Orthopedics

"To someone with a hammer, everything looks like a nail."
-I have no idea who first said this, but it's true nonetheless

I came into medical school without having a definite idea of what branch of medicine I wanted to go into, and I can still say that I am not totally sure exactly what I'd like to do. But always in the back of my mind I thought I would go into orthopedics.

It all started when I read a book entitled Hot Lights, Cold Steel, written by an orthopedic surgeon named Michael Collins. I think this is one of the best medical-general interest books that I have ever read--an maybe part of it is that I am the type of person that would be interested in orthopedics.

I played sports in high school (a rather common experience I've read), but I don't think that having played sports is the main reason that I became interested in orthopedics. The reason I feel that way is because if I went into orthopedics and never saw a sports-related patient, I would still consider it to be my first choice.

But when I consider the following reasons, I find it hard to believe that anyone would go into any other specialty, which partially explains why ortho is so popular.

1st (and foremost) Treatment-Effect Relationship: With what little medical knowledge I have, I've realized that I would never want to go into something like internal medicine, where the primary way of caring for a patient is by giving a drug that will fall somewhere on the working-not working spectrum. Orthopedics offers a very definite relationship between the work that you do for the patient (surgical or otherwise) and the results that the patient has, e.g. someone comes in with a broken arm, the orthopedic surgeon reduces the fracture, and a few weeks later the arm is restored to functionality. In orthopedics, problems are can often be completely (or nearly so) fixed, not attenuated to some degree. I've heard a doctor in another branch of medicine joke, "What's a lab test for an orthopedic surgeon? (Pretends to hold vial up to light) Yep, looks blue." Ben Franklin once said that it's better to be thought of as stupid and remain silent, someday I think that I would be perfectly content to be satisfied and thought of as less smart, rather than a miserable neurosurgeon.

2nd Stability through Time: This is one that I've never heard anyone else mention, but it always has stood out to me. I think that 10 years down the road, PAs, nurse practitioners, and supermarket clinics will drastically change the way many specialties will work, esp. family practice doctors (which also is something I considered). But 10 years from now, while the actual techniques and materials that orthopedic surgeons use will have changed, the principles behind the orthopedic treatment of patients will not have changed. Maybe this has some overlap with point one, but what I'm trying to say is this: 10 years ago someone with a bad hip came to an orthopedic surgeon to have it replaced (just like they will 10 years from now). But ten years ago, the treatment for cardiac conditions was largely surgical--now it seems largely medical (from what limited information I've heard). For me this is just another reason to go into a specialty that you can devote your working life to with no fear of having to make big changes somewhere down the road.

3rd Working with My Hands This was never something that consciously led me to consider orthopedics, but rather something that I noticed in hindsight. I enjoy working with my hands--I played baseball in high school, and I have done some woodworking these past two summers and I absolutely love it. Actually, I think it may even go back one level further. I enjoy creating things. I like taking nothing and turning it into something. I like having plywood and 2x4s and turning them into a coffee table. I like in baseball (now softball) that every time the ball is hit to me I have to "create" an out from different circumstances. I like seeing a color that stands out among many different colors and making a photo that I will appreciate for a long time. That's why I think that someday I'll enjoy both the process and the results of orthopedics.

4th Forming Relationships: Perhaps this first part is a biased opinion, it seems that orthopedic surgeons enjoy each others company and that they are generally one of the "happier" doctors that I run into (collectively, I'm sure there are exceptions). The orthopedic practice in my hometown plays as a hockey team in a rec league, and the doctor I shadowed just seemed to be really happy doing what he was doing. Also, I like that there is a component of clinical work in orthopedics. What you are doing isn't strictly surgical and because of this one can take the time to form relationships with his/her patients (although admittedly, there are other specialties which allow for greater relationship-forming). I guess it's the balance that appeals to me. Also, I like that even though orthopedics is demanding time-wise, from what I've heard one can still be a family man/woman--which is very important to me. I got into medicine to help people in a way that is challenging, rewarding, and scientific, not to desert my future wife and use the excuse of a calling. A calling is feeling led towards medicine--so much so that you would spend the prime of your life pouring over books and working through long hours of residency. It's not an excuse to spend 100 hours a week working (post residency) and think that is what's right for your wife/husband and 5 children. So to summarize that mini rant, orthopedics allows one to self limit the time put in so as to have a balanced life.

5th Medical Mission Work (not necessarily ortho-unique): Someday I would like to do medical mission work, and I think that having some surgical skill, be it general orthopedics or otherwise, would allow me to be the most effective at helping the under-served of another country. In other words, having a surgical skill would allow you to perform a greater variety of services to the indigenous population than perhaps an internist would be able to--this is not at all meant to be a knock on other specialties.

6th Condition Diversity Orthopedic surgeons work throughout the body and it seems like it is harder to be pigeon-holed (unless you want to be) than it is in other specialties. Whether it is true or not, I've heard that the majority of the work a general surgeon does is gall bladder removals and appendectomies, and to me at least it seems that orthopedics allows the doctor to decide what they would like to focus on/not focus on.

Cons: Long hours during residency, on the longer end in residency length

This is why I don't know who would want to do anything else, that said, I still have very little practical knowledge about medicine itself and am still open to changing my mind.