Let me be clear( to myself as well) I love Cardio- I did not quit Cardio because I did not like it. As a subject it is fabulous to learn and practice.In terms of outcomes- satisfaction of cure- it is Hearteningly leagues above say, Nephro or Neuro. The next generation in India is going to be one of the bards of lard, the centrally obese affluent who will come to ERs clutching at their chests while at the peak of their productive lives.Call it thrift gene theory, diesel exhaust related or whatever you choose to- we will be the Type II Diabetes capital of the world.And that translates into serious business of the heart. Whatever one has to say about the number of cardiologists passing out, and it being a market of sorts, them guys are never going to be found without work.Its what more and more people should be doing.
But what pisses me off is that the whole practice of Cardio seems to shift focus onto getting stents into improbable and really unnecessary areas.Into milking the Interventional cow to obscene levels. And it is not an isolated event - its ground situation everywhere. And you would be questioned if you wanted to practice preventive cardiology, if you elicited a plantar response, if you put someone on medical therapy for CVD or chose draw a blood culture.At a certain level, the scopist or Interventional Card guy provides a service- hence can be called a technician doing a 9-5 Cath Lab job- and is paid for the level of skill he can show. To be away from the "human touch" has its advantages too in a overtly litiginous society.
One cannot completely blame this state of things- one cannot be an expert in every given condition which the human body suffers from, and yet be fashionable in the way he/she slides a Cypher into the LAD.If you will be seeing ARVDs and Fazio Londe day in and day out, how would you possibly be wrong if you did not know the treatment of malaria off hand??!!
I am including an extract from Jerome Groopman's book How Doctors Think:
The narrowest subspecialist, the reasoning goes, should also be able to provide this [broad] range of medical services. This naive idea arises, as do so many other wrong beliefs about primary care, because of the concept that doctors take care of diseases. Diseases, the idea goes on, form a hierarchy from simple to difficult. Specialists take care of difficult diseases, so, of course, they will naturally do a good job on simple diseases. Wrong. Doctors take care of people, some of whom have diseases and all of whom have some problem. People used to doing complicated things usually do complicated things in simple situations--for example, ordering tests or x-rays when waiting a few days might suffice--thus overtreating people with simple illnesses and overlooking the clues about other problems that might have brought the patient to the doctor.
Which probably is a reason I am trying to pick on Pulmo/Crit Care or ID as subjects to specialise in. Of course this is not the only motivation...there are many more. But these retain the 'common touch'( why am I quoting Kipling so often, so outofcontext?!) with the broad motherlanguage of medicine while still providing you with the qualification to "earn more than the chaiwallah" as Dr Anand puts it.
There is an algorithm that I saw on someone's Orkut profile about making a choice of which subject to choose after medical school based on your traits. I think in choosing a subspeciality one has to look beyond traits into what your expectations are, what you want to acheive, or what will keep you going when down the line you can manage things at purely a spinal level.This is an algorithm I have come up with. Sorry for the patchy work. But inputs, if any, welcome.
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