I came into medical school wanting to go into internal medicine. My plan was to then do a fellowship in cardiology. My first two years of medical school pretty much solidified this – I loved all the lectures on heart anatomy, pathophysiology, EKGs, etc. Even through most of third year, I was convinced I wanted to go the internal medicine route – I loved the residents, I had no problem with hours of rounding, I liked the broad scope of diseases, etc.
Everyone said that we would change our minds about our specialty choice millions of times before residency applications. But for some reason, I never really believed I would. I even remember thinking, “Well even if I change my mind and end up hating cardiology – internal medicine still has so many other fellowship options, so I can always pick a different one later on.” Therefore, it seemed like a win-win to me.
Weirdly enough, it wasn’t until my ob-gyn and psych rotations that I began to look into alternative career paths. Ob-gyn was the first time I got to actually DO procedures (not just watch the residents do them). That is when I realized that if I went into internal medicine I would really miss working with my hands and actively doing things.
My psych rotation on the other hand, showed me how truly fascinating mental illnesses were. I had never expected to become so entirely enthralled by the field. Despite my fascination, I immediately knew that I did not want to go into psychiatry. The long-term management of these illnesses is such a huge part of the field – and long-term management is so deeply tied to psychosocial factors that mental health providers often have no power to change. So, it can quickly become frustrating and unprogressive. However, I realized the ER was the exact place where I could see and manage psych illness, but for a much shorter amount of time.
Since making the switch to emergency medicine, I have done two ER rotations and loved them both. I also discovered an unexpected caveat to emergency medicine – the focus on creating differentials and make diagnoses. It is almost like a puzzle; you have to use the history, physical, labs, and imaging to knock-off life threatening conditions and then use stats to pick the most likely one. I had originally believed that internal medicine or primary care would offer the most opportunities to make diagnoses, but I now see that it is also pivotal part of EMed.