What is the best specialty for me?
I am going to disappoint you by saying that I do not know the answer to this question. However the purpose of this blog is not to tell you what the best specialty in the world is but to allow you to find out what the best specialty for YOU is.
There is a difference here - What you like may not be preferred by others and vice versa. Talking to specialists in that field can be misleading at times as they will try their best to "sell" their specialty to you.
So what is the solution then?
I will start off with my personal experience.
When I came to the UK, I wanted to specialize in gastroenterology. My father is a gastroenterologist in my home country and I loved the endoscopy suite. In my free time, I used to go there and just watch everyone's bowels on the screen - I even knew what normal and abnormal looked like at a very young age. Maybe this is what sparked my interest in this field. Or maybe it was that I knew everything about this subject in my final year of my medical school.
However when I started working here, I realized that it is not as glorious as I perceived it to be. When I was on ward cover, the gastro ward was the biggest headache- The alcoholics, confused encepaholopathic patients and the malena kept me busy and I felt that this is not the life I wanted to lead.
Then I applied for my core medical training post and worked in respiratory. My consultants were absolute gems and they let me do everything - from inserting chest drains, pleural aspirations, managing sick patients on the ward. They supported me throughout and made me fall in love with this specialty. At the end of my rotation, I was equivalent to a respiratory registrar . I was signed off for all procedures.
When I started my core medical training, year 2 I realized what I enjoyed the most - The crazy on calls. I started working in renal medicine as my first rotation and my best moments were when it was just me on the ward dealing with a sick patient, organizing scans, liaising with ITU, keeping the consultant up to date , running between 2 computers and delegating tasks to the nurses and other colleagues. I used to look forward to my on calls for this very reason - seeing that Parkinsons patient with a low GCS, passing a NG tube immediately, getting a CXR to ensure that it is in place and getting his Parkinsons medications down his NGT - all within a few minutes. Seeing that patient with a headache, doing a lumbar puncture ( after discussion with the consultant), doing the discharge summary at the same time preemptively. Being the first one to grab a needle and stab a patient during a CRASH call and many other examples.
Now as you can see, during these 3 years I have changed my mind thrice - from Gastroenterology to Respiratory to Acute Medicine.
However I still remain confused. And I completely understand what people in my situation feel like me. So I have addressed some issued in these FAQs:
FAQS:
I am about to start as a SHO in the UK. My uncles friends nieces friends cousin has advised that **** is the best specialty.
**** may be the best specialty for the aforementioned person but it may not be the best for you. You CANNOT decide till you experience that specialty yourself.
How can I experience that specialty myself UNLESS I apply for it?
This is why we have taster weeks.
How can I arrange a taster week?
This will help:
https://naseersjourney.com/2018/09/30/my-gp-taster-week/
Similarly you can do a taster week in any specialty you fancy.
But is one week enough?
No of course not, however you can at least decide whether you like it or not.
How did you decide that you wanted to do medicine?
I just loved it. I did not like surgery ( but I love doing procedures but do not like spending time in theaters ) , GP ( although I love talking to patients and developing a good relationship with them- but do not like the idea of a 10 minute consultation or partnerships), PAEDS ( Found children scary - however after my first child, I think I could have managed working in it however now I have given my MRCP exams and have worked in medicine for 3 years), radiology ( I did not like looking at a screen rather than patients - which I know is NOT the case as radiologists do interventional radiology)
You reasons are INSANE!!!!
Yes, exactly. However they work well for me. They have helped my crazy mind decide what is best for me.
Have you ever worked in these specialties?
No, I have not.
So how can you say that you will not like them?
See, this is what I have believe- this may not be the truth. This may not be the right thing. But this is my reason and it has enable to at least narrow down my specialty of choice to medicine.
What do you like about in medicine?
I love the multi disciplinary approach to everything. Lets take a look at renal medicine. A dialysis patient is not only managed from that point of view. We have a renal psychologist, renal dietician, renal occupational therapists, renal pharmacist, renal MDTs, they are followed up in the dialysis clinics - their general health and well being is discussed, the possibility of a transplant is discussed. It is an amazing way of managing patients. And I did not understand it till I actually worked in it as a SHO and dealt with patients on my own.
I also love the relationship I have with patients and their relatives. They always remember my interesting words- stuff like " I am just as scared as you when it comes to taking blood tests. I remember I fainted when my bloods were taken when I started working in this country. I almost fractured my wife's hand by holding it so hard when I was given a vaccine. So what helps me is that I imagine I am in an amazing place doing my favorite thing- I want you to do the same." Even menial things like taking bloods from a nervous patient gives me immense pleasure.
I love the craziness of the on calls - Getting a full board of patients to see and constantly working during my shift along with my amazing colleagues and we manage to clear the board and have nothing to handover to the next shift.
I love my colleagues - the HCAs, OTs, PTs, nurses, pharmacists, foundation doctors, SHOs, registrars and consultants. I feel like we are one family and we support each other through thick and thin.
All of this has made me fall in love with this specialty. It is perfect - but ONLY for me. These reasons are justified - but ONLY for me. This do not make sense to anyone - EXCEPT me.
Have you ever thought of yourself as a consultant?
Yes - This is always on my mind. However I see myself as a consultant working in different specialties all the time, bringing about changes in those specialties. For example, I see myself as an acute medical consultant introducing a national safe handover from ED to AMU ensuring patients safety, avoiding inappropriate admissions, making sure all trainees get hands-on experience on all procedures done in the medical unit, ensuring the team is fully staffed.
However just a few weeks ago, I was imagining myself as a respiratory consultant researching on deodorants and whether they are the new "lung killers" and may cause fibrosis and doing state of the art research in it. How I would make my respiratory ward the center of excellence which every hospital can adopt and this way ensure all respiratory are managed according to the latest guidance.
Why is seeing yourself as a consultant so important?
You will be a SHO for a few years, a registrar in that specialty for 5 years and then you will be a consultant till you retire - and even after that, you will continue to do clinics and teach that particular specialty. Looking at it from a more dark point of view, you will take this specialty to your grave. Therefore look at yourself as a consultant in this specialty.
What advice do you have for me?
Do not listen to me, or to the aforementioned distant relative. Listen to yourself. See for yourself. Experience it yourself. No one can tell you what is right for you till you experience it on your own.
So what is the bottomline?
Time and experience teaches us a lot. We look at things differently. As we progress in our careers, we mature as well. We do not ONLY look at the short term but what it would be like working as a consultant.
However given our silly minds, we base our decisions on silly judgments -
Things like:
Oh that consultant is so young and drives a Porsche. I want to do that!
Oh that consultant is so rude therefore I do not want to work in that specialty.
When you are rotating in that specialty( be it your non training SHO post, GPST post, CMT/IMT post), become the best at it. Immerse yourself fully into it. Do all procedures, do clinics, take an interest in it like you want to do it for the rest of your life. At the end of that rotation, you should feel like you are competent enough to work in it as a registrar.
What are you going to do?
I have started as a trainee registrar in acute internal medicine and absolutely love it.
https://omarsguidelines.blogspot.com/2020/05/why-i-went-for-acute-internal-medicine.html
Remember, whatever you choose, do not take it as a job. Take it as your passion. Take it as the love of your life. Do not let small things ruin your "relationship" with it once you start working in it. You can become anything. All you have to do is be patient, love what you do and believe in yourself. Nothing in the world can stop you from achieving greatness.
Also read this post:
https://omarsguidelines.blogspot.com/2019/10/how-to-get-training-post-in-uk.html
There is a difference here - What you like may not be preferred by others and vice versa. Talking to specialists in that field can be misleading at times as they will try their best to "sell" their specialty to you.
So what is the solution then?
I will start off with my personal experience.
When I came to the UK, I wanted to specialize in gastroenterology. My father is a gastroenterologist in my home country and I loved the endoscopy suite. In my free time, I used to go there and just watch everyone's bowels on the screen - I even knew what normal and abnormal looked like at a very young age. Maybe this is what sparked my interest in this field. Or maybe it was that I knew everything about this subject in my final year of my medical school.
However when I started working here, I realized that it is not as glorious as I perceived it to be. When I was on ward cover, the gastro ward was the biggest headache- The alcoholics, confused encepaholopathic patients and the malena kept me busy and I felt that this is not the life I wanted to lead.
Then I applied for my core medical training post and worked in respiratory. My consultants were absolute gems and they let me do everything - from inserting chest drains, pleural aspirations, managing sick patients on the ward. They supported me throughout and made me fall in love with this specialty. At the end of my rotation, I was equivalent to a respiratory registrar . I was signed off for all procedures.
When I started my core medical training, year 2 I realized what I enjoyed the most - The crazy on calls. I started working in renal medicine as my first rotation and my best moments were when it was just me on the ward dealing with a sick patient, organizing scans, liaising with ITU, keeping the consultant up to date , running between 2 computers and delegating tasks to the nurses and other colleagues. I used to look forward to my on calls for this very reason - seeing that Parkinsons patient with a low GCS, passing a NG tube immediately, getting a CXR to ensure that it is in place and getting his Parkinsons medications down his NGT - all within a few minutes. Seeing that patient with a headache, doing a lumbar puncture ( after discussion with the consultant), doing the discharge summary at the same time preemptively. Being the first one to grab a needle and stab a patient during a CRASH call and many other examples.
Now as you can see, during these 3 years I have changed my mind thrice - from Gastroenterology to Respiratory to Acute Medicine.
However I still remain confused. And I completely understand what people in my situation feel like me. So I have addressed some issued in these FAQs:
FAQS:
I am about to start as a SHO in the UK. My uncles friends nieces friends cousin has advised that **** is the best specialty.
**** may be the best specialty for the aforementioned person but it may not be the best for you. You CANNOT decide till you experience that specialty yourself.
How can I experience that specialty myself UNLESS I apply for it?
This is why we have taster weeks.
How can I arrange a taster week?
This will help:
https://naseersjourney.com/2018/09/30/my-gp-taster-week/
Similarly you can do a taster week in any specialty you fancy.
But is one week enough?
No of course not, however you can at least decide whether you like it or not.
How did you decide that you wanted to do medicine?
I just loved it. I did not like surgery ( but I love doing procedures but do not like spending time in theaters ) , GP ( although I love talking to patients and developing a good relationship with them- but do not like the idea of a 10 minute consultation or partnerships), PAEDS ( Found children scary - however after my first child, I think I could have managed working in it however now I have given my MRCP exams and have worked in medicine for 3 years), radiology ( I did not like looking at a screen rather than patients - which I know is NOT the case as radiologists do interventional radiology)
You reasons are INSANE!!!!
Yes, exactly. However they work well for me. They have helped my crazy mind decide what is best for me.
Have you ever worked in these specialties?
No, I have not.
So how can you say that you will not like them?
See, this is what I have believe- this may not be the truth. This may not be the right thing. But this is my reason and it has enable to at least narrow down my specialty of choice to medicine.
What do you like about in medicine?
I love the multi disciplinary approach to everything. Lets take a look at renal medicine. A dialysis patient is not only managed from that point of view. We have a renal psychologist, renal dietician, renal occupational therapists, renal pharmacist, renal MDTs, they are followed up in the dialysis clinics - their general health and well being is discussed, the possibility of a transplant is discussed. It is an amazing way of managing patients. And I did not understand it till I actually worked in it as a SHO and dealt with patients on my own.
I also love the relationship I have with patients and their relatives. They always remember my interesting words- stuff like " I am just as scared as you when it comes to taking blood tests. I remember I fainted when my bloods were taken when I started working in this country. I almost fractured my wife's hand by holding it so hard when I was given a vaccine. So what helps me is that I imagine I am in an amazing place doing my favorite thing- I want you to do the same." Even menial things like taking bloods from a nervous patient gives me immense pleasure.
I love the craziness of the on calls - Getting a full board of patients to see and constantly working during my shift along with my amazing colleagues and we manage to clear the board and have nothing to handover to the next shift.
I love my colleagues - the HCAs, OTs, PTs, nurses, pharmacists, foundation doctors, SHOs, registrars and consultants. I feel like we are one family and we support each other through thick and thin.
All of this has made me fall in love with this specialty. It is perfect - but ONLY for me. These reasons are justified - but ONLY for me. This do not make sense to anyone - EXCEPT me.
Have you ever thought of yourself as a consultant?
Yes - This is always on my mind. However I see myself as a consultant working in different specialties all the time, bringing about changes in those specialties. For example, I see myself as an acute medical consultant introducing a national safe handover from ED to AMU ensuring patients safety, avoiding inappropriate admissions, making sure all trainees get hands-on experience on all procedures done in the medical unit, ensuring the team is fully staffed.
However just a few weeks ago, I was imagining myself as a respiratory consultant researching on deodorants and whether they are the new "lung killers" and may cause fibrosis and doing state of the art research in it. How I would make my respiratory ward the center of excellence which every hospital can adopt and this way ensure all respiratory are managed according to the latest guidance.
Why is seeing yourself as a consultant so important?
You will be a SHO for a few years, a registrar in that specialty for 5 years and then you will be a consultant till you retire - and even after that, you will continue to do clinics and teach that particular specialty. Looking at it from a more dark point of view, you will take this specialty to your grave. Therefore look at yourself as a consultant in this specialty.
What advice do you have for me?
Do not listen to me, or to the aforementioned distant relative. Listen to yourself. See for yourself. Experience it yourself. No one can tell you what is right for you till you experience it on your own.
So what is the bottomline?
Time and experience teaches us a lot. We look at things differently. As we progress in our careers, we mature as well. We do not ONLY look at the short term but what it would be like working as a consultant.
However given our silly minds, we base our decisions on silly judgments -
Things like:
Oh that consultant is so young and drives a Porsche. I want to do that!
Oh that consultant is so rude therefore I do not want to work in that specialty.
When you are rotating in that specialty( be it your non training SHO post, GPST post, CMT/IMT post), become the best at it. Immerse yourself fully into it. Do all procedures, do clinics, take an interest in it like you want to do it for the rest of your life. At the end of that rotation, you should feel like you are competent enough to work in it as a registrar.
What are you going to do?
I have started as a trainee registrar in acute internal medicine and absolutely love it.
https://omarsguidelines.blogspot.com/2020/05/why-i-went-for-acute-internal-medicine.html
Remember, whatever you choose, do not take it as a job. Take it as your passion. Take it as the love of your life. Do not let small things ruin your "relationship" with it once you start working in it. You can become anything. All you have to do is be patient, love what you do and believe in yourself. Nothing in the world can stop you from achieving greatness.
Also read this post:
https://omarsguidelines.blogspot.com/2019/10/how-to-get-training-post-in-uk.html
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