Consult Cards

I'm doing consult cardiology right now, and overall, I love it. Cardiology, or "cards" as it is referred to occasionally, is an amazing specialty. If you liked physics, or math, because "it just made sense," you'd love cardiology. It is far and away the most scientific of the branches of medicine, in that it takes evidence based medicine very seriously. Every point has to be proved. For example, even knowing nothing about physiology, you'd probably guess that someone with "inducible arrhythmias and heart failure" is worse off than someone with "heart failure alone", right? Well, cardiologists felt compelled to prove that, in a trial called MADIT 1. That's the other quirk of this specialty, all the important studies seem to be named. MADIT, CONSENSUS, AFFIRM, ISIS... the list goes on for ever. There are over 2000 named trials.

But I am being sidetracked. The intricacies of cardiology are not my point here, interesting as they may be. What I wanted to say was the oddity I've noticed with consult medicine. As a specialist, you are consulted to see patients you don't need to follow closely. You are concerned with one problem, or at least, one organ system. And so the connection with the patient is not as strong as from the primary team. So I see dozens of patients, but have difficulty remembering names. I see a slice of who they are, but I'm being forced to consider only one organ system, and the others only as they relate to that system. It keeps the patient at arms length in a sense. I'm fairly sure I don't like that.

The good news is that no specialty is entirely consults, as far as I know. It is also possible to see clinic, and have your own patients, in all of the medicine subspecialties. So, while cards remains at the top of my list of favorites, sober judgement (and review of my grades) is causing me to keep my options open. We'll see.