So this past Friday marked my last required day of my 3rd year of medschool. As I look back on this year it has been quite eventful, and honestly it all seems like a blur. Yesterday, I had a practical examination for my Family Medicine rotation, where they basically wanted me to do different sports medicine-like physical exams. Once that was over, the Family Medcine clerkship director met with me for my exit examination. When he found out that I was interested in specializing in orthopaedics he warned me to not fall into the same trap as so many orthopods in regards to medical knowledge. He recounted a patient that he just saw this past week who had seen an orthopaedic surgeon to evaluate her chronic right hip pain. They checked her out, and sent her back to him, saying that they found nothing wrong with her and could do nothing for her. The family medicine doc examined the patient more thoroughly and discovered that the patient had a limb-length discrepancy. The leg opposite the one that was evaluated by the orthopods was slightly shorter, causing her to compensate with the right leg, which led to her right hip pain. He told me this story to remind me to not just focus on one part of the elephant, but the whole (as much as possible) because it will make you a better doctor. While I must admit that I was looking forward to forgeting a lot of the general medicine that I learned in medical school, this story has really encouraged me to try as hard as I can to not be that stereotypical orthopod who can’t even manage hypertension, because my patient will probably suffer in the end.

As I look back over the year and reflect on my rotations, I can’t help but form general impressions for each rotation:

• Internal Medicine: In hindsight I am quite impressed with the vast amount of knowledge that IM guys possess. With a careful history and pertinent labs they are able to diagnose most diseases without even doing a physical exam. I think this rotation was a perfect one to start out my year with. I was fresh from taking Step 1, so I had a baseline knowledge and now I had to see if I could apply it. I must admit that it took me some time to warm up. But once I did I started to make connections and get diagnoses correct. Starting your year off with this rotation truly allows you to learn information that is the basis for just about all other rotations, and it allows you to get comfortable with the hospital setting, in preparation for future rotations. No matter how much I learned on this rotation, I just couldn’t get over the fact that there wasn’t enough “doing”. Your job for the day, was to wake up, see your patients, round on your patients with the team, write orders, then keep on checking in on your patients throughout the day, until you round again with your team in the afternoon. Maybe here and there you might be able to do a lumbar puncture, but honestly there just weren’t many procedures. Some of the residents would get excited talking about observing a bronchoscopy, or an EGD, but that stuff isn’t really a cool enough procedure for me to get excited about. This rotation truly made me realize that I wouldn’t be able to wake up everyday to do internal medicine alone. I needed more.
• OBGYN: Now that I have finished all of my 3rd year rotations, I can honestly say that besides ortho, I would definitely consider doing obstetrics. Now you notice that I didn’t mention gyneocology, because I truly hated that side of the field. I always felt like the patients were uncomfortable around me, which made me unconfortable around them. But when it came to the expectant mothers, I never had those issues. It was always a happy time, and I truly enjoyed every aspect of it, from the prenatal visits to the birth. I loved delivering babies, and the C-sections were pretty interesting too. With that said, I think that OB gave me the perfect mix between the OR and the clinic, although it was a little weak on the OR side. But alas, there is no way I could avoid doing gyn during residency, which was enough of a deal breaker for me. I have seriously thought about what I would do as a back-up specialty if for some reason God said no to me matching into ortho, and I honestly think I would go and do OBGYN. I think this was a great specialty to do before my surgery rotation because it got me somewhat used to the OR (gowning up, scrubing, etc), and helped me to be more comfortable with dealing with crazy scrub techs.
• Psychiatry: Overall, psychiatry is a good field to help patients that often would never be helped and make a good salary doing it. With that said;, if I didn’t like internal medicine because they didn’t do procedures, psychiatry was even worse. It was just non-stop talking to patients, which I enjoy doing, but I need something to break up the trend. As a student it was pretty painful to deal with these something crazy patients, but even worse was dealing with the patients who just used the system to get a place to sleep for the night. Overall, this is a field that I would never have considered going into.
• General Surgery: Since my first year of college, during my shadowing experiences I was absolutely sure that I was born to be a general surgeon. That’s why I was quite shocked to realize how much I hated it when I actually went through this rotation. The fact that many of the attendings were malignant didn’t really bother me because I have a pretty thick skin, but I just could not get over the offensive smell of poop or the sight of bowel. Whenever I would see a colostomy I was utterly disgusted. I loved the fact that as a general surgeon you seemed to have a firm understanding of how to manage a surgical patient, including many of their medical conditions, but that also meant that they ended up being the dumping ground for many of the other surgical specialties’ patients. The only thing I was drawn to, even back in college, was the trauma (gunshots, stab wounds, car accidents), but many of these were non-operative, and many actually required orthopaedic surgery, not general surgery (at least at my hospital). But I think the bowel and poop issue was my biggest, and about 2 weeks into the rotation, I knew it wasn’t for me. Which was crazy talk because it was all I had wanted to do since I started medical school. But medical students often change their desired specialty multiple times before they submit their residency application. I guess I was no different.
• Orthopaedic Surgery: This specialty kind of came out of left field for me. I got interested in it because a couple of my classmates really liked it, so I thought I would check it out. At first I was totally turned off by it because it seems so far away from general surgery. And to be honest, the musculoskeletal system wasn’t my favorite system to study in anatomy class first year. What changed everything for me was clinic and seeing patients. I really really really really enjoyed seeing patient’s with orthopaedic type conditions. While during most other rotations, I would be looking at my watch constantly, during my 1 week of ortho the time just flew by. And once I started to participate in cases in the OR, and I got a chance to drill screws and pins into a patient’s bone for myself, or use wire cutters, hammers, screw drivers, or any other gadget I was hooked. Its hard to describe the feeling when you find your specialty, but I guess I could describe it as a true elation to wake up every morning to see patients. No other specialty, probably besides obstetrics gave me this feeling, and to all other medical students who will be starting 3rd year, make sure you have that feeling before you decide to spend the next 50 years of your life practicing your trade in it.
• Urology, Neurosurgery, Ophthalmology: I knew I wanted to be a surgeon and after I realized that I didn’t want to do general a surgery I was looking at all of these specialties, however none of them really caught my eye. The neurosurgeons really worked a lot harder than I see myself working. And for the most part their patients are very very sick, meaning that their outcomes are not all that good a lot of times. I needed to do a specialty a little less morbid than that in order to be happy. As for urology, I like that they knew a lot of medicine like general surgery, and they had a good mix of surgery and clinic like OBGYN, however I just couldn’t get over putting a scalpel to a scrotum or a penis. Of course they do a lot of bladder and kidney work, but the scrotum and penis surgery kind of crossed it out for me. Ophthalmology was hands down the most boring thing I have ever seen…hands down. I would rather lick toilet bowls clean for a living than do ophtho. Just my .02.
• Pediatrics: My mom was trained as a pediatrician, but it wasn’t until I went through this rotation that I gained a tremendous amount of respect for them. I believe that pediatricians are hands down the best clinicians in medicine. Like veterinarians, they have to diagnose without necessarily being able to communicate with their patients, and because of that they are very observant and very vigilant. As part of that, I think peds tends to draw medical students that are somewhat OCD, and I just couldn’t deal with the residents. If they were girls they were passive aggressive, and if they were dudes that acted worse than the girls. Maybe it was just my particular rotation, but most of my fellow classmates hated peds the most, not because of the patients but because of the residents and some attendings. More so than internal medicine, I could not wait to be done with this rotation.
• Family Medicine: I really enjoyed my 1 month of family medicine. In one day I could diagnose a UTI, do 2 well child visits, manage a diabetic, do a prenatal visit, freeze off a wart a patient was concerned about, and deliver a baby. No other field offers that type of variety, and its a shame they get paid so little. Now would I do it for a specialty?…probably not because they don’t go to the OR, but I actually really enjoyed my time.

As you probably saw from my Twitter posts, ERAS has finally opened up and I have already started to populate my residency application. ERAS is by far the most detailed application I have ever seen, and I would caution any medical student to not procrastinate on filling it out because it could definitely delay you as deadlines approach. Anyway, since most of my time will be spent filling out ERAS and studying for Step 2 (which I take on Aug. 9), I won’t be posting much, except for ortho related stuff, which will of course be password protected until/if I match.