I realized pretty quickly that what I want to do with my life is outpatient medicine. I like longitudinal care. I like getting to know people and being involved with their care. I like seeing them while they're doing well. I like helping to keep people healthy.
I don't really like procedures much. I don't enjoy acute care. I absolutely hate codes and unstable situations. I don't like doing treatment that I know is most likely futile.
So, I've come to the realization that ICU medicine is the antithesis of what I want to do with my life. It's everything I don't want to do and everything I don't want to be. I might as well be a surgeon. It's so unappetizing to me that I thought about making myself DNR.
Maybe it'll make me a better doctor, but this critical care stuff is beating me down, and I'll be glad when I'm back in the office. Or maybe it's just that when you're alone, it's tough to see the point of buying a couple extra days for someone on death's door.
4 comments:
On most days, I dislike outpatient care. It doesn't give me the instant gratification that a heart cath, EGD, starting pressors, or intubation that I need. Labs never get done, imaging doesn't get ordred, the laundry list of 20 problems that the patient wants you to address in a 20 minute visit.. it's endless. And the concept of longitudinal care or being someone's PCP often becomes an excuse for them to call you for narcotics refills. Give me a MICU or CCU to run any day.
well I think it all depends on whether your hospital's unit is there more for the benefit of patients, or more for the benefit of critical care fellows. in med school I was taught that units existed mostly for extra nursing care. if someone needed drips titrated, or neuro checks or labs q 30 minutes, or basically just needed a lot of extra work that couldn't be adequately provided in step-down, then they belonged in the unit. however, other hospitals, it seems like the only way to get into the unit is if you're pretty much almost dead--sedated, paralyzed, trach'ed and vented, with central lines in and pressors going, and on the verge of coding (or, more likely, post-code.) anything less and you go to general medicine, despite being in DIC and having an NSTEMI and having 20 other problems that could make the patient unstable if they sneezed wrong.
In a unit setup for actual patient care, I think there can be a lot of rewarding experiences. I think it is really heartening to be able to send a critically ill patient out to the floor. someone who, two weeks ago, was comatose and not breathing on their own, now able to get up, walk, and talk. that's some cool shit.
Like everything else in medicine, there are good units, and there are bad units.
Actually, exposure to critical care medicine is very very helpful for those who go into primary care. This is because it is not always so obvious who is critically ill. For instance, someone with septic shock on 3 pressors at one time started out with malaise and tachycardia. The art of medicine (with experience in an ICU under your belt) is recognizing "healthy-looking" patients who will, in 12 hours, be in the unit intubated in full-fledged ARDS.
THAT's why all docs - even the primary care docs - should rotate through an ICU.
To clarify, I don't like ICU, but I don't question the educational value. It's part of residency training for a reason. Most people are not comforted by an internist that balks at DKA. ICU is good for my education, but as far as the rest of my life? No.
Dr Jennings, while I can appreciate that you have a passion for your profession I'm sure, I think you'd agree that critical care as a profession is not suited for everyone.
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