So this upcoming Sunday will make the end of my first inpatient experience as a 3rd year medical student. I would say that the first battle that I have had internally this month has nothing to do with my rotation…the battle has been with which specialty I should pursue, Orthopedics or General Surgery. I’ve talked to alot of Orthopedic surgeons and alot of General Surgeons and I have done shadowing in both, and it is still hard for me to make my decision. Some folks caution against trying to make a decision too early in your junior year but that is a ridiculous recommendation. Of course you should go into each rotation with a mindset that you could actually go into that specialty, but if you are thinking about pursuing orthopedics, it is so competitive that you need to start getting things in order very early. My main problem is that no matter how hard I want to be gungho about Orthopedics, and make a crap load of money, and have the prestige of getting into a hard residency, and be known as the “Bone Doc”, and work with power tools…I just am not excited by the field and particularly bones. To be honest the gut anatomy is much more interesting to me, and in fact, the management of diabetic ketoacidosis (DKA) is really interesting to me too, along with a bunch of other things that ortho guys just don’t deal with and don’t care to deal with. Do I prefer to have to know a whole bunch about a lot like General Surgeons or do I prefer to know a whole bunch about less material, like ortho guys? Do I prefer getting dumped on by every surgical service like General Surgery, or do I prefer just getting consulted and giving my patients back like the Ortho guys? Do I prefer the prestige of getting into Orthopedics? And even more importantly, which field is more conducive to long term missions overseas? The last question is pretty obvious which makes me wonder why I am even struggling with my decision. But yeah, these are the thoughts that have been racing through my mind this month.
Besides those internal struggles I have had some interesting patients. I had a 20 year old Asian kid who had weighed over 500 lbs but lost about 200lbs taking weight loss drugs. Well, we aren’t sure if the drugs did it but now he has heart failure (EF=20%) and ESRD. Its really hard to break that type of news to a kid who is younger than me (of course I didn’t break the actual news, but it was hard standing in the room and watching his parent’s faces as the news was relayed). I also had a patient who was so appreciative of the care that “I” (which is pretty funny since I was just the person who came to see him the most) gave him that he gave me a card:
I think that that is the coolest thing about being a 3rd year student. You see the patient so much (more so than the residents and the attending) that the patients think that you are their personal doctor and that you are primarily taking care of them. Its nice to get this kind of feedback from my patients.
Over this rotation I think that I have also became better at presenting a patient in an organized manner, and better at trying to figure out what the next step in management is. I have also gotten better at going down into the ER and working a patient up for various conditions that they might have. I feel pretty comfortable with chest pain patients or patients who complain of fatigue. I’m not sure how different my patient population will be at the VA and how different their diseases will be, but I am excited for the change.Some things that I didn’t do well in is that I usually just read review books during rounds since I could barely hear the person presenting and since I don’t learn well from audio material. But that whole point of rounds is that you are supposed to be learning from them, so I do feel like some important info feel through the cracks, but I’m not sure how to maximize my learning from rounds.
Today is my day off so I plan to catch up on all the studying I have missed.
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