Family Medicine to Emergency Medicine

So I’m due to start a family medicine residency in August – but I’m currently working in the emergency department and I LOVE this job. The hours are awful, other specialties can give me shit when referring patients, and patients often want more than what I can offer them, but I love the pace of the job and the work I do.

I’ve abandoned the thought of training in a surgical specialty because it requires a minimum of 5 more years of training (and most train for 7 years before becoming attendings). And speaking to my senior colleagues makes me realize that training is not as simple as keeping a surgical logbook and attaining specific surgical skills at different levels of training. In this country, it’s all about your tick-boxes: audits, audits, and more audits; research and publications, but not just in any journal – it must be a peer-reviewed journal; teaching, with “evidence” that you’ve taught; conference presentations and poster presentations. And you’re strewn all over the country at times. And they have almost the same requirements to get into the surgical training post as well – those who meet the tick-box requirements get in. There are no reference letters highlighting whether you’ve got the surgical skills to make it in the job. You don’t get “points” for being able to be a proficient first-assist in a laparotomy. The structure of the system is flawed.

I am now at the point where I’ll be entering general practice, and this also comes with its own set of requirements during training, one of which I’m particularly not looking forward to – reflections. Every week, a requirement is to two at least two reflections either about a patients encounter or on something you’ve learned from. Personally, I’m not one to reflect – in a blog, yes. But in a portfolio – no. Especially since I know it will be read and assessed by my supervisor. In that sense, I feel my reflections will be very superficial and I won’t be as honest as I truly feel. But, whatevs.

My other thought is what if I abandon general practice and try to jump into emergency medicine training. I’d be more satisfied with my job. But training would again be another ¬†years. The option I’m set on now is to endure the three years of general practice and then get a fellowship in emergency medicine and remain there. The options are endless. My career path is not a fluid one. The only path that’s certain for me with work is my return to Canada. My aim: return in a maximum of 3 years, if not earlier.

House of God

The “House of God” was written by Samuel Shem. It was about a doctor, freshly graduated from medical school, and starting his internal medicine residency. I had to re-start reading the book about three times, because each time I’d get about half-way through and then something would come up. When I’d try to pick up from where I left off, I’d be so lost that I just thought it better to start at the beginning. I wasn’t a big fan of the work. I mean, the story was interesting to read as a medical student, but the writing style was ugh for me to follow. And I thought the protagonist was far too pessimistic and cynical.

When I started my fourth year internal medicine elective in the general internal department, I felt like I was at the BMS Hospital myself. Gomers and gomeres abound. One gomere yelling, “Ma’am! Ma’am! Ma’am!” over and over again somewhere down the hall. Another patient urinating in his bed pan in the hall. The smell of C. diff diarrhea floating abound. I lost count of how many palliative patients there were on the ward. Many were frequent fliers. I don’t think I saw a single patient under the age of 40 during my stay there.

Maybe it was the book, but my view of internal medicine has forever been tainted. And having shifts in the ER was the worst. Awesome trauma cases would roll in. All the doctors would jump to their feet to see what had come in. As a student, I was excited, watching all the action. I even got to perform CPR on a patient one time. But that was about as exiting as it got. Because these cases would be handled by the surgical side of ER. As an internist, I got stuck with the headaches, the pneumonias, the diarrheas, and the drunks. And there was no treatment. There was partial diagnosis. There was the BUFF and TURF, as Shem would put it. Every single patient, every single ER shift. The resident I worked with prided herself with clearing all the beds – either through discharge, or by shipping the patient off to another department.

When I started medical school, I always considered internal medicine as one of my top choices in case I went the medicine versus the surgical route. During the third year rotation, I hated internal medicine. But I hated it because of the way the course had been structured, and not necessarily because of the patients and practice. In fourth year, however, internal medicine has completely fallen off my choices for residency. Maybe it was Shem that did me in? Maybe my experience? Maybe a bit of both? Who knows. But what I do know is that I can’t go down that route. It’s just not for me unfortunately. But I do realize what an important field of medicine it is – if I do go into general surgery, there are many things that I’ve learned in rotations like Gastroenterology and Hepatology that come in very useful. In fact, if I go down the UK-route, I do hope to rotate through an Internal Medicine elective at some point in my Foundation year. I just can’t do it for the rest of my life.