Primary care Physician versus Sub specialist

After my post graduate training in Internal Medicine [ie MD], I had two options. Either to work as a primary/secondary care General Physician or go for a sub- specialisation [or as it is called in India, Super specialisation,ie DM]. I chose the first option. Why? Do I regret it?

Why I chose not to study more? Primary reason was I had become fed up with studies . I had spent almost 26 years of my life studying by then[including KG].
Also I was married and had just become a proud father. Wanted to earn something for myself and my budding family.
Another factor that made my decision easy was the appointment letter from the Government, posting me as a Physician in a small town not very far from my home.

There was also another big reason. I hated confining myself to one organ or organ system. Internal medicine had all the thrills. The wide variety of illnesses that an internist manage made it an exciting profession.
At that time, I had some noble ideals too [young and romantic?]. I wanted to help as many patients as possible especially the poor. So rather than being a super specialist in a 5 star hospital looking after the cream of the society, I preferred the Govt job as an internist in a small, run down Taluk hospital.
Do I regret it?
Yes, some times.
Especially when patients ask, 'Sir enthinde specialista?'[ in what subject are u specialised in?]or when they ask 'do you feel I should see a specialist?'
Some times it is the relatives who ask the same question.
I reply to them trying to make them feel I am an all rounder, knowing about all diseases.
Also, I regret it some times when I realise that the sub specialist's consultation fee is twice or thrice that of mine.
But most of the time I don't regret it. Looking back I feel my decision was right.

I enjoy my profession. I like the thrill of finding out the cause of fever in a FUO [fever of unknown origin]. I like the satisfaction I get when I correctly diagnose the cause of breathlessness in a poor patient by just patiently listening to the history and using the stethoscope,without ordering any fancy investigations. I like the way people come to me for advise regarding anything related to medicine. I am happy taking disease prevention classes to house wives or school kids or teachers or Taxi drivers or 'Positive'[HIV] people. I feel I am doing something when I console and give hope to a crying man or woman when they first realise they are 'Positive'.
So as of now I am happy being a Generalist who 'know a lot about a lot of illnesses rather than a super-specialist who 'know more and more about less and less'.

Sad News

The Type 1 Diabetic patient in 'Strange Interview' and 'Happy News' called me to tell that she had a spontaneous abortion.
Her recent blood sugars were between 80 and 220mg but her frequency of testing was only about once a day or once in 2 days.
Early foetal loss is most commonly due to congenital defects in foetus caused by high blood sugar during first few weeks.
For a diabetic woman who wants to be pregnant, keeping a very good control over her blood sugar is very important.The first 42 days after conception is the most important period, but in most cases the woman will be aware that she is pregnant only after a missed period, which is about 14 to 21 days after conception.
So planning the pregnancy in advance and keeping a tight control on blood sugar is absolutely essential.
The loss of that foetus was a personal failure for me too. I should raise the standard of my care of care of Diabetes in Pregnancies.
I had emphasised all these to her and I hope she will have a successful pregnancy next time.

Thirty versus Forty -- Part 2

Reading my last post again I realised I was too negative. Is it true that at Forty I have lost everything that was good in me? No It is not true. Let me try to enumerate the positive changes in me.

My ability to communicate with patients have improved over time eventhough time available for each patient is less. My ability to find out the correct cause of the each patient's problem have also increased very much. This have helped my patients from undergoing unnecessary investigations and mental trauma.

I have established a very good practise with a large number of loyal patients. I read [when I get time] journals and Text Books.Still now I am one of the better informed doctor of my age.
I have a very good relationship with all other doctors I work with.
I have done some good work in training other doctors in HIV/AIDS. I have become a much better speaker in front of general public and even in front of doctors.
The quality of care I give to my patients as a whole have improved.
Lastly and not the least I have a blog of my own which I am able to maintain with frequent posts.
So Forty is not bad at all.