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Is a specialist, such as a trauma surgeon, able to prescribe medication, similarly to an IM doc, for things like the flu? In general, what things can a generalist do that a specialist cannot?
Can a specialist (eg surgeon) effectively do what a generalist (eg IM) does?
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Why would a trauma surgeon want to? If they are a dedicated trauma surgeon, then they are most likely practicing at a busy trauma center and do not have time to see general patients.
Nevertheless, yes, they can still prescribe general meds for the flu. They have a medical license just like any other physician, and as such, can prescribe non-surgical meds.
Nevertheless, yes, they can still prescribe general meds for the flu. They have a medical license just like any other physician, and as such, can prescribe non-surgical meds.
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coolness said:
Any MD can prescribe - a psychiatrist can write for ace inhibitors and a cardiac surgeon can write for SSRIs... but neither of them would do it.
I think your thread started as "can a specialist >effectively< do what a generalist does" and I'd have to say no. While they're legally allowed to do so, I don't think you'll find any specialists who feel fully competent doing anything general.
On that not, IM and surgery are so vastly different that you can't really call one general and the other specialized. Both have generalists and specialists within themselves.
along the same lines as the above post, a surgeon might not be completely up-do-date on the current practice guidelines for specific conditions. of course, they'd be able to tx the basics but they'd probably be pretty uncomfortable with managing an inpatient in a medicine ward.
actually, even IM subspecialists wouldn't want to treat a complicated case in a different IM subspecialty. after all, that's why they go through their fellowships. and in the surgical field, techniques are so specialized that you wouldn't want a general surgeon doing something beyond his/her scope.
actually, even IM subspecialists wouldn't want to treat a complicated case in a different IM subspecialty. after all, that's why they go through their fellowships. and in the surgical field, techniques are so specialized that you wouldn't want a general surgeon doing something beyond his/her scope.
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That's true. A friend of mine who is a GI attending (ERCP guy) hates his gen med ward months because
1) what does he know about managing hypertension? and
2) every single resident knows more about general medicine than he does
He basically just lets the 3rd years run the service and signs the billing forms.
1) what does he know about managing hypertension? and
2) every single resident knows more about general medicine than he does
He basically just lets the 3rd years run the service and signs the billing forms.
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Don't medical licences say something like "Joe Schmo, M.D. is herby licensed to practice medicine and surgery in the state of Ohio"? That doesn't mean an FP is gonna attempt a heart transplant!
Like the above posters said, you can leagally write for ANYTHING w/ a license, but most doctors know what they're qualified for and what is better handled by someone else.
Like the above posters said, you can leagally write for ANYTHING w/ a license, but most doctors know what they're qualified for and what is better handled by someone else.
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I know of many FP's who do C-sections.Amy said:
Yes, but Family docs are trained in obstetrics and peds. General surgery and minor procedures are also definitely within the scope of an FP's residency training. Whether or not they actually keep up that aspect of their skills-set is up to the individual doc and the type of setting where he practices. Urban/suburban family docs probably would consult with an OB-GYN for a C-section but in the rural settings, FP's are often the ones that handle that sort of thing. Also, in rural type settings it's often the FP who handles the emergency rooms. Just depends on what's needed.
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When i was nsurg resident in my country, like many other residents in the field, i developed a thinking - we, nsurgeons don't look below the brain and do this and do that. It was kind of a demi god concept. True, many beginners in a hi tech field think like that. But as they move on they start respecting other specialists when they call them for referral for an issue in a different field of expertise. This is when the concept of 'i can also prescribe this and do this' diminishes.
Now that i start int med to move on to neuro, i realize that the job of internist is far from easy. Internists know much more than subspecialists on the wide spectrum of drugs prescribed, their adverse effects and interactions and also recognizing the early features of certain diseases clinically before someone from a non related field does.
If someone asked me about Dilantin(phenytoin), i could speak volumes about it. But if you ask me about ACE inhibitors, my knowledge was limited. But internists know about it and many other things. I eventually admired certain attendings who also taught residents dignity and respect for generalists and other specialists. There was a post op parasagittal meningioma with seizures we found difficult to control. Repeat CTs showed no hematoma or hydrocephalus. As nsurg residents our ego was preventing us from asking neurology referral. Our nsurg prof told us to do it. The neurology team evaluated and worked up the epilepsy and seizures were controlled.
There was a diabetic pt with brain tumor posted for surgery receiving dexamethasone to keep ICP in check. The blood sugar levels were high and we knew it was due to dexa, but how to modfiy antidiabetic drugs. All of us read about OHA and insulin preparations, but which to give and how much. So referred to an internist and it was done and everything was perfect.
Now i have a profound respect for internists (generalists) and their work. Most specialists cannot deal with many issues.
If i were asked this question, i would say- Sure i can prescribe, but i cannot use it to the patients benefit. By the way how much dose should i prescribe !!!!
Now that i start int med to move on to neuro, i realize that the job of internist is far from easy. Internists know much more than subspecialists on the wide spectrum of drugs prescribed, their adverse effects and interactions and also recognizing the early features of certain diseases clinically before someone from a non related field does.
If someone asked me about Dilantin(phenytoin), i could speak volumes about it. But if you ask me about ACE inhibitors, my knowledge was limited. But internists know about it and many other things. I eventually admired certain attendings who also taught residents dignity and respect for generalists and other specialists. There was a post op parasagittal meningioma with seizures we found difficult to control. Repeat CTs showed no hematoma or hydrocephalus. As nsurg residents our ego was preventing us from asking neurology referral. Our nsurg prof told us to do it. The neurology team evaluated and worked up the epilepsy and seizures were controlled.
There was a diabetic pt with brain tumor posted for surgery receiving dexamethasone to keep ICP in check. The blood sugar levels were high and we knew it was due to dexa, but how to modfiy antidiabetic drugs. All of us read about OHA and insulin preparations, but which to give and how much. So referred to an internist and it was done and everything was perfect.
Now i have a profound respect for internists (generalists) and their work. Most specialists cannot deal with many issues.
If i were asked this question, i would say- Sure i can prescribe, but i cannot use it to the patients benefit. By the way how much dose should i prescribe !!!!
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What you know is entirely based on 1) what you do 2) what you study. Doctors in the US are very specialized. In other countries, some surgeons do enough general medical care that they feel comfortable on the wards, in the clinic, etc. If you only do orthopedics for 20 years, you will be very good at ortho and know very little about anything else.
As an EM doc I know a lot about resuscitations, trauma, acute medical care and outpatient care. I am weaker on complicated chronic problems, but if I worked in a clinic I'd probably get better at those.
Some of the smartest docs I know have had multiple specialities, or have worked in multiple fields, and so they know medicine from all angles.
As an EM doc I know a lot about resuscitations, trauma, acute medical care and outpatient care. I am weaker on complicated chronic problems, but if I worked in a clinic I'd probably get better at those.
Some of the smartest docs I know have had multiple specialities, or have worked in multiple fields, and so they know medicine from all angles.
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FP's who do C sections do so because there is an OB fellowship for FP grads to train them to do just that.
I have heard that some FP's do some basic general surgery like appys. However I don't think that FP's are qualified to do "general surgery", and I'm not very comfortable with the idea of them doing appys. What if you find a normal appendix but some other intraabdominal pathology? Surgery is a 5 year residency for a reason. It takes a great deal of time to learn the skills and judgement necessary.
Medicine is to complex a field for any one person to be competent in all areas. Surgeons are often maligned for getting a medicine consult for their pts. While I agree that we should be able to take care of basic issues (HTN, DM, etc), what If I've tried 2 different BP meds and the pt's BP isn't under control? At that point my pt is better served by the assistance of someone who knows about all the different BP meds and keeps up with that literature.
By the same token, if a pt is on the medicine service, and the pts BP remains uncontrolled by multiple meds, I hope the medicine docs get a surgical consult to help make sure there's not a rare but surgcially correctable cause of the HTN.
It's up to each individual physician to know what his/her limits are. However, the procedures you perform in a hosptial would also be limited by what you are credentialed for. I imagine it would be difficult for a FP doc to get credintialed to perform general surgery.
I have heard that some FP's do some basic general surgery like appys. However I don't think that FP's are qualified to do "general surgery", and I'm not very comfortable with the idea of them doing appys. What if you find a normal appendix but some other intraabdominal pathology? Surgery is a 5 year residency for a reason. It takes a great deal of time to learn the skills and judgement necessary.
Medicine is to complex a field for any one person to be competent in all areas. Surgeons are often maligned for getting a medicine consult for their pts. While I agree that we should be able to take care of basic issues (HTN, DM, etc), what If I've tried 2 different BP meds and the pt's BP isn't under control? At that point my pt is better served by the assistance of someone who knows about all the different BP meds and keeps up with that literature.
By the same token, if a pt is on the medicine service, and the pts BP remains uncontrolled by multiple meds, I hope the medicine docs get a surgical consult to help make sure there's not a rare but surgcially correctable cause of the HTN.
It's up to each individual physician to know what his/her limits are. However, the procedures you perform in a hosptial would also be limited by what you are credentialed for. I imagine it would be difficult for a FP doc to get credintialed to perform general surgery.
