Wednesday, February 09, 2011

Change of Heart

Woopsies! It has been a little while since my last post.

So the last time we spoke I had just finished Emergency Medicine. I have since also completed my Geriatrics rotation. This was my first medical inpatient rotation. I really enjoyed this rotation and part of that has to do with the 4 day weekends. But I also enjoyed it because it showed me an area of medicine that I was interested in pursuing.

Notice I say "was." I'm still interested in Hospitalist medicine but it's definitely a lot more stressful than I thought it would be. You are responsible for EVERY SINGLE PROBLEM THEY'VE EVER HAD! That's a shit ton of things to be held accountable for. Now it's not that I don't want to help these patients. But when you have failed to control your blood sugar, hypertension, high cholesterol and never stopped smoking... well I just don't think it's fair how much liability is put on me. If you're not willing to take care of yourself, then why should that be put on me?

I also got a lot of experience in the ICU. This was particularly helpful because my elective rotation was going to be in critical care. I got a good sense of what you see in the ICU. It's normally either very old people that should be in hospice, very complicated patients that I mentioned before, or rarely acutely sick people that make full recoveries. The reason I was interested in critical care was because of those few acutely ill people that have the potential to have good recoveries. So I still maintain interest for critical care, just not as exclusively. I enjoy the complicated inter-system workings of the field, but it rarely even matters that I understand why things are going wrong. Getting a patient to "stable" isn't nearly as satisfying as I thought it would be. Because of this exposure to critical care I decided that I didn't need a rotation dedicated to critical care to know what it's all about.

During didactic year class I was always very interested in Urology, but the only elective we had was in Uro-oncology. That was a little too specific for my interest, but nonetheless a very important and relevant aspect of Urology. While in geriatrics we had a couple of urologists lecture to us and it reminded my past interest. It was also quite obvious that Urologists love what they do. They don't seem as burnt out and they seem to get gratification from what they do. One urologist also pointed out that this is becoming a very PA in demand field. Urologist are finding great ways to utilize PAs and other PAs are telling me it's a great PA field.

All this being said I still have no idea what PAs do in urology. I don't know what kind of patients they see in clinic, what their role is like in surgery or what kind of procedures they get to do on their own. So I decided this is what an elective rotation is suppose to be used for. I have an area of medicine that I'm interested in but don't have a clue what day-to-day is like. My clinical coordinator gave me a little grief saying I'm always changing my mind on my elective but said it was an easy enough change. In my defense I only asked her once about her thoughts on me doing CT-Surg. I've never actually changed my elective before.

This rotation isn't Uro-oncology though. She told me that we have a general urology rotation at our affiliated hospital. She also said they are BEGGING her for students, which often means they are looking to hire. I would DIE to get a job at this hospital since it's TWO blocks from the apartment I'm moving to this upcoming summer. I won't deny that this also plays a role into my decision.

I'm currently doing pediatrics. I've only been there for 2 days and I already have a cold. I guess that's what happens when you are holding a kid down that's getting an IV and they're spitting into your mouth.


Ana Paola said...

I am really enjoying reading your posts. I am two semesters away from starting my rotations. I am pretty sure that will be the time I will figure out what I really want to do in my PA career and what I don't. Good luck on your rotations and enjoy!


Gregory House, PA-S said...

Glad to see someone actually reads this thing. Good luck with the rest of didactic year!

Morning-Rounds said...


I am a Hospitalist PA. Just so you know: yes, a lot of the patients come in with a laundry list of issues they have been dealing with. MOST of the time the majority of these things are chronic in nature, and of those, mostly stable things that you dont really have to "mess" with. The goal for inpatient medicine isn't to cure their world. It's to get them back to baseline, as quick as possible. The rest is followed by their primary/other physicians in an outpatient setting. Don't get too worried. You don't have to solve the world's problems. Just ask yourself this: Why did the patient say they came in. (Focus on that first and foremost.) Generally of course. If they come in complaining of chest pain but have an axe coming out of their head, well you might have to spread out on two fronts :-)

Gregory House, PA-S said...

My experience was also a little skewed by the fact that it was a geriatric rotation. Of course everyone was old with a million different things the matter with them. To be honest I don't know if any of the patients really were sent home in any great condition. I still have my Internal Medicine rotation to get a better idea of what the patient population will look like.

Melissa said...

Just found your blog and read all your posts. I'm finishing up my Senior year of undergrad and am unsure of whether I'm doing PA or MD. Your blog is very humorous but also very realistic!

Thanks for posting!

Gregory House, PA-S said...

Good luck Melissa! It's a very tough decision. I finally decided on PA after the majority of physician's told me they wouldn't do it again, among other reasons.

Remember to look at how med school and residency will impact other plans you have for your life. If you're willing to dedicate the time, then go for it!

Becca said...

Hi Greg...I just so happen to stumble across your blog and found myself reading every word!!! I just got accepted to PA school and cannot wait to experience all the things you speak of...thanks for posting.


Gregory House, PA-S said...


Obviously I haven't portrayed enough of the bad parts of PA school.