The Cards On The Table

Ugghh.

I'm at a loss.

I don't know where to go from here.

I realize now that, yes, life after the board exams doesn't get any easier -- more complex choices, more personal life-altering decisions, more difficult situations -- that's not including the lives we hold in our hands as medical doctors.

As much as I've admitted never really thinking about doing this for a living until I was soaked in the proverbial sea of my PGI-ship, I didn't also realize that it would be this difficult deciding what actually to specialize in.

Let's put all the cards on the table and let's see what we get (all of these are my opinions and formed (mis)conceptions, but insight is appreciated, haha).

SURGERY: Ah, the glamour specialty. Everybody knows the surgeons. They get the glitz of the profession from having your hands inside a man's insides to doing life-saving emergency procedures. I've had the fortune of being in the presence of good surgeons and great surgeons (haha, playing it safe).

I know that: I love of surgery (or at least part of it). Orthopedics comes easy to me being a physical therapist. Neurosurgery has always been a dream job for me and I love the challenge and rare skill set to be in the same boats as my neurosurgeon role models. I love the diagnostic part of General Surgery and actually doing something about the problem. Plus the scrubs, the sutures, the excitement of trauma, it makes one look so cool.

The thing about it is that: Though I think I'd do good in Orthopedics, it's just that I'm not really feeling it (as if that makes it clearer), not to mention too many orthopods in Dumaguete (that is if I end up practicing there) and Ver plans to become one as well. For neurosurgery, well there are no vacancies. I haven't really ruled out training in Manila, but I'd rather be nearer to home. I hate diabetes insipidus and my aversion to long OR's has long been established. As for GS, I don't fancy working on colon evacuation and colostomies and despise not being able to scratch my nose when it itches and wipe my brow when I sweat.

INTERNAL MEDICINE: The thinking specialty, as claimed. These are filled with the brainy doctors who, as the popular medical joke says, "know everything but do nothing." They find out what's wrong with you, tackle the diagnostic probabilities and give you the treatment you need.

I know that: I grew to love IM. It's probably because I've had my eye on surgery for so long that I never considered it, but after internship, I discovered a whole new aspect of IM that called to me. I've also had the fortune to have had the experience of working with great clinicians and diagnosticians over my few medical years. I love the thinking aspect, the constant diagnostic challenge, and the fact they often are at the frontline in ER's. I love mixing up insulin regimens, the coolness factor of nailing the reading of the ECG and of course, getting your diagnosis right.

The thing about it is that: Well, I've always appreciated what I could see. It's different just judging how much your good your doing by seeing a patient's O2 saturation pick up or an improvement in blood pressure than actually say, fixing a fracture or removing a mass. I can't see a hormone's actions on its receptors nor antibiotics donning armor and battling microbes. Sometimes, I wonder if that adage I mentioned is true -- it tends to be passive at times, just waiting for the medications to take effect (thank you for interventional subspecialties!)

Those are the two I've narrowed my choices down to.

The rest of the field:

1) Radiology: I don't know if I could take looking at X-rays all day, MRI's, CT's. It's just not my thing. I think I'd get even more obese thinking about it. (Dream sequence: X-ray. Eat. CT. Eat. MRI. Eat)

2) Pediatrics: I love kids. But I've never really quite gotten the hang of drugs and dosages for pedia, computing the fluids for every patient, immunizations and computing for the nutrition requirements for preterms. I can handle the kids but I don't have the required temperament and patience to deal with overbearing parents. Pediatricians are given that gift. I guess I missed out on it.

3) Family Medicine: I can't handle the genograms, family case studies, among other things. I have all the respect for family medicine specialists who manage their patients, but I guess I have been disillusioned by so many others who just refer to a specialist when the going gets tough (I think, they're required by law and ethics to do that, but it shouldn't ever reach that point, in my humble opinion).

4) Anesthesia: Hi Doc Ness, haha. I think it's a rare breed to be in anesthesia, as well. It's scary breathing for the patient like that. Just a slight overdose of pento and wham, I'd be out of a job. I'm more of out-in-the-wards kind of guy than an OR person, (except of course neurosurgery haha).

5) Obstetrics and Gynecology: Haha, I've drawn a lot of flak and praise by getting Best in OB-Gyne during my PGI-ship. I got it because I did well during exams, answered right during rounds, did my patient rounds almost 3x a day, and well, generally did my job well. Let's just face it, I'm not cut out for OB-Gyne. I shy away from primiparas and delivered the grand multi's so I won't have to do episiotomies, not to mention all the stress, anxiety and panic I get just mounting a fully dilated patient.(I'd die young). See previous post on this subject.

6) ER Medicine: I love the ER, but I've appreciated the art of following up patients in the ward too much to give it up.

7) Sports Medicine: I love sports. Aside from the fact that there isn't anything like this in our country (I think), there are too few leagues to matter. If I went abroad and did this for a living, I'd really question my dedication because there really is just one franchise I'd consider, haha, see previous post on this subject.

Again, I'd like to reiterate that I mean no disrespect to those who have come before me and have chosen to blossom in the fields where they have chosen to be planted. If you can enlighten me and the rest of the young doctors like me who are just as confused, we'd appreciate it.

I'm lost.

I'm sending out applications this week.

To where, I guess I'll just wing it.

If anybody out there knows where I should be, preferably with an address, a name to send the letter to and the requirements, suggestions are appreciated.