Outside Ohio.

So this is the show! I left Ohio, and I'm finally a doctor, my student years are mostly behind me.

My intern year has been almost what I expected, except for the part where I have become on the cusp of not believing in inpatient medicine. Perhaps this is because the patients who have sufferred from iatrogenic harm stick out in my mind more than the ones that we have helped.

Being an intern mostly feels like being a kind of busboy or waiter. Asking what patients want, figuring out what attendings/residents want, and carrying out orders. Intern year at its best is a constant game of chess where you evaluate multiple pieces of information simultaneously to make prudent and efficient diagnostic and therapeutic decisions. However a mediocre intern simply shows up, reads plans off from yesterday's progress notes on morning rounds, places orders, calls consults, and follows his resident like a shadow to keep up on hew admits whose history and physical exam forms we have to write. I would say my internship experience has been more consistent with this scenario.

Well, it only gets better. Once you become an upper level resident, your patient load doubles, but you don't have to preround as much, and the number of notes you write decreases by 50%.

The million dollar question becomes where do I go from here.

Should I see where this neurology experiment leads me? I'm not sure I believe in throwing the million dollar workup at patients with vague symptoms, but as a jaded intern my skepticism has often been unfounded as obscure tests have occasionally come back positive allowing zebra diagnoses to be made. The best physicians seem to be able to approach medicine as a science, but also act on their gut feeling and be right about their hunches which do not yet have fact backing them up.

What is the alternative to all of this?

Pathology! Weekends off, path reports/biopsy reads based on facts/science. Autopsies are nice because you can't kill someone that's already dead. Ample opportunities to teach medical students...

But do I want to completely give up patient contact? Can I spend approximately 50% of my career sitting in front of a microscope? If I'm lonely now, how will I handle a day with almost no human contact?

I like North Carolina and UNC, but I miss Ohio and I miss my free time...