Pain Management

ROAD to life
(Radiology, Opthamology, Anesthesia, Dermatology)

I shadowed an attending at the UCSF pain management center today. Learned several useful things. First, that personality match really determines what kind of residency a person ends up in. In addition, a balance of what kind of impact you want with the economics of how to make enough money to support a family seems to play heavily into this (I guess considerations when you are in your 30s with a family is very different from the 20s). And specialties like Dermatology are not just important for their money making potential and lifestyle but also seem to offer a wide range of options for practice anywhere from myeloma to private cosmetics clinic.

Research is important in getting into such competitive residencies because most people want folks that will advance the field. Note to self: shadow and participate in research early in med school so I can know if I want or don’t want to go into these fields early on.

In addition, I was not that happy about a few things I saw today in the treatment of patients. First of all, an outpatient clinic may be a great place for seeing VIPs (CEOs, presidents of companies and institutions, professors, etc) but the doctor I worked with didn’t seem to like poor people much and used words like “crazy”, “draining”, “waste of time” when it came to describing the Medi-Cal patients she HAD to see. I also did not like the general trend of very specialized tertiary care in which you really stick to what you know and although you “Communicate” with psychiatrists, neurologists, etc you don’t really know enough to form a unifying diagnosis about the underlying cause of some pain and can only treat the symptoms. Seeing the patients also allowed me to better understand some of the problems of western medicine. For instance, many chronic pain patients will live with pain the rest of their lives and the drugs can only help control and “manage” the pain, not cure it. Meanwhile, many do not respond to certain drugs, most have to take a combined regimen and will experience varying degrees of side effects. Dosing is very much an idiosyncratic art form (based on experience and trial and error) rather than a science since it varies patient to patient.

Also the very existence and marketing of “miracle” drugs creates a dependence mentality whereby some “treatment or diagnosis seekers” just go around trying everything because they think there MUST be ONE single scientific diagnosis or magic pill they can take to make the pain all go away.