Showing posts with label Surgery. Show all posts
Showing posts with label Surgery. Show all posts
Monday, November 30, 2009
Tuesday, November 17, 2009
David breaks down Surgery
3 reasons to become a surgeon:
1. You get to do stuff and see if it works
Surgery is the pinnacle of immediate feedback; you identify a problem, do something concrete to fix it, and then evaluate whether or not it worked. More than any other specialty, the outcomes are measurable, tangible, and observable. You may sacrifice the continuity of primary care fields, but you also experience the unique satisfactions of knowing what’s wrong and getting your hands dirty trying to make things right. Fields like neurology, psychiatry, and others may involve long battles with nebulously defined disease processes where victories are measured in small, incremental improvements over years. That process yields its own personal and professional rewards and frustrations, but may not provide the same acute results that some students may find particularly appealing and which surgery deals out in spades.
2. Certified badassery
Few things in medicine are cooler than surgery. Though it may not be for everyone, no one can deny the sheer awesomeness of removing tumors, transplanting organs, and augmenting breasts (just kidding…?). Perhaps more commonly than in other fields, decisions are realistically life or death; a miscue here or a careless error there in the OR could have disastrous results. What’s more, the wealth of new technologies and general trend towards minimally-invasive procedures ensure that general surgery and the many surgical subspecialties will only further badassify in the future. Sure, more surgeons spend their lives in the bread and butter world of inguinal hernias and appendectomies than in the rarified air of reconstructive plastics and neurosurgery, but even the more vanilla procedures provide all the benefits listed above and below and may, due to volume, be even more targeted for technological advancement in the coming years.
I can’t believe Da Vinci painted the Mona Lisa and invented this robot…
3. Options like whoa
It is generally believed that medical students should first and foremost decide whether they want to be surgical or medical. If surgery is your cup of tea, there is a seemingly limitless array of opportunities to pursue. A general surgery residency is a common gateway to further subspecialty options such as burns, cardiothoracic, vascular, and pediatric surgery, among others, while other students choose to enter fields such as orthopedics, plastics, and ENT straightaway. Going further, many surgeons identify a specific procedure or set of similar procedures that becomes their uber-specialty within their broader branch of surgery. Basically, if there’s some type of cutting you want to do, you can probably make a career out of it.
3 reasons not to:
1. Training don’t quit
More than any other field, surgery demands an extensive period of training. A typical general surgery residency lasts five years, and further subspecialty fellowships can push that requirement into the two-digit territory. An R3 I worked with recently is pursuing a career in pediatric cardiothoracic surgery, a path that, with a general surgery residency, two years of research, a three-year CT fellowship, and a one-year peds CT fellowship, will ultimately require 11 years of training after medical school. Assuming one entered medical school immediately after undergrad at 21-23 years old, this would push off attending status – and the benefits of a legitimate salary and some semblance of a personal life – until one’s mid-to-late 30s. And though in a badass field like peds CT surgery you’d make it rain early and often thereafter, you’d still be spending the majority of the prime of your youth before ever realizing many of your career goals.
2. The hours never stop
Similar to OBGYN, surgery in nearly all of its forms is notorious for an extremely demanding workload and long hours on call. Though some subspecialties and practice settings may be less demanding, the fact remains that surgeons spend more time in the hospital than almost any other type of physician. When you factor in the extensive training required before even reaching the attending level, the demands of the subsequent career may simply not be something many medical students want in their future. (On a related note, it's worth mentioning that the hours / training demands take their toll on relationships as well; some surgical residencies have been known to have divorce rates exceeding 100%. In other words, residents get divorced, remarry and get divorced again. Just FYI...)
3. High-intensity work environment
By its nature, surgery is a high-stress world. The patient is commonly under general anesthesia and the manipulations of the procedure often entail significant blood loss. Small or careless transgressions can kill a patient either immediately or as a post-operative complication, and the surgeon running the show is ultimately responsible. Many surgeons trumpet the philosophy “trust no one,” something potentially disheartening on its surface but logical in a world where the surgeon is held accountable for any number of errors in the pre-, intra-, and post-operative setting. All these truths foster an environment some find less than hospitable, especially to those lower in the training hierarchy. Surgeons, on average, may be blunter and less forgiving in a professional environment than other physicians, and this, coupled with the long hours, can create a working world some students may choose to avoid.
1. You get to do stuff and see if it works
Surgery is the pinnacle of immediate feedback; you identify a problem, do something concrete to fix it, and then evaluate whether or not it worked. More than any other specialty, the outcomes are measurable, tangible, and observable. You may sacrifice the continuity of primary care fields, but you also experience the unique satisfactions of knowing what’s wrong and getting your hands dirty trying to make things right. Fields like neurology, psychiatry, and others may involve long battles with nebulously defined disease processes where victories are measured in small, incremental improvements over years. That process yields its own personal and professional rewards and frustrations, but may not provide the same acute results that some students may find particularly appealing and which surgery deals out in spades.
2. Certified badassery
Few things in medicine are cooler than surgery. Though it may not be for everyone, no one can deny the sheer awesomeness of removing tumors, transplanting organs, and augmenting breasts (just kidding…?). Perhaps more commonly than in other fields, decisions are realistically life or death; a miscue here or a careless error there in the OR could have disastrous results. What’s more, the wealth of new technologies and general trend towards minimally-invasive procedures ensure that general surgery and the many surgical subspecialties will only further badassify in the future. Sure, more surgeons spend their lives in the bread and butter world of inguinal hernias and appendectomies than in the rarified air of reconstructive plastics and neurosurgery, but even the more vanilla procedures provide all the benefits listed above and below and may, due to volume, be even more targeted for technological advancement in the coming years.
I can’t believe Da Vinci painted the Mona Lisa and invented this robot…
3. Options like whoa
It is generally believed that medical students should first and foremost decide whether they want to be surgical or medical. If surgery is your cup of tea, there is a seemingly limitless array of opportunities to pursue. A general surgery residency is a common gateway to further subspecialty options such as burns, cardiothoracic, vascular, and pediatric surgery, among others, while other students choose to enter fields such as orthopedics, plastics, and ENT straightaway. Going further, many surgeons identify a specific procedure or set of similar procedures that becomes their uber-specialty within their broader branch of surgery. Basically, if there’s some type of cutting you want to do, you can probably make a career out of it.
3 reasons not to:
1. Training don’t quit
More than any other field, surgery demands an extensive period of training. A typical general surgery residency lasts five years, and further subspecialty fellowships can push that requirement into the two-digit territory. An R3 I worked with recently is pursuing a career in pediatric cardiothoracic surgery, a path that, with a general surgery residency, two years of research, a three-year CT fellowship, and a one-year peds CT fellowship, will ultimately require 11 years of training after medical school. Assuming one entered medical school immediately after undergrad at 21-23 years old, this would push off attending status – and the benefits of a legitimate salary and some semblance of a personal life – until one’s mid-to-late 30s. And though in a badass field like peds CT surgery you’d make it rain early and often thereafter, you’d still be spending the majority of the prime of your youth before ever realizing many of your career goals.
2. The hours never stop
Similar to OBGYN, surgery in nearly all of its forms is notorious for an extremely demanding workload and long hours on call. Though some subspecialties and practice settings may be less demanding, the fact remains that surgeons spend more time in the hospital than almost any other type of physician. When you factor in the extensive training required before even reaching the attending level, the demands of the subsequent career may simply not be something many medical students want in their future. (On a related note, it's worth mentioning that the hours / training demands take their toll on relationships as well; some surgical residencies have been known to have divorce rates exceeding 100%. In other words, residents get divorced, remarry and get divorced again. Just FYI...)
3. High-intensity work environment
By its nature, surgery is a high-stress world. The patient is commonly under general anesthesia and the manipulations of the procedure often entail significant blood loss. Small or careless transgressions can kill a patient either immediately or as a post-operative complication, and the surgeon running the show is ultimately responsible. Many surgeons trumpet the philosophy “trust no one,” something potentially disheartening on its surface but logical in a world where the surgeon is held accountable for any number of errors in the pre-, intra-, and post-operative setting. All these truths foster an environment some find less than hospitable, especially to those lower in the training hierarchy. Surgeons, on average, may be blunter and less forgiving in a professional environment than other physicians, and this, coupled with the long hours, can create a working world some students may choose to avoid.
Monday, October 26, 2009
David Takes Call
As you may have noticed, many moons have passed since our last post. Due to a mind-boggling lapse in (Kevin’s) judgment, our previous intertube oasis at iddxblog.com has been seized by web squatters. Still, in an effort to better the world (and stop Amanda from crying), we will soldier on at this address until Kevin can undo his folly.
Meanwhile, Kevin and I have narrowly avoided board failure and transitioned to the world of white coats, SOAP notes, and Jesse’s iatrogenesis. For Kevin, this has meant a fantastic voyage of babies and bad smells, while on Surgery, I’ve realized I was never truly tired at any point in my life until now. To illustrate, here’s a quick running diary of a recent call night.
0400: Mmmm, a fresh new day! Only 30-plus hours until next we meet, bed. I’ll think of you fondly while I’m gone.
0505: Pre-rounds and dressing changes. Note to self: Try not to do heroin.
1015: OR, first case. I don’t even know what you’re asking, but I’m going to go with “atelectasis.” Please don’t take my suture scissors away; they’re all I have…
1400: Second case. Pros: I’m actually touching a beating heart. Cons: I can’t feel my legs.
1600: Back on the floor. Are those my bowel sounds or the patient’s? Will he see if I eat some of his pudding?
1830: ED: Hmm, so that’s the most common orifice to hide drugs and drug-related paraphernalia...
1945: I didn’t realize so many people are allergic to "everything but 'Dah-lowd-ee.'” Must be an epidemic.
2100: If I crawled into the scanner and acted somnolent, would the nap be worth the repercussions while they imaged my head? Tough call.
This is the dream…
0020: If only I had some No Doze…
0200: Boo-yah, there’s my second wind. This isn’t so bad. That stapler wasn’t an awful pillow and that guy waiting in the hall stopped giving me the stink-eye.
0600: Rounds II: Son of Rounds. I don’t even remember life on the outside. This must’ve been what Brooks felt like in Shawshank Redemption. I hope the sun is as bright as it is in my dreams. I hope…
It’s OK, Brooks. I understand.
0945: Clinic. Can you turn your head and cough, please?
1215: Off. If I don’t make it home alive, at least I touched a heart.
Meanwhile, Kevin and I have narrowly avoided board failure and transitioned to the world of white coats, SOAP notes, and Jesse’s iatrogenesis. For Kevin, this has meant a fantastic voyage of babies and bad smells, while on Surgery, I’ve realized I was never truly tired at any point in my life until now. To illustrate, here’s a quick running diary of a recent call night.
0400: Mmmm, a fresh new day! Only 30-plus hours until next we meet, bed. I’ll think of you fondly while I’m gone.
0505: Pre-rounds and dressing changes. Note to self: Try not to do heroin.
1015: OR, first case. I don’t even know what you’re asking, but I’m going to go with “atelectasis.” Please don’t take my suture scissors away; they’re all I have…
1400: Second case. Pros: I’m actually touching a beating heart. Cons: I can’t feel my legs.
1600: Back on the floor. Are those my bowel sounds or the patient’s? Will he see if I eat some of his pudding?
1830: ED: Hmm, so that’s the most common orifice to hide drugs and drug-related paraphernalia...
1945: I didn’t realize so many people are allergic to "everything but 'Dah-lowd-ee.'” Must be an epidemic.
2100: If I crawled into the scanner and acted somnolent, would the nap be worth the repercussions while they imaged my head? Tough call.
This is the dream…
0020: If only I had some No Doze…
0200: Boo-yah, there’s my second wind. This isn’t so bad. That stapler wasn’t an awful pillow and that guy waiting in the hall stopped giving me the stink-eye.
0600: Rounds II: Son of Rounds. I don’t even remember life on the outside. This must’ve been what Brooks felt like in Shawshank Redemption. I hope the sun is as bright as it is in my dreams. I hope…
It’s OK, Brooks. I understand.
0945: Clinic. Can you turn your head and cough, please?
1215: Off. If I don’t make it home alive, at least I touched a heart.
Friday, February 22, 2008
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