At the beginning of your medical career you need to choose a specialty. I would suggest using a checklist, like the ones that Atul Gawande wrote about that we now use in surgery. I would suggest something more elaborate than seeking (1) fame and (2) fortune, although reputation and reasonable prosperity are important. The checklist that I would suggest is (1) values, (2) practical matters, (3) satisfying work, (4) experience with the specialty, and (5) group influences. The first three correspond roughly to Freud’s super ego, ego, and id, and to Aristotle’s ethos, logos, and pathos (values, logic, and emotions). I will describe how this checklist applied to my own decision, since it will be helpful for you who are starting out to have an example. I don’t expect any of you to follow in my footsteps. You must find the path that is right for you.
I am a retired orthopaedic surgeon. I can’t imagine that I could have been as happy doing anything else. First, in terms of values, I really cared about helping people with injuries or disease return to walking, or using their hands, or having a sound spine. Second, in terms of practical matters, my skills include a sense of mechanics and an ability to think in three dimensions. My medical school roommate recognized before I did that orthopaedics was the obvious choice for me.
Practical matters also include hours of work and call. It’s not that I never grumbled about the nights I spent up with emergencies, but I accepted it, and I came to be proud of my stewardship of the health of the community that I served. Other practical matters for you to consider include pay, the communities where you might work, and the preferences of your significant other, or if you are unattached, the possibilities of a social life.
Third, satisfying work includes the gratification that I felt when fracture treatment turned out well. Was every day satisfying? No, of course not. Sometimes weeks went past that were routine, with occasional dreadful moments. That’s life. But you need to find some moments that are satisfying in your chosen specialty, and you must be able to accept the dreadful moments. I had also considered neurosurgery. What I found dreadful in neurosurgery were the comatose patients. When more than half the patients on rounds could not interact with me, I became too depressed.
Fourth is experience with the specialty. I knew people who had had orthopaedic injuries as teen-agers. A wonderful orthopaedic surgeon had treated them. They decided that they wanted to go to medical school and become an orthopaedic surgeon like the one who had treated them. My early experience with orthopaedic surgeons was very different. As a teenager I met the orthopaedic surgeon in my small hometown. He was big, loud, and crude. I was much more impressed by one of our general surgeons. During my medical school orthopaedic rotation I saw residents indifferent to the pain that they caused their patients. I wanted to be a general surgeon, not a brute like those residents. A year and a half out of medical school I had a three-month rotation in a county hospital (Santa Clara Valley Medical Center) on the orthopaedics service. For the first time I was doing the care myself, and it was clearly what I was meant to do. Moreover, the orthopaedic surgeons that I was working with were not brutes, and I saw much to admire in them.
Fifth is group pressures. I am sufficiently independent so that this was a minor consideration for me. My group in medical school described orthopaedic surgeons as a bunch of jocks. I was not a jock, and I never fit into the crowd of jocks in my college. But then the orthopaedic surgeons I worked with at Santa Clara Valley Medical Center accepted me. I fit into this new crowd, and I found that I did not lose my old crowd from medical school. At least for me, out of the five items on the check list, group pressures are the least important, but they are something to consider.
Was orthopaedics the only specialty I could have chosen? While it may have been the best, I think that I could have been successful and very happy in other areas. The same will be true for you who read this. It is an unfortunate that life is too short to master everything, so that we must make choices. It is fortunate that several choices could be good ones for each of us. I made choices, and then found that I hadn’t excluded other alternatives as much as I had thought. Perhaps because of my aborted interest in neurosurgery, I subspecialized in the spine, the area where orthopaedics and neurosurgery overlap. Even before that, my choice had been between mechanical engineering and medicine. Orthopaedics took me back to the engineering interest, so that the publication in my personal bibliography that later got the greatest number of citations was one where I collaborated with biomechanical engineers.
Within each specialty one can function in patient care, in research, in teaching, or in administration. That is another choice to be made. The same checklist can be applied to those choices. Perhaps one of my classmates who made different choices from mine will post about her or his experience.
So that is my story. I recognized that values, practical matters, and satisfactions were all positives for my choice of orthopaedic surgery. I struggled with my earliest experiences with orthopaedic surgeons and, to a lesser extent with the group pressures that I felt. Hopefully this check list will help each of you as you make your own choices. Good luck!
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