Brawn, meet brains

Even though I've been pretty sure for a while that I wanted to go into Orthopaedic Surgery, I was concerned up until recently that there wouldn't be much clinical decision-making involved. Just cutting and sawing. There are a few reasons I thought this, but primarily I think it's due to the perception other clinicians have about surgeons, that they're "all brawn and no brain."

Well, I've now completed 4 months of Orthopaedics electives and I can safely say I'm not concerned in the least. There is PLENTY of clinical decision-making involved in being an Orthopaedic Surgeon. I would argue there's just as much as in any other medical field. 

I found during these electives that, to my surprise, not every patient that walks in the door complaining of knee pain gets a Total Knee. Maybe they almost all do eventually, but there's lots of evaluation and calculation to be done before a patient can be indicated for surgery. 

Yes, if they're 70 years old, otherwise healthy, have debilitating symptoms, failed conservative management, and radiographic evidence of advanced OA, they're probably going to be booked pretty quickly. But what about the 46-year old active guy who has activity-limiting hip pain but not much to be seen on X-ray? What if he's 53? You going to indicate him then? How about at 61? What if he failed PT? What if he's otherwise a good candidate but not motivated at all to do the rehab work?

But that's just arthoplasty. There's still Sports, Pediatrics, Tumor, Foot and Ankle, Upper Extremity, Spine, Trauma, and Shoulder. In each of those, I found a satisfactory amount of evaluation and workup... which isn't too much, really.  I honestly don't need there to be extensive lab tests and discussions about every case, because yes, there are some straightforward cases in any specialty, I just wanted to make sure I wasn't committing myself to be a mindless scalpel jockey for the rest of my life like the internists would have you believe.

That, combined with the parts of Ortho that I already knew I loved (working with hands, ability to FIX a patient, pure fun aspect, relatively healthy patients, mostly grateful patients) have fully convinced me I'm doing the right thing for me.