I have now completed almost a year of surgical internship, and as I’m sure you’ve noticed from my sparse blogging, I’ve had little free time for writing. It’s a shame too because surgery is just so cool.

Intern year is mostly about learning to manage surgical patients, basically people in varying degrees of health who have the added stress of having surgery recently performed on them. Although the 80-hour workweek and case requirements have pushed more exposure to the operating room into the process than previously existed, it’s still mostly medical management of patients at this stage. We are required to perform at least 750 cases in our 5 years of training. Of these cases, we are required to have exposure to a broad range of different surgeries with certain “defined” major cases counting towards specific quotas. For example, a recent requirement was added that we have at least 85 surgical endoscopy cases, including upper endoscopy and colonoscopies before we graduate. As a result, most of my day is spent dealing with medical issues with post-surgical patients, and if I’m lucky I get to go to the OR and, with an attending of course, learn some simple procedures.

As your training progresses you take care of more critical patients, with your second year largely devoted to ICU care. You also are involved more extensively in complicated cases, so by the time you’re a third year you are able to help attendings with complex surgical cases, are responsible for evaluating surgical admissions, and begin to manage patients as a chief in some cases. In fourth and fifth years you are in charge of managing whole surgical services and are operating a majority of the time. By fifth year you are a chief, and you should be preparing for eventually operating on your own as an attending or for additional specialty training in a fellowship position.

My day starts at about 5AM, when I pre-round on patients, collect the data from the previous day for the all-important list, and get signout (news on what happened overnight) from the intern who was on call. By 6AM the chief arrives, you round on the patients, and formulate a plan for the day. You’ve got to discharge patients who have recovered, manage the medical issues of your post-surgical patients, admit new patients and see the new surgical consults. Basically general surgeons get training to be excellent medical doctors who also learn to do surgery.

The day ends around 5-6PM when you either sign out to the surgeon on call overnight, or take signout from the other services you will cover overnight. Surgical interns usually cover 3 services overnight, so I might be taking care of pediatric patients, plastic patients and urology patients, or emergency surgery, minimally invasive surgery, and surgical oncology patients for 12 hours until the next shift comes in the morning. This means you work for about 30 hours straight, the maximum allowed by the new hours limitations. You address any issues that come up in the night, staff any consults that can’t wait until morning, and every once in a while deal with some terrifying emergency that arises at 2AM. It’s not that bad, but after a full shift you sleep like the dead. Saturday calls are of course the worst, because you start at 6AM on Saturday and don’t go home until around noon the next day, basically losing your whole weekend. Usually we only have to take one Saturday call a month so we don’t lose our minds.

So that’s why I haven’t been blogging. When not at work I’m usually eating, sleeping, or trying to keep my life in some kind of order. The goal though is to get back into this, to manage my time so we can still talk about medicine, and crankery, and the ever increasing tide of denialist movements. Not to mention TV shows. Anyone else seen Jesse Ventura’s new show? It’s like crank crack. Leave it to Ventura to figure out how to free-base illogical thinking.

This day in Crankery, November 16th

So who here has actually read the health care bill?. I’ve been devoting a bit of time each week to peruse more and more of it, and while there are endless obstacles to a complete understanding of it (including legalese and the annoying tendency of legislation to contain edits to other bills without including the text of the other bills being edited) it is telling that opponents of the bill are having some difficulty coming up with real criticisms of it. For example, the now infamous death panel fiasco was a willful misunderstanding of a completely wholesome concept, the idea that physicians should be compensated for having end-of-life discussions with patients. It makes sense on multiple levels to reward such discussions. For one, they are hard conversations to have, and without a motivating factor, they are avoided by many physicians. The result is a situation in which many patients fail to communicate their desires for the end of their lives, they fall in the default pathway of over-utilization of resources at the end-of-life, with invasive and often pointless interventions that have no benefit and burden and overwhelm the health-care system. The ideologues who sank that language in the bill should truly rot in hell, because they destroyed a good thing just to create a bogus political argument.

And speaking of the death panel conspiracy theory, has anyone been checking out Arthur Goldwag’s coverage of Sarah Palin’s conspiratorial beliefs? How sad is it that we still have candidates for national office that believe things that fail the test? Palin gives me the creeps, she represents my worst nightmare, a crank candidate with inroads towards a national campaign. Goldwag’s writing on the birther movement is also excellent and I’m glad to see these crackpots are being laughed out of court for the fools they are. In particular I liked the text of Judge Carter’s decision describing what it’s like to deal with cranks in court:

The hearings have been interesting to say the least. Plaintiffs’ arguments through Taitz have generally failed to aid the Court. Instead, Plaintiffs’ counsel has favored rhetoric seeking to arouse the emotions and prejudices of her followers rather than the language of a lawyer seeking to present arguments through cogent legal reasoning. While the Court has no desire to chill Plaintiffs’ enthusiastic presentation, Taitz’s argument often hampered the efforts of her co-counsel Gary Kreep (“Kreep”), counsel for Plaintiffs Drake and Robinson, to bring serious issues before the Court. The Court has attempted to give Plaintiffs a voice and a chance to be heard by respecting their choice of counsel and by making every effort to discern the legal arguments of Plaintiffs’ counsel amongst the rhetoric.
This Court exercised extreme patience when Taitz endangered this case being heard at all by failing to properly file and serve the complaint upon Defendants and held multiple hearings to ensure that the case would not be dismissed on the technicality of failure to effect service. While the original complaint in this matter was filed on January 20, 2009, Defendants were not properly served until August 25, 2009. Taitz successfully served Defendants only after the Court intervened on several occasions and requested that defense counsel make significant accommodations for her to effect service. Taitz also continually refused to comply with court rules and procedure. Taitz even asked this Court to recuse Magistrate Judge Arthur Nakazato on the basis that he required her to comply with the Local Rules. See Order Denying Pls.’ Mot. For Modification of Mag. J. Nakazato’s Aug. 6, 2009, Order; Denying Pls.’ Mot. to Recuse Mag. J. Nakazato; and Granting Ex Parte App. for Order Vacating Voluntary Dismissal (Sep. 8, 2009). Taitz also attempted to dismiss two of her clients against their wishes because she did not want to work with their new counsel. See id. Taitz encouraged her supporters to contact this Court, both via letters and phone calls. It was improper and unethical for her as an attorney to encourage her supporters to attempt to influence this Court’s decision. Despite these attempts to manipulate this Court, the Court has not considered any outside pleas to influence the Court’s decision.
Additionally, the Court has received several sworn affidavits that Taitz asked potential witnesses that she planned to call before this Court to perjure themselves. This Court is deeply concerned that Taitz may have suborned perjury through witnesses she intended to bring before this Court. While the Court seeks to ensure that all interested parties have had the opportunity to be heard, the Court cannot condone the conduct of Plaintiffs’ counsel in her efforts to influence this Court.

Plaintiffs have encouraged the Court to ignore these mandates of the Constitution; to
disregard the limits on its power put in place by the Constitution; and to effectively overthrow a sitting president who was popularly elected by “We the People”-over sixty-nine million of the people. Plaintiffs have attacked the judiciary, including every prior court that has dismissed their claim, as unpatriotic and even treasonous for refusing to grant their requests and for adhering to the terms of the Constitution which set forth its jurisdiction. Respecting the constitutional role and jurisdiction of this Court is not unpatriotic. Quite the contrary, this Courtconsiders commitment to that constitutional role to be the ultimate reflection of patriotism.
Therefore, for the reasons stated above, Defendants’ Motion to Dismiss is GRANTED.

You can just taste the crankery. The complete looseness with the truth as long as it conforms to the warped worldview of these crackpots is part and parcel of cranks the world over. Reading the follow-up of this case from right wing sites like Free Republic, and Storm Front, it’s impossible to tell the difference between the conservative ideologues and the unrepentant racists. All the appeals to patriotism and the constitution are such weak cover for the fact these cranks are angry we have a black president.

I continue to work the long hours of a surgical intern and must say, it’s a lot of drudgery. Internship is much more about paying your dues than about learning a whole lot, although my daily routine is occasionally punctuated by moments of extreme excitement. For instance, I will not forget the first time I placed a chest tube in a patient in the bedside, the blood that poured out of the guys chest that was keeping him from breathing, or the time I walked into a room to discover a patient in the midst of having a heart attack. Luckily, the training sets in, and we have a lot of supervision, so even when things get crazy I’ve always got someone with me who has seen it all before.

I also am increasingly motivated to write more as I feel less plugged-in than ever to the outside world since writing at least forced me to read tons of diverse information on lots of different topics. Cranks and crankery are all around us and I’m constantly reminded of the problems they create. It seems every time I see some topical show, and the commentators pause to reflect for a moment on the problem they’re all facing, it seems like they all know what the problem is but just don’t have a good name for it. The problem is that lies can be equally effective as the truth, and denialism creates very real problems for us and our democracy every single day. Denialism works, and cranks run amok throughout our country and the world. We have to keep writing about it until rather being on the tip of everyone’s tongue, people are willing to come out and call out denialism for what it is, and shout it down when it rears its ugly head.

Surgical Internship

You might have noticed I’ve been busy for the last couple of months. This is because I’ve started my surgical internship, and when not working, am usually either sleeping or eating. I’m going to endeavor to write more though, because I think important things are going on in the world, and because it’s somewhat therapeutic.

I’ll tell you first about a day in the life. What does a surgical intern do? Well, pretty much what most interns do in medicine. We are the ones who run the floor, who do the day-to-day stuff that keeps a medical or surgical service running. The work isn’t that exciting. We put out fires, do a lot of administrative work, and deal with the moment-to-moment issues with patients admitted to the hospital. But it is important work and necessary to keep the system running.

A day usually starts around 5-6AM, when you show up on the floor and get “sign out”, or information on the patients on the service from the person covering them at night. We then start collecting data from the previous day, the vital signs and labs that let us know the status and trends of our patients, and put them together in a list. The list, they say, is life. It becomes the vital piece of reference information the team uses throughout the day to determine what has happened with our patients so far, where they stand now, and what needs to be done in the future. Usually consisting of a few pieces of paper, in tiny print it contains the information we use for rounds that morning, and then use to refer to our plans for the patients on service for the rest of the day.

Rounds are critical. Rounds are when everyone on the team learns what is happening with every patient, we talk to them to hear about any new issues or new complaints, do a physical exam, discuss plans with members of the team and the nurses, write our notes for the day and address acute issues that have come up in the previous night. On surgical services, because the first cases are usually scheduled to start between 7-8AM, rounds have to be efficient and succinct.

Then between 8AM and around 5PM my day is dividing between implementing the plans decided on by the chiefs and attendings during rounds, addressing issues that come up during the day, and hopefully getting into the OR once or twice a day to continue to improve my surgical skills. Internship is mostly about the basics of patient care though, and keeping the service rolling to the patients get better and out the door so a new batch can come in and get treatment.

Around 6PM the night call person usually gets sign out from us, and we endeavor to communicate the critical issues for our patients that need to be addressed during the night, and the problems we anticipate coming up. It’s an under-emphasized aspect of hospital medicine, the day-to-day communication that makes sure nothing falls through the cracks and when we try to make the care of patients as seamless as possible, despite the need to hand-off care to the next guy. We are only human after all, and can only keep the plates spinning for so long before we need to eat, sleep, and get cleaned up for the next day’s work. During the day you’re running from task to task as quick as you can, and I lost about 15 lbs in the first month (unintentionally) from the constant activity and lack of time for meals. Fortunately I can miss the weight. My second month has been a bit calmer and there is free food, so I’ve stabilized, but I’ll start to melt again once I get back on one of the more crushing services.

Every 3-4 days, or just on weekends if there is a night-float system, you have call. This means you start at 6AM and work until about 11AM the next day in a 30-hour marathon shift. At 6PM you pick up a couple of other surgical services you will have to cross-cover overnight. It’s brutal, but necessary, and you learn to deal with issues as they come up efficiently, and even more importantly, to ask for help from the covering chiefs when you’re out of your level of comfort or expertise. Post-call you sleep for about 12-14 hours and show up the next day at 6AM to start the process all over again. Amazingly, despite these requirements we have to keep our total hours under 80 hours a week on average.

We’ll talk some more about what it’s like to be a new intern. Specifically, we’ll have to talk about the July effect (whether or not it even exists), the 80-hour workweek, and the impact medical reform may have on graduate medical education. It’s an exciting time to be in medicine, I can only hope we get past the current noise and nonsense to make some real improvements in how we apply the science of medicine to human health.

Changing medical school requirements for scientific medicine

Science has an editorial today discussing a topic near and dear to me, what medical schools should require from undergraduates before admission.

Since I was a bit non-traditional as an undergraduate premed (I was a physics major), I am happy to see that they’ve ignored calls to overload undergraduate education with a bunch of pre-professional courses that prevent people from being anything but biology majors.

How should preparation for medical study be assessed? Medical schools generally determine scientific readiness for admission by course requirements and scores on the MCAT, which mainly reflects the traditional content of those courses. In contrast, medical schools have long evaluated readiness for medical practice in terms of competency–specific learned abilities that can be put into practice–rather than by mandating standard courses and curricula for all medical schools. The report recommends that scientific readiness for medical school entry be assessed similarly: The current list of required premedical school courses should be replaced with required science competencies. Instead of a nationwide requirement that premedical undergraduates take specific chemistry classes, for example, a required competency might be described as being “able to apply knowledge of the chemistry of carbon compounds to biochemical reactions.” The report suggests competencies for premedical and medical school science education, recognizing that there may be multiple routes to gaining a competency. An integrated approach to both undergraduate and medical education may help both to innovate.

The editorial discusses this report from the American Association of Medical Colleges and the Howard Hughes Medical Institute that suggests what should medical students arrive at medical school knowing. For years, I’ve thought the premedical requirements were absurd. You are required to have a year of physics, a year of calculus, a year of organic and a year of inorganic/analytic chemistry (at least when I went through). While I benefited from having a basic science background before arriving at medical school, I have to say, the only things I’ve retained from organic chemistry class of any importance are that like dissolves like, and hot solvent is great for cleaning. I still can not think of anything valuable I learned from inorganic chemistry that I didn’t get in high school like computing basic stoichiometry or making solutions. Physics? Maybe it was more useful (and for me it was interesting in fun), but mostly as a course of study in rigorous scientific thinking, statistics, error analysis, etc. Calculus? Totally worthless for medicine. Even the biology courses tend to be exceedingly general (which I think is good). You know what’s been most useful? Knowing how to write. Knowing how to research for a paper, whether it’s on history or quantum mechanics. Knowing how to think and teach yourself about subjects rather than just memorize them. That’s what college should do, and that’s what medical schools should select for, rather than those who memorized the most facts in premed science requirements. And the MCAT? Don’t get me started. The smartest people I know did the worst on that test, and some of the most useless do well, because it doesn’t test reasoning or anything useful, just memorization of all that worthless junk in all those premed classes.

The report acknowledges this, and emphasizes a different skill set and set of “competencies” for premed requirements, rather than some rote knowledge on subjects you’ll never use again in your life. This made my heart swell and brought a tear to my eye.

The fact is, the first year of medical school is a great deal of catch-up for many students, even chemistry and biology majors, because the majority of what we learn in college is irrelevant to medicine, and that’s a good thing. College should not be treated as a pre-professional school that merely exists to give you specific knowledge to get you ready to be a doctor. There is great value in young people coming to medical school with a diversity of experiences and knowledge. If you like chemistry? Great! By all means, take 3 years of organic chemistry if that’s what you like, but we shouldn’t pretend it will ever be used again for medical school. I’m still angry about the hours of life I wasted in organic chemistry class, never to be used again, when I could have been learning about something I really cared about, or exploring more of the liberal arts classes at my university.

This is why it’s good that experts in medical school have begun to acknowledge that premed requirements do nothing useful to prepare one for medical school, but only really serve as a barrier to the unmotivated by virtue of being a giant pain in the ass. One could easily imagine a 1 year, or 1 semester course containing all the basic science required for medical school (which should be administered pass/fail). It’s more important that people arrive at medical school knowing how to think, knowing how to evaluate the scientific literature, having knowledge of the world and hopefully having a higher level of maturity. The physiology, pharmacology, anatomy – all of it is available in the basic science years of medical school. There is very little specific knowledge one needs at the start.

I’m glad to see there is talk of finally breaking from the stodgy and pointless premed requirements that generations of medical student hopefuls have had to suffer through (despite some, like Jules Dienstag, defending the premed torture as a “necessary gauntlet”. Let’s just hope they implement some of these changes, save premeds years of excessive study of irrelevant subjects, and maybe, if we’re lucky, burn the MCAT for the useless test that it is.


What to say about psychiatry that isn’t already completely covered by television and movies? It’s unique among the specialties for its coverage in the media. Maybe because we’re such social animals, or maybe because such shows about psychiatry or therapy appeal to a voyeuristic impulse in us to peer into people’s most private thoughts and feelings.

Our exposure to psychiatry in medical school, however, is primarily with inpatient psychiatry – people who for whatever reason require hospitalization to deal with their mental illnesses. Reasons may range from soul-crushing anxiety attacks, to addiction, to suicidal ideation, to frank psychosis from schizophrenia, depression or bipolar disorder. I’ll also say it’s very upsetting at first to treat the subset of patients who are being held against their will due to court orders. One of the most basic tenets of medicine is that a physician must respect the autonomy of their patients, and psychiatric patients have often had a court take this autonomy away from them because of their actions or behavior. Not surprisingly, many patients are not happy about this. They may not be willing to accept they have a problem, or be very reasonably upset about the financial, social, or legal consequences of a hospital stay, or occasionally they don’t necessarily feel that their delusions regarding their absolute dictatorial control of the US government and their need to evade agents of foreign nations by breaking into a pet store are actually a problem. However, others necessarily are disturbed by such things, often resulting in a temporary detention order, or TDO, to assess their need for psychiatric treatment. I’m not making light of mental illness, but psychotic states result in behaviors that are frankly bizarre, and the self-reinforcing nature of delusions often put patients into a state that makes them feel you are part of a plot designed to persecute them. Worse, there are times when a TDO can be devastating to a patient’s life. An inpatient admission for psychiatric, alcohol or drug treatment is not a benign intervention and often has pretty major accompanying legal and social consequences. Patients are often facing criminal charges for DUIs, violence, or other behavior that has finally come to a head, and cost of treatments is often a huge burden.

The two major things I learned as a part of this process are that (1) the state of Virginia drastically underfunds the treatment of mental illness relative to other medical illnesses (and this is a very bad thing) and (2) anti-psychotic medications are amazing drugs. Let’s start with a case – details, of necessity, are highly altered due to the sensitivity of psychiatric treatment but the fundamentals are real.

A 22 year-old-male is admitted to the inpatient psychiatric unit at a private hospital after his family brings him to the ER for bizarre and uncontrollable behavior…
Continue reading “Psychiatry”

Choosing a Medical Specialty IV — Interviews!

The process of choosing a medical specialty, and applying for residency programs is nearly complete as I have returned from my tour of the West Coast and am nearly done with interview season. This is when medical students travel the country at great (and unreimbursed) expense to find their future training program. When all is said and done, all your research into programs and time spent interviewing boils down to a simple question. Do you want to work with these people for the next 3-7 years of your life?

It’s also nice to see the cities where you may live and get a feel for the type of lifestyle you may enjoy. You also get to take pictures from helipads! Like this one from UNC:


And then there is the famous medical art like the Gross Clinic at Penn which also graces a common surgery text:


Or Ether Day (in the Ether Dome at MGH):

i-e7a15501c4bbbbd3b269b763122e6cde-ether day.jpg

More pictures and some fun interview questions below the fold…
Continue reading “Choosing a Medical Specialty IV — Interviews!”

What is an internist, and why should you care?

A (long) while back, I gave you a brief explanation of what an “internist” is. I later gave you a personal view of primary care medicine and some of the challenges involved in creating an infrastructure of primary care (only 2% of American medical grads are going into primary care). We also had a little chat about medical mistakes and medical training.

No matter what changes we ultimately make in the way we train internists, one of the lessons that residency teaches is to identify who is truly sick. I don’t mean who is faking it, I mean being able to look at someone briefly and decide whether or not they need your immediate attention. It may seem obvious, but it’s not. Objective factors can sometimes be deceiving. For example, an asthmatic may have perfectly normal vital signs, including a normal oxygen level, and yet be moments away from needing a breathing machine. For an asthmatic, a normal respiratory rate may indicate fatigue rather than health, and absence of wheezing my indicate such severe airway obstruction that wheezes aren’t even possible. The ability to recognize severe illness is one of the critical goals of residency.

This is one area in which the so-called alternative medicine folks can really be dangerous.
Continue reading “What is an internist, and why should you care?”

Choosing a medical specialty III – applying, interviewing and matching

Aside from taking 4th year medical school classes it’s also the time of year that medical students who plan to graduate in 2009 (like me) are applying to residency programs across the country. This is an interesting process and one that many people outside of medicine are unfamiliar with, and quite surprised by. For one, did you know that we don’t have final say on where we train in residency but that the decision is made by a computer?

It’s true. The process is called “the Match” and it’s a time of great excitement and anxiety for 4th year medical students. For one, there are far more applicants than there are residency positions around the country – largely due to application from foreign applicants. Also, depending on which field you’re applying, there may be many more applicants for each given position than there are positions. So let’s look at some of the match data from the National Residency Match Program that they publish each year (Charting Outcomes in the Match 2008 – PDF) to give you an idea of what a 4th year medical student is facing. Table 1 of the report is enough to give many students palpitations.


Divided by US vs other applicants, this is what your chances are as a 4th year senior for getting into the various medical specialties.


So, now that you’ve chosen your medical specialty what kinds of things can you do to make your chances of matching better? And what’s it like applying for these programs even though you can’t outright pick them, and conversely, they can’t directly pick you? How does this crazy system work? More below the fold…

Continue reading “Choosing a medical specialty III – applying, interviewing and matching”

Choosing a Medical Specialty II—the view from above

MarkH is going through the process of deciding what to what to do when he grows up. This is a much more difficult and important decision than many may realize. In order to understand the gravity of this process, I’ll have to refresh your memories a bit regarding medical education.

In the U.S., to apply for medical school, you must have completed a (usually) 4-year bachelor’s degree from a university. During the final year, you take what amounts to an entrance exam (the MCAT), and send out preliminary applications (often with fees). If the schools like your preliminary applications, they will send you secondary applications which are more lengthy and involve more fees. If they like your secondary application, you will be invited for interviews. For those of you who may not be familiar with U.S. geography, this place is big—really big. When I went on my interviews, I typically crossed two or three time zones. I took the red-eye out of SFO for Washington National, leaving around 11 p.m. and arriving around 7 a.m. The process is time-consuming and expensive.

After finishing the interview process, you may or may not receive invitations to matriculate. If you don’t get an offer, and you still want to become a doctor, you must repeat the entire process the next year. It is, needless to say, unwise to go through this process unless you’re pretty sure you’ll be happy with your decision to go to medical school.
Continue reading “Choosing a Medical Specialty II—the view from above”

Choosing a medical specialty

It’s that time of year, 4th year medical students (like me – kind of) are choosing their future careers and starting to interview all over the country in their residency programs of choice. I’ve been notably quiet – subsumed in work, study and applications – but I am catching up on writing about the clerkships I’ve done in the meantime (Pediatrics, Psych, OB/Gyn and Family Medicine). But since I’m applying for residency now (MD/PhDs have an abbreviated 4th year) I figured now would be a good time to tell people about what this is like, and in the coming months what cities I’m going to be in from time to time.

Choosing a medical specialty is a big decision. I’ve necessarily made up my mind, am very confident I’ve made the right choice and encourage you to take bets on my choice – it will be fun to see what people think. But the decision making process is famously difficult and many different strategies have been devised to help the indecisive (not me). Perhaps most famous is this chart first published in the BMJ by then-resident Boris Veysman:

If you’re very patient you can answer 130 redundant questions at this site offered by UVA to help you make up your mind, or read one of the books on the subject.

Then there is the famous Goo index, which I think may be quite useful. Basically, chose your specialty based on which types of bodily fluid you can stand being in contact with every day for the rest of your life. If you have a low tolerance for any goo, psychiatry or neurology might be up your alley. If you can take any fluid being sprayed at you at high velocity, surgery may be an excellent specialty for you.

Then there is the general opinion among the goo-heavy specialties that you should avoid the goo you dislike the most. For instance, if snot is bothersome, avoid pulmonary specialties and pediatrics. If it’s urine, maybe you shouldn’t go into urology (or if you don’t want to stare at genitalia all day). If you don’t mind blood but don’t like any of the stinky stuff, maybe neurosurgery is the right match. It’s all about balancing your goo exposure.

If you don’t want to get divorced during residency, maybe read this paper. The surprising result? Psychiatry is the worst at a 50% cumulative divorce rate followed by surgery at 33%, and most other medical specialties between 22-30%. I guess psychiatrists drive their spouses nuts when they bring their work home.

There is the Myers-Briggs guide to specialties which is only useful if you’re the type of person that likes astrology or other advice based on vague, general descriptions of people coached in psuedoscientific drivel. There is a lot of study of personality traits specific to different specialties, a review of the subject concludes that for the most part medical students tend to be too homogeneous for the blunt-instrument personality tests to distinguish something so specific as an ideal career choice and there is more variation of personalities within a given field than between fields.

So, using these highly-scientific and time-tested methodologies, which kind of medicine would you like to practice? Which do you think I chose?