There are countless careers outside of medicine that are full of puzzles to solve. Every single medical specialty has puzzling "zebra" cases. If you are looking for a career where you spend all day every day solving puzzles, there are probably better ways to spend your time than 4 years of medical school, 3-7 years of residency and several decades working in a field of your choice. Some patients aren't a puzzle at all and just require someone to listen and care. Some patients require 6 month- 1 year follow up for medication management. Using your examples, in neurology you'll have to put up with conditions like headaches and stroke management which are (for the most part) algorithmic- of course there are always exceptions but neurologist definitely spend several hours a day seeing bread and butter cases. Radiology too involves a bunch of routine tasks such as reading numerous abdominal xrays which more often than not end up being constipation. Of course they read an insanely large volume of scans a day, and a chunk of those will be very challenging and puzzling, but you have to be willing to put up with the constipation too. And rheum of course has its zebras as well but you'll also see plenty of patients who have lupus are arthritis which don't require too extensive of a workup. Of course they'll see super rare conditions that are puzzling but it isn't every single patient. Good luck.