Tuesday, July 1, 2008

Medicine vs Peds

The main reason people will give you for choosing medicine over peds is, "I can't stand dealing with the obnoxious parents."

Here's the thing I don't get: when you go into medicine, the parents are your obnoxious patients.

Medicine was, in fact, more fun than I thought it would be. However, I discovered a not-so-pleasing fact about myself, which is that I don't enjoy taking care of people as much when what I am doing is trying to re-arrange the deck chairs on the Titanic. AND, the reason the Titanic is sinking is that the captain repeatedly and intentionally rammed it into every iceberg in sight, despite being told each time that if he did that again he was gonna sink the sucker.

It felt like 90% of our patients were in the hospital secondary to one of three reasons (and often a combination of all three):
1. Years of drug abuse (tobacco, alcohol, heroin, crack--I also include the HIV or hepatitis they contracted because they were using dirty needles).
2. Years of eating everything within reach (and never getting off the couch).
3. Years of either not going to the doctor or flatly ignoring everything doctors have told them.

Actually, now that I think about it, I think that you could combine 1 and 2 given that for many people food seems to be an addiction akin to any other drug.

In any case, I find it hard to enjoy taking care of these patients. It isn't that I don't feel empathy and pity for them. I do. I took care of a lot of people right at the moment that it occurs to them that they have thrown away their entire lives. That is not a happy moment. I suppose it's good that I can be there for them, but what am I supposed to say? You're right, you have thrown away your life, and now you're dying, and there's nothing we can really do about it. But buck up! It's sunny outside!

The thing is, I'm sure that they have horrible, sad life stories. I've heard a lot of them. My problem isn't that I can't find any compassion in myself. My problem is that I have what my dad calls "a strong bias towards action". I don't like to deal with problems that have no solution. I'm not proud of that, but I can't pretend that it isn't true. When I find a problem, my natural instinct--no, my need--is to solve it.

And, for most of these people, that can't be done. The best you can hope for is maybe postponing their eminent death for a short while, or making it more comfortable. Which, actually, I feel is a very honorable mission. It's just not my mission.

To survive in medicine, you have to have a mission. You have to have something that makes you excited and fulfilled. Because Lord knows you don't get money, or leisure time. You don't often get kudos either. When you do, it definitely feels great--but if you rely on those, that's a one-way ticket to Burnout Town.

Anyway, I like Peds because the proportions are reversed. 90% of the patients did nothing do themselves to get sick or hurt. 90% of them will get better and lead normal lives. They have problems which you can diagnose, treat, and solve. Yes, parents can be annoying. But as I said, I'd rather have them as parents than as my patients.


Old MD Girl said...

Another way to look at it: In medicine you have to take care of the obnoxious parents AND mediate the situation their grown up, freaked out, litigious, now also obnoxious children.

I actually didn't find the parents in Peds all that bad. But then I also find that I enjoy calming hysterical people. And the crazy ones merely provide ample fodder for feeling morally superior.

mpbo said...

Dude... totally. I hadn't thought of that one but it is true.

I only ran into one bad mom, and she wasn't all that bad.