Choosing a specialty in medicine and why I left surgery

I left surgery to pursue a career in anaesthetics or anaesthesiology for our friends in the USA. In this episode aimed at medical students and Foundation Year Doctors I talk about why I left surgery, my general experience when it comes to choosing a specialty and why I think it’s important to take lots of things into consideration before disregarding other specialties.

For the general public, this episode definitely serves a purpose into providing an insight into the different choices a doctor has to make early in their career as well as some of the different roles an anaesthetist has and what they do during an operation.

Linked episode: Professionalism and bullying - my experience
https://www.buzzsprout.com/342848/2975830

Thank you for listening! For more information please visit adoctorsview.uk
email: adoctorsview@gmail.com
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twitter: @DrPolyvios

Transcript

Hello everyone, welcome to another podcast episode. This episode is mainly aimed at medical students and foundation year doctors but given the large numbers of questions I get from non-medics about career paths in medicine and also about my job as an anaesthetist I thought it would be a good idea to have a chat about it. I see a fair number of medical students throughout the year when they come to theatres for a taster week in anaesthetics. And this is something that wasn’t really offered as much when I was at medical school. Anaesthetics tended to be the specialty no one really knew a whole lot about until after they qualified and started working in a hospital. When you came to theatre it was to shadow the surgeons and watch operations. Not spend time with the person at the other end of the table looking at monitors and writing down numbers on a chart (I promise I don’t just mean suduko).

I have to start by addressing something that in my opinion a lot of medical students spend far too much time stressing over, and that it is choosing a specialty that they want to go into without ever having experienced it. And I’ve met some who know what specialty they want to go into before they’ve even started medical school and then start stressing over the process of becoming a surgeon or an oncologist or neurologist or whatever the specialty that they have in mind is. And whilst it’s lovely to have a goal in mind I feel there is this unwarranted need to choose something and stick to it right from the beginning or else you’re seen as not showing commitment to a specialty or that you feel you’ll miss something. And I get it, but I’m also here to say from my own experience you really don’t need to put so much pressure on yourself so soon in your medical career. Medical school serves a lovely purpose other than obtaining a medical degree. It gives you a little bit of insight into each specialty but what it doesn’t do is give you an insight into the day-to-day life of working in that specialty or even the work-life balance of a specialty, which may not seem so important when you’re 23 and can get by with 2 hours sleep a night, but believe me that very quickly begins to change. And this is something that only after you’ve spent some time working in a hospital can you really figure out. For example, I KNEW I wanted to be a surgeon. Without question, I knew. I based my work experience around surgery, my elective during medical school around surgery and even chose my foundation year jobs, that is the first 2 years after you qualify, around surgery. I then applied and was given a place in a surgical training program and spent 2 years as a surgical trainee and after the first 6 months of those 2 years I knew I wanted to leave. Why didn’t I leave sooner? Well, I never really thought about other specialties and didn’t know what else to do. You see, what I really should have done was have far more of an open mind. What your first year and to some extent your second year of working after you qualify does is it never really shows you exactly what you want to do. What it does do though is it makes you very aware of what you don’t want to do. I knew very early on when I started work that a medical specialty like cardiology for example was something that I wholeheartedly did not want to do. And the reason for that is very simple, I hated the ward rounds. I find them very difficult to enjoy. And a medical specialty spends a great deal of time doing ward rounds because the majority of the patient’s management involves the history, the investigations and tests, the diagnosis and treating that diagnosis with medicines. Now of course medical specialties do have their fair share of procedures as well such as angiograms and endoscopies which are carried out by doctors. But this wasn’t enough for me. The practical stuff vs ward round ratio was not high enough. Now surgery, I knew had ward rounds, but I knew that on the whole they were shorter. And that was appealing. Plus, I love working with my hands, I loved design and technology at school and love to make things and tinker. Surgery seemed like a fantastic option. So, there I was a surgical trainee. And unfortunately, I very quickly began to hate it. Why did I hate it? Well, sadly a large number of my seniors gave me no real option but to hate it. I worked in some departments that were very unpleasant indeed, mainly due to the people who I was working with. And I won’t accept the excuse of character building. This has its place for sure, when the end goal is to make you a better person, a better doctor, a better surgeon. And this can be seen in the army for example. And I like to think that I’m a thick-skinned person. What made this different was, I felt these people didn’t want to see you become a better person or a better surgeon, they simply saw you as a target and a way of taking out life’s frustrations on you. They couldn’t care whether you succeeded or not. And this takes its tole when you work your guts out to do everything you can to help on a unit and all you get back is venom. But I like to think that, and in fact I know that this isn’t always the case and surgery as a specialty is a wonderful specialty that sadly at the time, I lost a little respect for purely based on the very few number of people. I speak more about this in a previous podcast episode about professionalism and bullying which is linked in the description. And ultimately that’s not actually why I left. In fact the rageaholics inadvertently did help me become a better person… I was once in theatre as a surgical SHO and my registrar at the time kept shouting at me or instructing me really loudly and was basically being a bully for no reason, to the extent that the scrub nurse actually said “can you stop shouting at him”. Now this threw him a little bit and he tried to act somewhat remorseful and said “Oh, you must really hate me, I’m always having a go at you”. I simply said, “of course I don’t hate you, you’ve taught me exactly how I don’t ever want to become.” He didn’t speak to me for the rest of the case. Yes, I disliked working with some people which made me dislike the job even more, but actually I found myself not enjoying the specialty even when I was working with lovely consultants who helped me enormously. I disliked the job outside of theatre. I loved being in theatre. I loved the atmosphere, the banter between the staff and the rapport you developed with a patient who you were literally going to open up and see inside of and the trust they had in you. But the ward jobs that followed and the countless calls from a busy A&E for a surgical review; I really didn’t enjoy that. Don’t get me wrong, I love a busy day that you lose track of time of but the type of work that was keeping me busy just wasn’t for me. I went on a date a number of years ago when I had just left surgery and had applied for anaesthetics. And as usual dating protocol dictates, we began talking about jobs and she asked me why I left surgery and my simple answer was “it wasn’t fun anymore.” Now, this woman looked really bemused at this and said “but, it’s work, it’s not meant to be fun”. Needless to say, we didn’t see each other again. Of course work should be fun. You spend most of your life there, how can expect to be happy at work if you don’t find it fun? I can’t imagine not being able to enjoy the work I do. To laugh with the people I work with or make a joke or even take a joke and sadly whilst I could do all of this in surgery, the job itself made me not want to. It drained me. This isn’t because surgery is a bad specialty. It’s a wonderful specialty. It’s because ultimately, it didn’t really suit me.

So… why anaesthetics. Well. I knew I still hated ward rounds. This never changed. But I knew I loved theatre. And I found myself becoming more and more interested in the physiological side of things in surgery and began taking interest in what the anaesthetist was doing, watching them put in central lines, intubating and so on. So for me it wasn’t so much a logical progression as it was a natural one. And it’s a decision I’ve haven’t regretted. For any non-medics listening, yes an anaesthetist is a doctor. The number of times a patient is surprised when I introduce myself as Dr Polyvios is quite a lot; often saying “I didn’t know anaesthetists were doctors.” This is also one of the many reasons I introduce myself as Dr Polyvios and not Paul (I talk more on this in the professionalism episode I’ve linked in the description). So a typical day starts with seeing patients who are due for surgery, pre-assessing them, coming up with an appropriate anaesthetic plan for them, then we start the list and spend the rest day in theatre anaesthetising each patient, you keep them alive during the operation and then wake them up. And that’s what I love about it… I can devote myself to one patient at a time and do the very best I can for them and then move on to the next patient. And I found I can do this more in anaesthetics than any other specialty I’ve worked in. It suits me. Patients also don’t realise that the anaesthetist is present throughout the operation constantly making adjustments to the anaesthetic and ventilator and giving medications and keeping the patient’s physiology as stable as possible as the body responds to different stages in the surgery and then safely waking the patient up. I was chatting to a pilot and I explained what I did and he told me “I just thought you gave an injection and then walked off.” I told him that that’s like me saying “I thought you just got into the plane, took off hit the autopilot and then fall asleep, I’m pretty sure there’s more to it than that.” And in a way, if you’re not medical, or not had an operation before, why would you know this? And I once had a medical student say to me that he didn’t want to do anaesthetics because “it’s a bit boring sitting at the end giving drugs and looking at monitors.” I simply said to him, it’s boring because I’m doing my job properly; I can show you an exciting anaesthetic, but you probably wouldn’t want to be a part of it. And that’s the thing on the surface of things, as cheeky and as arrogant as he was, he may have a point. But that’s because he was seeing a fit and well 18-year-old on the operating table having a simple procedure. With patients like this, an anaesthetic is pretty straight forward. What he didn’t see is the very unwell 80-year-old with a bad heart, bad lungs, who takes 2 carrier bags of medications and in need of a major operation at 3am because they’ll die without one. Where you spend the whole time fighting to keep them alive whilst the surgeon operates. And what he also didn’t see is the on-calls when you’re called to A&E because someone’s taken an overdose and they’re unconscious and barely breathing or the practical things like inserting central venous lines, arterial, lines, epidurals on labour ward or spinal blocks for c-sections or nerve blocks or even pain management for certain patients. And I believe that most specialties have these hidden things that unless you witness, they don’t really spring to mind. 

And the other thing that medical students and foundation doctors forget is that if everything really is going badly, and you choose something that you really find yourself not enjoying. It’s not the end of the world. You haven’t lost anything, you’re still young and at the beginning of your career… you can choose something else. Personally, a career is a long time to be unhappy. even for those who have chosen a something just because they have a relative already in that specialty and feel they have to carry some sort of batton. Just because it’s for them, doesn’t mean it’s for you. Be true to yourself and the most important take home message from all of this is don’t dismiss a specialty rotation just because it’s not what you want to do. I can’t tell you how many times I’ve seen a very junior doctor show little to no interest in a specialty that they are actually working on because it’s not surgery or it’s not cardiology or wherever they want to end up. It doesn’t work like that. Life doesn’t work like that. It doesn’t make you seem more committed to surgery or haematology, it just makes you seem untrainable. People talk and, in a hospital, a bad reputation is really hard to shake off. Don’t have tunnel vision; keep an open mind and you might find you enjoy something you were quick to write-off.

With that I’ll leave you, as always, please look after yourself. I’m Dr Polyvios, Goodbye.