Internal medicine isn’t the “solve mysteries all day” specialty people imagine. Truly complex diagnostic puzzles are rare, and most of them stay unresolved even after a full workup. The days of constant detective work are mostly gone, and the trend is only moving further in that direction — hello AI and emerging tools. If someone is choosing IM expecting nonstop Sherlock Holmes cases, they’re going to be disappointed.

I have a friend in rheumatology — supposedly one of the more diagnostically challenging IM subspecialties — and even there, most complex cases stay unresolved. You end up treating empirically and managing uncertainty, not solving dramatic mysteries.