Choosing your Specialty in Medicine

Received a few messages from my juniors on choosing their career path in the future, some of them are house officers and some are still in medical school. I’m going to share some of my thought in this topic today, and I hope it will be useful!

When to choose the career path??

Actually there is no right or wrong on the timing to choose any specific specialty, but my advise is, don’t pick it from the beginning. Some of the students have set their target even from medical school, eg to be a neurosurgeon or obstetrician. Some of my juniors took their 1st part of external postrgraduate papers even before entering housemanship. It is good to prepare early for the road ahead, but for me, don’t set it too early and as your choices become narrowed.

Of course if you have already decided and you are quite certain you can be as successful as my friend, as he set his goal quite early during housemanship and he completed his MRCP exams during his 2nd year of being a medical officer.

I always wanted to be a surgeon when I was in my medical school, as I was deeply inspired by my surgeon lecturer, who was not only a beautiful woman but was successful in both her career and family life. I tried my best to perform well during my examination in surgical rotation during medschool, but I knew, I wasn’t up to the standard. So I pushed myself even harder.I went to Australia for a Liver Transplant and Hepatobiliary rotation during my elective posting, and I found myself to be very weak in anatomy, which is very important in the surgical field. To be a surgeon in Malaysia, we have to enrol ourselves into the local master programme, where the seats and availability are limited and very competitive. I joined some symposiums that time, and it got me quite depressed after learning the prospects. Yet I still keep my mind’s decision to be a surgeon, as I prepared myself for the MRCS exam in the beginning of my housemanship. I even bought myself a basic suture set to motivate myself as graduation gift. 

Although I have to ask myself, was I happy?? To be honest, I felt scared most of the time as I don’t feel secure. My BFF in my uni, Shah teased me before our graduation, that she did not see me as a surgeon, but as a paediatrician. Well, who knew she was right and I’m on my path currently to become one, hoping I won’t quit in between haha.

So, what changed my mind?? When I entered housemanship, I started with my posting in general medicine. I enjoyed the adrenaline rush and the part where I was involved in making decision for patients’ medications, which my medical officers guided me very well. Then I entered Obestetrics and Gynaecology posting as a 2nd poster, and I was lucky to have more chances to be an assistant in the operation theatre than my colleagues. I enjoyed assisting caesarean section a lot, but I could not really stand the long operating hours. I felt a bit fatigued for that. Still, I held my will, and I promised Feena that we will get through this together. Sorry Feena, I left you alone in surgical XP

I got into orthopaedics as third poster, and it really changed my mind a lot. I didn’t enjoy being in the  OT anymore, as I felt very burdened and I didn’t  really knew my role well in the begining. My job in the OT was to make sure the medication was ready, get the board done with the procedure’s and name list of surgeons, getting the x-ray ready onto the lightbox, getting myself scrubbed in, and blank staring in the OT most the time. I enjoyed the non complicated procedures, when I was the 1st or 2nd assistant, rather than just holding on to the yonkers suction. But when it came to a procedure that involveds 2 surgeons/ 2 senior MOs, trust me I don’t even have chance to touch the retractor or yonker suction.  I cant recognise the operating instruments on the operational table, they looked exactly the same to me. I felt a bit lost that time. The surgical based environment may be a bit toxic I would say, they have long working hours, get scolded for minor mistakes, and ya, some political arguments in between. From that moment onward, I decided not to continue to hold onto a dream that I don’t feel I belong to. I need a good work life balance; I want my holiday fully undisturbed.  I don’t see my surgeons getting a real holiday, they need to rush back to hospital immediately if the patient that they in charged of get into complications.

Then I entered my 4th posting into paediatrics, where I received a lot of good guidance from my seniors from my alma mater – UPM . I was happy in the department, and that moment I agreed with Shah, yeah I do love paediatric but I hid it up before this. I have shared my stories of my paediatric posting in my previous post so Im not going to repeat it here again.
What made me sealed the decision for paediatrics??Well, I was badly traumatised by adult patients, , the non compliance on medication, the complications of chronic illnesses, the midnight emergencies. Okay, I had enough of that, I decided I’m not going to deal with adults, so I got myself into paediatric.

This happened to many of us in real life. My senior who was very passionate in Obstetrics and Gynaecology when she first started her housemanship, is now an Anaesthesiology medical officer in the masters programme. My friend who always wanted to be a cardiothoracic surgeon previously, is now an internal medicine medical officer. My paediatrician wanted to be a public health specialist previously. As you can see, many of us changed our direction after working.

What we expected during the medical school, and what we experienced during our working life is totally different. Let’s say if someone is too stubborn from the beginning, he/she would not enjoyed the journey as he/she might think that, neh, this is not related to my future career, I might not need this. They might do very well in the field that they interested in, but they failed to be a doctor who treats a patient as a whole. That is why I hate to get referrals for Upper Respiratory Tract Infection (URTI) from the other departments, as a doctor you cannot manage a child URTI ? grrrrr…… So ya, please learn from each department, use the knowledge, treat the patient from head to toe, instead of overlooking the details and the patient ends up being readmitted in a bad shape.

My advice is to have a goal from the beginning, but let yourself explore more during housemanship. Try to learn everything as much as possible, and when it comes to the end of  housemanship, decide the pathway you choose and go for it. It would be most ideal to make up your mind in 5th or 6th posting in housemanship, or during the 6 months floating period before getting transferred. Getting labelled too early during housemanship is not a good thing either, people will think that you are not respecting the department and you might be targetted easily. It is okay to have some failures, learn and stand up again. I gave up my dream as a surgeon, but I’m happy with my life currently as a paediatric medical officer.

Some people might question, you are not experienced enough yet to make a decision, why don’t you just follow the flow?? My answer will be, why should I when I know what I want to do, and what Im going to do?? And that is the time we see the importance of holding an external paper, we have more right to fight for what we want, we sharpen our knowledge of the field that we are interested in so we can do better for our patients. Housemanship is not a honeymoon period.

So, for those who are still indecisive, or maybe excellent in all postings ( like some of my friends haha), maybe you can try on the elimination method. 

First, do you like surgical or medical based specialty? Do you enjoy working with drugs, or with surgical equipment in the operational theatre?
If you don’t like both, then, do you enjoy communicating with people?? If yes, maybe can try on public health or admin work; if no, then maybe you can try on pathology, radiology, blood bank and etc
If surgical based , which one is your preference?? Head, nose, ear/throat, eyes, abdominal cavity, thoracic, heart, or limbs???
If medical, do you like adult or children??
then slowly we will eliminate those we do not want and that will make our choices clearer.

In the end, let me share a joke that I told my junior on recently,. She is interested in medical based specialties and talking to patient, but she is new to the field and asked for some advice. I told her
psychiatry - basically its all about talking
paediatrics- most of the time we are nagging like a grandma
geriatric- err, your patient will talk more than you
anaesthesiology – shut up and tube.
Xppp, no offense to anyone ya. Thank you for reading and have a good night! 
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