Controllable lifestyle as a factor in choosing a medical career

Article Abstract:

A survey of over 10,000 1983 medical school graduates revealed that there is a marked increase in the selection of specialties having a controllable lifestyle, such as radiology, ophthalmology, or dermatology. There has been a marked move away from the choice of primary care specialties. Medical educators are seeing the effect of the 'yuppie' mentality on medical students. For these students their main interest during medical school is to secure a residency in a specialty with a less demanding program, a lucrative future and limited patient responsibility: a controllable lifestyle. Increased demands for medical care by a better informed public resulted in overburdening of the primary care provider, who responded by further specialization, limited appointment hours and the formation of group practices. The Emergency Department became the after-hours M.D., and the emergency room physician emerged as one physician who had regular hours. Medical students, seeing the differences in lifestyles among various specialties, are showing a preference for the controllable specialties. Since performance in medical school affects selection for a residency program, it is not surprising that a higher proportion of the top medical students are now choosing controllable lifestyle specialties. Additionally, young physicians in primary care are frequently switching to controllable lifestyle specialties. There has been a decrease in interest in the medical profession by top students in colleges; their goals and mores are more person-centered than service-centered. Surveys of senior medical students have shown lifestyle issues to be the single most important factor in selection of specialty. The yuppie mentality is diametrically opposed to the traditions of service to patients and teaching that have previously been so cherished and have made American medicine a noble vocation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Social aspects, Medical education, editorial

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Operative cholangiography

Article Abstract:

One of the most frequently performed abdominal operations is gallbladder removal, or cholecystectomy. One reason for performing this procedure is to remove a hidden gall stone, often in the common bile duct, the duct formed by the joining of the cystic duct from the gallbladder and the hepatic ducts from the liver. There is controversy over the best method of evaluating the common duct for stones. The diagnosis of a stone in the common duct is usually made based upon a positive cholangiogram, an X-ray of the bile ducts taken after injection of a radio-opaque contrast dye. There is disagreement over whether this test should be routinely performed on all patients as a method of diagnosing retention of common duct stones. A study of 579 cholecystectomies was undertaken to determine the usefulness and safety of routine cholangiography in diagnosing biliary duct stones. During surgery, cholangiography was performed on 84 percent of these patients. The procedure added only 10 minutes to the operation time. By using cholangiography, 23 patients (5 percent) with unsuspected common duct stones were identified; all underwent successful stone extraction. The patients experienced no complications or ill effects from the common duct exploration. Fifteen patients (3 percent) had false positive cholangiography and underwent unnecessary duct exploration, but they suffered no adverse effects from the exploration. There were 59 patients (12 percent) who, because of other indicators, would have undergone common duct exploration, but this was avoided because their cholangiograms were normal. In follow-up, one patient developed a stone in the common duct, eight years after surgery. It is concluded that routine use of cholangiography as a screening measure is effective, helpful and safe for use in patients being evaluated for common bile duct disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Methods, Cholecystectomy, Bile ducts, Gallbladder, Biliary tract diseases

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A rural surgeon's perspective on general surgery

Article Abstract:

Medical school applications and the grade-point average of students admitted to medical school are declining. At the same time, medical students' choices of specialty training are changing. Before 1978, 75 percent of medical students chose internal medicine or general surgery; today less than 40 percent enter these specialties. The top 10 percent of students are currently choosing specialties that allow for controlled life styles, such as radiology, anesthesiology, dermatology, emergency medicine, neurology, ophthalmology, pathology, and psychiatry. The practice of general surgery does not allow for a controlled life style and has a poor image; a physician in this specialty is 'just a general surgeon.' The gap between the number of physicians serving rural communities and urban areas has continued to widen. A surgeon who practices in a small town is a true general surgeon. He/she performs some of the more common and less complicated procedures in orthopedics, gynecology, urology, otolaryngology (ear,nose and throat) and thoracic surgery. The author feels that medical students are asked to choose specialties too early in their training. Rotating internships should be brought back to give them exposure to different areas of medical practice before they choose a specialty. A recent study reported that a greater number of residents entering rural practice had completed a rural rotation experience, compared with those who entered urban practice. Communities need to maintain closer contact with medical schools and provide an environment that will attract physicians. Medical schools should establish programs for residents interested in general surgery practice in small towns, and provide the opportunity for rotations in rural areas. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Demographic aspects, Training, Surgeons, Medicine, Rural, Rural medicine

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