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Feb. 10, 2011

What Kind of Doctor Do You Want to Be? Part II

by Dana Greenfield

I just got a text from a UCSF friend: “Anesthesia or Urology?? I can’t decide!!

Five months into my Ph.D. and my simultaneous departure from medical school, I gathered with some medical school classmates for the first time in a while. I wondered: Will they seem older? Wiser? More competent?

As I start another career, I forget how far my former classmates have come. They are almost done with their third year, the most trying part of a medical school education. A time when learning and time both proceed at a grueling pace. The third year also may be the most formative part of our education—even more so than the much-written-about rite-of-passage, the anatomy lab. During third-year clinical clerkships, students break in their white coats, and get dirty (literally and figuratively) in the medical trenches. The clerks participate in the care of patients, observe the beginning and end of life, and try to figure out where they want to fit into the complicated world of health care.

Some friends have wanted to be orthopedic surgeons or pediatricians since kindergarten. But most are still trying to figure out what they want and how best to balance their private lives with their interests, balance acute intervention with palliative care, and balance shift work with call schedules. I’m in the latter group –- ambivalent and indecisive. Rotating through various specialties and medical settings is the best way to find a professional home. I may be benched for now, but the long road ahead to my Ph.D. affords me the luxury of time to dwell on my options. Let me share.

Unlike most medical students, growing up I had a close-up view of the life of surgery, as well as pediatrics. Throughout my childhood, I attended the bustling clinics at the colorful children’s hospital in which my parents both worked. Residents and students who my parents taught and mentored came over for dinner. Clinical research came alive when my parents brought us to conferences or practiced their slide sets for talks. (This was before the age of PowerPoint, so the blue light square on the library wall always seemed so mysterious to me!) I saw the practice of medicine as teamwork, because I met other doctors, nurses, OR techs, and office staff. Their days were busy, varied, and challenging.

But my parents' highly specialized worlds of pediatric urology and ENT (ear, nose, and throat) were all I knew. I didn’t know any doctors who didn’t teach, research, write, operate, and attend to emergencies in the middle of the night. My view was skewed to a hands-on, specialized medical arena that included research.

Enchanted by the elegant and complex hormone pathways, I originally considered pediatric endocrinology. But in medical school, I learned that the field was more interesting to me in theory than in practice

Excited by my first year preceptorship in emergency medicine, I wanted to work with my hands, solving problems directly with patients who were acutely ill. Getting thrown into the ER with just a few weeks of medical school under my belt, I didn’t understand most of what went on. Many of my hours in the emergency room were a blur, but there are a few moments that stand out. The first time I performed CPR on a young woman my own age who had overdosed on drugs. The first time I witnessed a man --a professor of medicine, actually--with low oxygen due to pneumonia. The many times we set broken and dislocated bones. The first patient I ever examined who had a neurological disease. And the first time I participated in a ‘code’ on a collapsed marathon runner.

It only takes a few minutes in an ER for classroom knowledge to be transformed from theory to something applicable to real people and real problems. Aside from hazy recollections of excitement and chaos, I also took away from my time in the ER the tool of medical decision-making. My mentor hammered into me his 10-point list of “things that can kill you” that he recited to himself every morning. He runs through that list when patients arrive unconscious or in major distress. Even years into practice, he drills himself with this list, lest he forget something or lose a life.

I loved the variety of problems that walked through the ER doors—from a gunshot wound to the initial diagnosis of diabetes in a child. Emergency medicine is a mixed bag, where you attend to minor as well as life-threatening conditions. And the interventions are just as diverse -- from sewing up a deep cut to diagnosing a complex disease process. What’s more, my rotation in trauma surgery last summer confirmed my attraction to hands-on work, especially for acute and critical situations.

However, I also have to confront the realities of my chosen M.D./Ph.D. career path. After an extended medical school career, do I want to add a five- to seven-year residency training period? Can I maintain surgical competency while also pursuing anthropology? Will a life in social science work better with the flexibility of shift-work (as I would have in emergency medicine or anesthesia) or with a more rigid OR/clinic/on-call schedule? What specialty will mesh best with my social research interests? Does it matter or will I just make it work?

So that’s the current state of affairs. These questions don’t necessarily vex me right now. Social theory and writing papers occupy my mind most of the time these days. But I have my most formative years of training ahead of me, where the real work of deciding will begin. For now, I’m trying to find my place in anthropology, a much less structured and regimented field of possibilities.

About Dana Greenfield

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