<p>I’m trying to decide if I want to be a doctor or not and I was wondering if doctors typically deal with the same common things everyday ie. fever, flu, cold, broken arm, ect. or if they get other things. Would those before mentioned things go to the primary care doctor or the hospital? If you worked at the hospital would you see the same thing over and over, or do you get many patients with different illnesses.</p>
<p>Hospital cases tend to be more complex and interesting. There’s a reason the patient needed to be admitted to the hospital for further workup. Otherwise, if the case was straightforward, they would’ve been sent home straight from the ED.</p>
<p>Primary care, you tend to see the same things over and over again (flu, sinusitis, high blood pressure, high cholesterol, etc.). I’m a bit biased since I’m not going into primary care but I see primary care as more of a routine 9-5 job.</p>
<p>There are lots of different areas within the hospital. Not all doctors see all the same things, but each doctor does tend to see the same thing day after day. A cardiologist is going to see lots of chest pain and high blood pressure/cholesterol/body mass. He’ll prescribe lots of statins and tell all his patients to exercise and diet (which they usually won’t). Sometimes, if he’s lucky, he’ll get an irregular heartbeat, which is usually corrected with a medication which may or may not work. If it doesn’t work, you try another one until you find one that works. (Of course, patients might not take them anyway.)</p>
<p>A nephrologist is going to see lots of diabetic-related kidney disease. A pediatric pulmonologist is going to see lots of asthma. An ER doc is going to see lots of fevers, drunks, and lacerations (and sometimes feverish-drunk-lacerations). A trauma surgeon is going to see lots of really exciting things, but eventually they’ll mostly be the same gunfights, knifefights, and car crashes.</p>
<p>Medicine is also trending towards “evidence-based” guidelines and following clearer, more concrete steps rather than intuition and autonomy. Gawande and Pronovost are going to win. This is very very good for patients and the country as a whole and it ought to happen. It will make being a doctor less fun.</p>
<p>Medicine can still be fun despite the monotony. For one thing, if you enjoy the physiology in question, it can still be interesting even after you’ve seen 100,000 of them. Second, there are slight variations and complications from patient-to-patient. Third, guidelines do evolve. There will be new medications, devices, and even new diagnoses.</p>
<p>The other way that it can be fun is if you are a very social person and you really enjoy dealing with the people involved. I’ve met some waiters and waitresses who genuinely enjoy the work–even though the house specials must get tiresome over time. And being a waiter is one of very few fields that has more time pressure and multitasking than medicine. But they love meeting customers, joking with the kitchen, and teaching folks about the menu. If being a waiter – but with more science, higher eventual income, and not having to depend on tips – sounds fun, then medicine will probably stay fun even after you’ve dealt with the same thing day-after-day.</p>
<p>^^ LOL BDM! D1 interviewed with a surgeon at the med school she’ll be starting at this summer. He asked what she did for a living now–she told him she waitressed at a high end restaurant. They ended up having a rather long discussion about how waiting tables and being a surgeon have a lot commonalities. (Including long irregular hours, standing for hours at at time, customers/patients who are rude and noncompliant, getting stiffed by customers/patients, juggling multiple patients/customers at the same time…)</p>
<p>The old saying in medicine is “when you hear hoofbeats, think horses, not zebras”. The point is that common things are common.</p>
<p>One of my med school professors made the frequent point that every field has it’s 5 things that physicians in that field will see over and over and over and over and over and over and over and over. The trick to being happy was to find the field with the 5 things that you don’t mind seeing repeatedly. </p>
<p>Certainly, some fields have very repetitious. But I’d challenge you to find the variety in fields that go beyond different cases. As a pediatrician, much of my variety on a day to day basis comes from my patients being very different ages. I get to approach the same problem a multitude of ways depending on whether the patient is 6 weeks, 2 years, 6 years, 12 or 18 years old. In Radiology, you may look at 100 chest x-rays (yawn) but there may 100 different types of pathologies or diagnoses to be made. </p>
<p>One of the other things you can do, is to remain a generalist - yes you’ll have far more “run of the mill” stuff, but you’ll also have all the other patients who do have something out of the ordinary - they may need a specialist to completely manage the disease, but you as the primary doctor will still be involved in their care.</p>
<p>Beyond that, I definitely agree with BDM and the similarities between waiting tables and being a physician - when I’m doing a shift in the ER I often feel exactly like I used to do when I waited tables, mentally running checklists on where my patients/tables are at in their visit, juggling a bunch of different tasks, prioritizing my time, and dealing with the inevitable interruptions that arise in a 8 or 12 shift…</p>
<p>I have been practicing neurology for 30+ years. On Friday I looked ahead to see what I will be seeing tomorrow. I have 8 NEW referrals scheduled. There are 3 ‘headaches’, one ‘tremor’(in a youngish fellow, they are concerned it is parkinsons but it will turn out to be essential tremor or an enhanced physiological tremor), one ‘ptosis’(they are concerned about myasthenia gravis. One young female(20’s) with an isolated optic neuritis(but her MRI showed multiple other lesons, so it the beginning of multiple sclerosis) and a couple of ‘tinglings’(large differentials- TIA’s, complicated migraine, fibromyalgia/psychoneurotic etc). A mix of the daily mundane with some that have a little more interest(at least to me). I also had a case last week that the number of cases in the world can be counted on one hand. I once impressed a medical resident when I diagnosed a new case of ALS(Lou Gehrigs disease) while the patient was walking down the hall toward the exam room(not many things give your nasal-pharyngeal speech and a foot drop), but it takes many years of repetitive practice to be able to do instant ‘pattern recognition’ diagnosis(which is a hallmark of clinical neurology). Yes, there are days that are real bad, if you have to see 6 middle-aged females with migraine, depression and fibromyalgia in a row, it can be a wearisome day. But those days are uncommon as well.</p>
<p>^^ I’m currently in a medical neurology course, and we’ve learned about everything you talked about! haha that got me a little excited.</p>
<p>I think medicine is inherently monotonous. The goal is to be good and efficient and effective and that takes a lot of time and repetition. Seeing “fascinomas” all day long would actually leave you way behind in your schedule, irritating your patients and your partners. House is a fun TV show, but it’s not the way medicine is practiced anywhere that I know. Repetition and expected outcomes are our friends. Every type of medical practice has it’s own common themes both good and bad.</p>
<p>The neurologist posting above mentioned pattern recognition and for a lot of physicians we do so much of that. The pediatricians know a sick (“sick” means something different to a doctor than it does to a lay person. When most people say they feel sick they typically mean they don’t feel normal – like with a head cold. Sick to a doctor means serious business) kid the minute they walk in the room just because they look and act a little bit differently than the average fussy kid. It takes a lot of hard won experience to be really good at seeing the patient and not just hearing them and then to trust that judgement.</p>
<p>I’ve been an emergency physician in a large urban level 1 trauma center for 20 years now. And there have been a lot of drunks, lacerations and fevers to be honest! But everyday I meet some great people, see a couple really cute little kids and get to take care of some insanely sick people – all of which I love immensely. In addition, I love it when things surprise me. With every patient I make an educated guess. Sometimes that’s enough for me and sometimes I want to back it up with a confirmatory test. The neurologist often knows that a patient they’re seeing for the first time has MS, but that doesn’t mean they don’t get an MRI. It’s the same with a lot of issues, but you don’t always find what you were expecting and it’s that humbling moment that keeps me reading and working to get better. It remains a pretty interesting job for me.</p>