What are the most intellectually stimulating specialties in medicine?

[sbrugby]

Sorry if this is the wrong area to post this in, do let me know if it is.

 

I was just wondering what people felt were the more intellectually demanding specialties in medicine?

 

And for what reasons? Like what about them (or say some examples) makes them intellectually challenging?

[Jamer]

Kind of opinion based.

[medisforme]

ever watched the tv show house? Diagnostic medicine seems to be pretty intellectually stimulating (i guess it would be a branch of internal medicine). Kind of like detective work. although i doubt real cases are as dramatic and thought provoking as the cases presented on that show.

[Jixe]

Intellectual eh? Academic medicine?

[Ian Wong]

ever watched the tv show house? Diagnostic medicine seems to be pretty intellectually stimulating (i guess it would be a branch of internal medicine). Kind of like detective work.

Unfortunately, there isn't a specialty known as diagnostic medicine. For overall intellectual breadth, I would put pathologists at the top. Unlike most other areas of medicine, they are sheltered from a lot of the other time constraints/non-intellectual scutwork faced by other physicians (managing an office, writing notes, rounding on patients, dictating discharge summaries and filling out forms/prescriptions, etc). Pathologists by definition have a huge knowledge base and function in the role of a doctor's doctor, helping other physicians to diagnose their patient's illness.

 

For the same reason, radiologists have a huge knowledge base. Medical imaging crosses the entire age range, and both genders. Radiologists also spend little time on non-intellectual scutwork, and the majority of their time is spent interpreting images and generating differentials based on that imaging which is appropriate for the patient's age, gender, lab data, and presenting symptoms.

 

As far as clinicians go, two subspecialties that routinely are known to be extremely rigorous in their knowledge base include nephrologists and critical care specialists. Infectious disease guys also get props routinely.

 

If you were trying to be politically correct, all specialties of medicine have lots of intellectual challenges out there if you seek them.

 

The person who mentioned academic medicine is onto something. The reality is that common things are common, and therefore, many/most complex cases will eventually find their way to the large academic institutions, as these are the centers with the resources to treat these work-intensive patients. These centers also tend to be the sites where most of the medical research is being generated.

 

Ian

[Rock*]

If diagnostic medicine did exist as a specialty like on House, it would have to be an 18 year residency: 5 years of surgery, 5 years of pathology, 5 years of radiology, and another 3 years of general internal med.

 

This must be why House's Princeton-Plainsboro hospital can afford to have such a posh work environment with those fancy sliding glass doors everywhere: 1) there aren't any lab techs or nurses to pay and 2) all the doctors are still residents getting paid a resident's salary :-).

[sbrugby]

Hey everyone, thanks for the helpful replies.

 

Just to clarify, when I said intellectually stimulating/demanding, I didn't mean not having to do any random physical labour or necessarily requiring the most knowledge.

 

In particular, I was wondering about which physicians are presented with the tougher/complex problems in their work, that say require more deeper thinking and creativity to help their patients.

 

I really enjoy trying to solve challenging problems, and would love to have a career where I don't always have to resort to standard solutions, and will often be put in spots where I have no idea what the heck to do, and will need to figure that out.

[Darla]

Rheumatology. The answer is always rheumatology.

[flying kumquat]

will often be put in spots where I have no idea what the heck to do, and will need to figure that out.

 

Family medicine? It's not all sniffles and diabetes, you know. Of course, chronic care management can be a large part of a family practice, but you're also the first line person a patient can see. As such, you often get the early, fairly unspecific presentation of whatever that person might have. You have to rule out what's common and what will kill them; as such, you need a wide knowledge base. Referrals are often a part of family medicine, but you have to do a workup to determine a) who the right specialist is for your patient, and why that specialist should see them based on X positive and negative findings.

 

I'm only a MS4 right now, and I know there are some family med residents and docs floating around the board, so maybe they can correct me if I'm wrong on this. However, this was my experience on my family med rotation. Although there were always people coming in for things that were obvious, there were definitely the undifferentiated head-scratchers too.

[Satsuma]

Geriatrics often sees complex problems. Many older pts have multiple medical conditions and are on so many drugs. So teasing out what the problem is NOW is tricky sometimes....you must consider how each condition affects the other and drug interactions etc. Also geriatric pts can often have atypical presentations for very common things. That being said there are many healthy elderly pts not on meds that come in for just plain bad luck! I saw an 80-something year old who broke his leg (maybe his hip I don`t remember) downhill skiing which he does every year. It was a total random accident due to a poor trail that they ended up having to close.

 

It is a subspecialty of internal medicine. There is at least one geriatrician who combined ICU and geriatrics....to stay on top of acute care skills.

 

Geriatricians are among the happiest of specialties. But it isn`t for everyone. And you should like dealing with pts with dementia etc. If you want to do alot of procedures it is maybe not for you either. There is alot of grey as well as psychococial aspects in geriatrics ...and I think that contributes to why students tend to not like it.

 

Once you start in medicine you may not actually feel that you want to be put in situations often where you don`t know what to do. I mean, it isn`t a very good situation for the patient!

 

Hey everyone, thanks for the helpful replies.

 

Just to clarify, when I said intellectually stimulating/demanding, I didn't mean not having to do any random physical labour or necessarily requiring the most knowledge.

 

In particular, I was wondering about which physicians are presented with the tougher/complex problems in their work, that say require more deeper thinking and creativity to help their patients.

 

I really enjoy trying to solve challenging problems, and would love to have a career where I don't always have to resort to standard solutions, and will often be put in spots where I have no idea what the heck to do, and will need to figure that out.

[ploughboy]

Family medicine? It's not all sniffles and diabetes, you know. Of course, chronic care management can be a large part of a family practice, but you're also the first line person a patient can see. As such, you often get the early, fairly unspecific presentation of whatever that person might have. You have to rule out what's common and what will kill them; as such, you need a wide knowledge base. Referrals are often a part of family medicine, but you have to do a workup to determine a) who the right specialist is for your patient, and why that specialist should see them based on X positive and negative findings.

 

I'm only a MS4 right now, and I know there are some family med residents and docs floating around the board, so maybe they can correct me if I'm wrong on this. However, this was my experience on my family med rotation. Although there were always people coming in for things that were obvious, there were definitely the undifferentiated head-scratchers too.

 

In some ways, the more specialized you get, the more homogenous your patient population and, in some respects, the less challenge. As the clerk in specialist clinics, I've spent whole mornings basically following the same routine for patient after patient. I've asked my preceptors about that, and they'll say that while every once in a while you'll get a real head-scratcher, pretty much every specialty has its bread-and-butter cases that you see over and over and over again.

 

If you want to be kept on your toes primary care specialities, where you never know what's going to walk in the door next, might be a consideration. I'd also agree with Ian about path and rads, and might add ID to the list (based on conversations with friends. I haven't done an ID rotation).

 

It also depends on what you consider "intellectually stimulating", I guess. Some people like looking at slides and listing off a 50-point differential based on the pink and purple smears. Others might enjoy the challenge of sitting down with sweet 87-year-old Mrs. Snickerdoodle and her dysfunctional family and convincing (read: manipulating) them that it's time for her to go to The Home. Still others find that nothing stimulates their brains like three or four ambulances rolling into their ER all at the same time.

 

 

PS: FK - If we both graduate in '09, how come you get to call yourself an M4 while I'm still just a lowly M3?

[ploughboy]

Geriatricians are among the happiest of specialties.

 

Aside: I remember Dr. Brymer at UWO pitching geriatrics to us in first year: "I work 9-5 and make a quarter of a million dollars a year".

 

 

Once you start in medicine you may not actually feel that you want to be put in situations often where you don`t know what to do. I mean, it isn`t a very good situation for the patient!

 

This is actually a really good point. As a primary-care wannabe, I sometimes envy the specialists who've had their patients screened and worked up before hand by other docs, and can tell their patients "this is definitely what's going on with your [random organ/disease], and this is the definitive treatment for it." Their internal dialogue seems to have a lot less "what if what if what if?" than mine does...

[flying kumquat]

PS: FK - If we both graduate in '09, how come you get to call yourself an M4 while I'm still just a lowly M3?

 

It seems that at Queen's, once the upper year class graduates, we're expected to start signing CC4/MS4 instead of CC3/MS3. That means, with our clerkship starting in January, we get a whopping 6 months as "3rd year" clerks. It definitely makes me feel I should know a heck of a lot more than I do.

[Rock*]

Hey everyone, thanks for the helpful replies.

 

Just to clarify, when I said intellectually stimulating/demanding, I didn't mean not having to do any random physical labour or necessarily requiring the most knowledge.

 

In particular, I was wondering about which physicians are presented with the tougher/complex problems in their work, that say require more deeper thinking and creativity to help their patients.

 

I really enjoy trying to solve challenging problems, and would love to have a career where I don't always have to resort to standard solutions, and will often be put in spots where I have no idea what the heck to do, and will need to figure that out.

If you enjoy pain like that, I would highly recommend endocrinology or nephrology. If you can make it through residency without requiring a lobotomy from going crazy thinking so much, you'll love it.

[leviathan]

I love ICU / critical care medicine! I'd say it's pretty intellectually stimulating, although EBM is starting to take challenging patients and for better or worse turn them into algorithmic care (eg. early goal directed therapy in sepsis).

[ploughboy]

It seems that at Queen's, once the upper year class graduates, we're expected to start signing CC4/MS4 instead of CC3/MS3. That means, with our clerkship starting in January, we get a whopping 6 months as "3rd year" clerks. It definitely makes me feel I should know a heck of a lot more than I do.

 

Interesting cultural difference! I'm Meds 3 until August, and that suits me just fine. I like to keep people's expectations low.

 

On a related note, I'm already having "oh crap, there's way too much stuff I need to know before I'm a resident" moments. 12 months...

[unknown user 7]

Aside: I remember Dr. Brymer at UWO pitching geriatrics to us in first year: "I work 9-5 and make a quarter of a million dollars a year".

 

:D :D