Did I Make the Right Decision?

I've been second-guessing myself a lot lately.

This time it's in regards to work. I love emergency medicine. Don't get me wrong. And I don't regret leaving the FRCP program-- I really had no intention of doing research, administration, or academia in general. Gah. I am SO through with academia. But I have to admit that after getting my independent practice license in family medicine, I have definitely been doubting my decision to do an extra year.

Some of it is envy. I hear what my fellow family residents are doing-- hospitalist, clinics, family practice. They have all settled into real job where they seem to have control over their work environments and are getting on with their lives. Suddenly, spending my days in a university student health clinic writing sick notes and doing STD testing actually looks appealing. I'm not sure what aspect of it is suddenly looking good to me... realistically, it might just be the possibility of making an actual secure salary and starting to pay off the debt. Money has been a major stress since residency started, and is only getting worse as I face maternity leave. The idea of getting on top of our finances rather than just making ends meet is incredibly appealing. 

But it's more than that. Family medicine was... comfortable. Familiar. Safe. I rarely felt like I was in over my head. If I did, I would refer. I would show up to the office in the morning after rounding on my patients at the community hospital across the street, make myself a cup of green tea, eyeball the lab results that had come in that morning, see a few patients-- there was usually the odd curveball thrown at you during the course of the day. Someone sick enough to warrant being squeezed in between patients, someone who was sick enough to send over the the ER across the street (with a quick phone call to the ER doc with the head's up, and another to the charge nurse with some orders to get testing started at triage)... just enough to make the day interesting.

There was always one or two of what a former preceptor referred to as 'heartsink patients'... the ones whose names you see on your schedule for the day and sigh reflexively. The ones who always come in with numerous complaints, none of which are serious and none of which you can ever fix to their satisfaction. And there are always the no-shows, the people who book for an assessment of an ingrown toenail and just happen to confess a 4 year history of bulimia as an aside, the people who show up for their appointments with two family members and expect everyone to be seen in the one appointment slot... it's certainly not smooth sailing all the time. And there were definitely days that bored me to tears.

But the emerg is different. And although I love it, I can't imagine ever feeling as comfortable in the ER as I am in the office. In emergency medicine we're always taught to look for the 'what if?' that could be hiding in the patient's presentation. Sound like typical GERD? Sure, until the otherwise healthy 34-year-old woman goes into v-fib arrest. Looks like a medical clearance brought in by police? Ah, only until the 20-year-old man seizes secondary to the 6 grams of cocaine he swallowed trying to evade police. Abdominal pain with LFT's typical of acute obstructive choledocholithiasis? Only until the incidental finding of dissecting AAA on the CT. All of these cases actually happened, and have made me view every patient as a potential ticking time bomb. In fact, the more I learn about emergency medicine the more I'm convinced I will never know enough to be a good emerg doc. I know I'm not even halfway though the program, but the docs I've worked with just seem to know SO MUCH. Everything I learn just seems to highlight how much I don't know yet. 

When I look at the big picture, I still want to do emergency medicine. I love shift work, the pay is better, I don't have to worry about the overhead and 'running a business' aspect of family medicine, I like working with people who are actually sick and not just spending my days holding hands and practicing preventive medicine... I'm not sure where the sudden uncertainty is coming from. 

Must be hormonal.