order of preference based on what I happen to be thinking at the moment (if you asked me next week, the order may change again).
Here was my list last year:
Good Possibilities: (roughly in order of most likely to least)
And here would be my current order:
Here was my list last year:
Good Possibilities: (roughly in order of most likely to least)
- Med-Peds (combined internal medicine/pediatric training)
- Peds
- Emergency Medicine
- Heme/Onc
- Genetics
- Family Medicine
And here would be my current order:
- Peds
- Med-Peds
- Family Medicine
- Genetics
- Heme/Onc
- Emergency Medicine
A Good Reminder
Recently, we had an assignment which involved interviewing a standardized patient (paid actor to aid in our training). We were to obtain a complete medical history, a description of their chief complaint ("What brings you in today?"), do a focused physical exam (only the parts that we thought were relevant to their case) and try to come up with what we thought was the condition being described by the patient. We were going to be graded not on if we got the diagnosis correct, but on how we talked to the patient and if we asked about and checked relevant details.
It would be easy to blow off these assignments as just another thing we have to do and to get through it as quickly as possible before moving on to our next project. But it didn't feel like just another assignment to me.
My "patient" came in with a chief complaint of pain in her chest. There are a hundred things that could cause that. She was a young woman, which narrowed the likely possibilities. Throughout the history taking, I picked up on several clues that directed my thinking towards what I thought was going on. I strongly suspected a pulmonary embolism (PE) - which is when a main artery of the lung has become blocked by something traveling through the blood stream, often a blood clot. PEs can easily be fatal, especially if not caught and treated quickly.
I knew this was a fake patient. I knew that nothing would have changed whether I diagnosed her with a PE or a stubbed toe. But it still felt good. It felt good to know that I would have saved her life because I picked up on the clues. Through talking with the patient for only ten minutes, I was able to gather the necessary evidence and deduce what the problem was. For the first time in months, I remembered very clearly why I am in medical school.
It wasn't a real patient, and clues will often not be so clearly presented to us in real practice, but I'm making progress towards truly being valuable to patients and the medical community - and that feels good. I left that assignment walking a little lighter with a smile on my face, because I am reminded now that I get to do that the rest of my life. It won't be every day, or maybe even every month, that I catch a potentially fatal but treatable condition, but I'm going through the lectures and the exams now so that I can catch them. I have to sit in class now so that when I'm sitting in an exam room later, I can put the pieces together. Every long lecture or seemingly pointless assignment will contribute to my ability to better serve my patients in the future, and it's good to be reminded of that.
It would be easy to blow off these assignments as just another thing we have to do and to get through it as quickly as possible before moving on to our next project. But it didn't feel like just another assignment to me.
My "patient" came in with a chief complaint of pain in her chest. There are a hundred things that could cause that. She was a young woman, which narrowed the likely possibilities. Throughout the history taking, I picked up on several clues that directed my thinking towards what I thought was going on. I strongly suspected a pulmonary embolism (PE) - which is when a main artery of the lung has become blocked by something traveling through the blood stream, often a blood clot. PEs can easily be fatal, especially if not caught and treated quickly.
I knew this was a fake patient. I knew that nothing would have changed whether I diagnosed her with a PE or a stubbed toe. But it still felt good. It felt good to know that I would have saved her life because I picked up on the clues. Through talking with the patient for only ten minutes, I was able to gather the necessary evidence and deduce what the problem was. For the first time in months, I remembered very clearly why I am in medical school.
It wasn't a real patient, and clues will often not be so clearly presented to us in real practice, but I'm making progress towards truly being valuable to patients and the medical community - and that feels good. I left that assignment walking a little lighter with a smile on my face, because I am reminded now that I get to do that the rest of my life. It won't be every day, or maybe even every month, that I catch a potentially fatal but treatable condition, but I'm going through the lectures and the exams now so that I can catch them. I have to sit in class now so that when I'm sitting in an exam room later, I can put the pieces together. Every long lecture or seemingly pointless assignment will contribute to my ability to better serve my patients in the future, and it's good to be reminded of that.
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