A high school student has questions about a medical career and pathology vs surgery

A female high school student asks about pathology, surgery, and medicine in general. [Email edited for length.] See if you agree with my answers.

The field I am most interested in is pathology. I have a very logical mind and would enjoy being able to solve the complex puzzle of disease. I would also like the somewhat flexible hours compared to other more intensive specialties. However, I do have some qualms.

Im also interested in general surgery. I would love to learn how to perform all the different types of surgeries that surgeons perform. If I were to be a pathologist, would it be "knife-free"? Pathology really intrigues me, but participating in the occasional surgery sounds like it would be extremely interesting and full of learning opportunities.

There is some knife wielding in pathology. Specimens must be properly cut, and there is the occasional autopsy. However, its definitely not surgery.

What does a pathologist really do? Ive looked at various descriptions online, and none of them seem to be very specific. What would a typical day look like for a pathology resident? I was also wondering what types of skills pathologists are taught?

Pathologists spend most of their days looking at specimens, mostly microscopic slides. Here is what pathology residents at Johns Hopkins learn.

I know that medicine is constantly evolving. With new medical technology, certain fields will soon become obsolete. Do you think this will happen to pathology?

I suppose there will be some technical advances that might involve automated digital reading of pathology slides, but I believe there always will be a need for pathologists. A residency position in pathology is much easier to obtain than one in general surgery.

Since Im interested in both pathology and general surgery, I was wondering if there was a way I could do them both (in a combined program or something like that). I know this is highly unlikely.

It cant be done.

I am a very anxious person. Specifically, I have health anxiety. (Im all too aware of the irony). Do you think that the amount and intensity of the material covered during med school and residency could take a severe toll on a persons mental health?

I think every medical student at some point worries she might have a disease she just read about. Im not sure what to tell you because I am not a psychiatrist, but studying diseases for four years and having a health anxiety might be a problem.

I would also like to know whether being involved in medicine could dramatically alter a persons personality by magnifying their negative characteristics. I am very driven, hard-working, ambitious, logical, easily annoyed/frustrated, and sometimes easily distracted. Im quite anal-retentive and OCD. Some of my friends and family have described me as an emotional robot. How do you think these characteristics would be affected by a journey through medicine?

Many medical students and residents become less empathetic and more jaded as they go through medical school and residency. Except for being easily distracted, many of your traits are common in med students. Heres more about empathy and medical students.

Do you know how difficult it is for Canadian students to get into American med schools? Or do you know any medical schools abroad in English speaking countries (e.g. Scotland, England) that would be willing to admit international students? Also, would it be more difficult for a woman?

Its not easy. Here is a link to a website that has some data on Canadian applicants to US schools. I dont know much about UK schools. Ive written about Caribbean schools. Type "Caribbean" in the search field of my blog. Being a woman wont matter.

How would medicine affect interpersonal relationships? Im really close with my immediate family, and it would be difficult not being able to see them all the time, let alone during holidays or breaks. How can a person manage a serious relationship and medicine at the same time?

It can be done, but it takes some effort. I have written a few posts about so-called work-life balance.

Choosing a specialty is difficult
More about choosing a specialty
Anguish about choosing a specialty
Surgery and work/home conflict

I hope this helps. Good luck.

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Board passage rates and residency program quality

On my "Ask Skeptical Scalpel" blog, a medical student wonders if a programs board passage rate is a good measure of whether its graduates can practice independently.

You can read that post here.

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Pain is not the 5th vital sign

No, contrary to what you may  have heard, pain is not the 5th vital sign. Its not a sign at all.

Vital signs are the following: heart rate; blood pressure; respiratory rate; temperature.

What do those four signs have in common?

They can be measured.

A sign is defined as something that can be measured. On the other hand, pain is subjective. It can be felt by a patient. Despite efforts to quantify it with numbers and scales using smiley and frown faces, it is highly subjective. Pain is a symptom. Pain is not a vital sign, nor is it a disease.

How did pain come to be known as the 5th vital sign?

The concept originated in the VA hospital system in the late 1990s and became a Joint Commission standard in 2001 because pain was allegedly being undertreated. Hospitals were forced to emphasize the assessment of pain for all patients on every shift with the (mistaken) idea that all pain must be closely monitored and treated .

This is based on the (mistaken) idea that pain medication is capable of rendering patients completely pain free. This has now become an expectation of many patients who are incredulous and disappointed when that expectation is not met.

Talk about unintended consequences. The emphasis on pain, pain, pain has resulted in the following.

Diseases have been discovered that have no signs with pain as the only symptom.

Pain management clinics have sprung up all over the place.

People are dying. In 2010, 16,665 people died from opioid-related overdoses, a four-fold increase from 1999 when only 4,030 such deaths occurred. And the number of opioid prescriptions written has doubled from 109 million in 1998 to 219 million in 2011.

Meanwhile in the 10 years from 2000 to 2010, the population of the US increased by less than 10% from 281 million to 308 million.

Doctors are caught in the middle. If we dont alleviate pain, we are criticized. If we believe what patients tell us—that they are having uncontrolled severe pain—and we prescribe opioids, we can be sanctioned by a state medical board or even arrested and tried.

Some states now have websites where a doctor can search to see if a patient has been "doctor shopping." I once saw a patient with abdominal pain in an emergency room. After looking up her history on the prescription drug website, I noted that she had received 240 Vicodin tablets from various doctors in the four weeks preceding her visit.

Thats a lot of Vicodin, not to mention a toxic amount of acetaminophen if she had taken them all herself during that month.

What is the solution to this problem?

I dont know, but as long as pain is touted as the fifth vital sign, I do not see it getting any better.

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What about a rural track surgical residency program

Heres an email from someone interested in rural surgery:

I am a senior medical student planning on going in to general surgery and practicing in a moderate sized city (~70k people), but would also like to do some medical missions. I currently do not plan on doing a fellowship after residency, and would like to go directly into practice. I have seen a growing trend of "rural programs” popping up including Mayo starting a rural track this year, Wisconsin has one rural spot, and Gundersen is another notable program. For many of these programs you leave your primary training hospital during PGY3-4 and go train rural hospital, you may also spend more time doing OB/GYN cases or other surgical specialties. How do you think this affects the preparedness of the residents leaving these programs vs a community program with a high case load or university program? Most of these programs advertise all the “extra” skills acquired from participating in their rural tracks but don’t discuss what that means you will miss.

Great question. I have no personal experience with rural track surgical programs. From what I have read, most residents who go this route emerge satisfied.

I think you need to speak to a few residents who have done it and see if they feel they missed anything. It probably wouldnt be too hard to get some names from coordinators in programs that have the rural option.

My concern for your situation is that if you plan to practice in a city of about 70,000, it is highly unlikely that you will be doing C-sections, orthopedics, or G.I. endoscopy. This would negate much of the value of doing a rural track. I have a few former residents who practice in small towns and do C-sections and endoscopies, but those locations have fewer than 10,000 people. My program provided a decent endoscopy experience, but since we had an OB/GYN residency, I think my graduates learned to do C-sections after they left the program.

Since you are planning to practice in a community hospital, you may want to consider training in a busy community hospital residency program. The way things are going in general surgery, case volume is becoming more and more important. As a general surgeon in a city of 70,000, you will probably not be doing big cases such as Whipples and major vascular surgery anyway.

Can any of my readers offer you more advice?

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