Does a specialty exist such that...

[Rocket3004]

Sorry for the cliff hanger title... and I'm not quite sure this is the right place, but:

Does a specialty in medicine exist, such that you can:
A.) Diagnose the problem
B.) Go in and fix it (I'm thinking via a procedure).


The reason I ask: In my spare time, I really enjoy doing stuff with my hands: building things, wrenching/working on cars, doing handy work, other mechanical things playing with gadgets, etc. Also, as far as medicine, if I were to do surgery, I assume not much diagnosis is involved, and that's also something I *think* I enjoy... (and on a side note: it seems weird not diagnosing things later on considering so much of your MS1/MS2 years seem to emphasize the diagnosis/understanding of pathology - I don't know if I would be comfortable throwing that out the window) using your knowledge of basic science/physiology and pathology along clues presented to you to figure out what is going on, sort of like a puzzle.

I think I would like to do that (solve the "puzzle"), then take it one step further in planning and executing treatment by "going in and fixing the problem".

This might sound weird, but I hope if makes sense. It's late and I'm procrastinating.

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[masterofmonkeys]

basically all of the surgical specialties?

Ortho - yup
ORL - yup
Uro - mostly yup

 

[Law2Doc]

basically all of the surgical specialties?

Ortho - yup
ORL - yup
Uro - mostly yup

I would expand that to say all of the procedural specialties as well. You can diagnose and fix things in GI (endoscopy), Cardiology (caths), etc.

But I wouldn't necessarily downplay the ability of pharmaceuticals to fix things. More than a few surgical procedures have gone by the wayside historically because the problem was better treated by drugs.

 

[Winged Scapula]

As a medical student, have you done your clinical rotations yet?

Because for the life of me, I cannot understand where you get the idea that surgical specialties don't diagnose patients.

 

[dragonfly99]

A word to the wise. You better NEVER say to a surgeon during your 3rd and 4th years that surgeons don't diagnose things. They will be PISSED.

Traditionally internal med is probably stereotyped as the specialty with all the eggheads where patients are referred if nobody can figured out what the heck is going on. And then we do a "chart biopsy", thorough exam (hopefully) and maybe order a lot of obscure tests. LOL.

In actuality, a good surgeon (particularly in general surgery, but also some other surgical subspecialties) should be good at diagnosing things within their area also. For example, "abdominal pain" is a common complaint that an ER doc might call a surgeon to get a consult and an opinion about. If you are an ortho doc, you might get a patient with shoulder pain the primary care doc was trying to treat but it's not getting better...so you get to decide is it rotator cuff problem, something else, etc.

The procedural fields like interventional radiology, GI, and interventional cardiology are highly hands-on as well.

So I think there is some diagnosing in most medical specialties, but if you like a lot of random/undifferentiated cases, you might like primary care or general surgery.

If you are a "tool time" guy then you would be stereotyped as an ortho guy. You could shadow some clinicians, senior residents, etc. before 3rd year if you want to help narrow down your ideas about what to specialize in.

 

[Winged Scapula]

Eh, I see where the OP is coming from. Most of the time, once the surgeon is called, they have a reasonably good idea of the diagnosis or at least have narrowed it down to a surgical problem.

Surgeons do diagnosis, but they don't get the same number of fresh "virgin" chief complaints off the street that a Primary Care doc will.

Sure, I get that. Patients generally do present to their PCP or ED first, if only because I require a referral and insurance to be seen. Especially as a specialist, patients often come to me with some sort of specific complaint that either often needs biopsy or surgery for a *real* diagnosis (ie, mass is not a diagnosis).

But even in general surgery, there are many areas in which the diagnosis is up to the surgeon or is clarified by them. IMHO, "abdominal pain, possibly appy" is not a diagnosis. Its a guess; may be right, may be wrong.

I'm fairly sure the OP has not done a surgical rotation otherwise he would see its about a lot more than just cutting people up because the PCP or ED says we should. Just today, I turned away 3 patients sent to me with "surgical problems" which did not require surgery or even biopsy. A good clinical exam should be in the armamentarium of every specialty.

 

[masterofmonkeys]

And things might be kinda skewed in an academic setting.

At least where I am, it's true that GI or Vascular Medicine might do all the workup for a general surgery or vascular surgery workup, but out in private practice that's not always true.

About the only surgical specialty that I can think of where you almost never do the diagnosis is cardiothoracic surgery (where cardiology will do the workup with echo and/or diagnostic cath).

 

[Winged Scapula]

And things might be kinda skewed in an academic setting.

At least where I am, it's true that GI or Vascular Medicine might do all the workup for a general surgery or vascular surgery workup, but out in private practice that's not always true.

That would be highly variable. For example, I've never heard of Vascular Medicine and even if it did exist our Vascular Surgeons wouldn't trust anyone else with their patients (we were even doing their hernia repairs, and other assorted general surgery stuff). And our GI guys would pass off the minute it looked like a surgical problem...the exception would be the IBD patients and liver failures.

So depends on your ED and the culture of your hospital, as ours generally came fairly unworked up.

 

[Ludicolo]

Even if a patient comes to you "worked up", you can't necessarily assume that the referring physician got it right. We've all seen poor workups lead to faulty diagnoses. Part of our job is to confirm/clarify/redirect the diagnosis, and treat appropriately.

 

[Blade28]

Eh, I see where the OP is coming from. Most of the time, once the surgeon is called, they have a reasonably good idea of the diagnosis or at least have narrowed it down to a surgical problem.

Surgeons do diagnosis, but they don't get the same number of fresh "virgin" chief complaints off the street that a Primary Care doc will.

As WS noted above, often the only information we get during a consult is "abdominal pain." So we are left to workup the patient and arrive at a diagnosis.

 

[masterofmonkeys]

That would be highly variable. For example, I've never heard of Vascular Medicine and even if it did exist our Vascular Surgeons wouldn't trust anyone else with their patients (we were even doing their hernia repairs, and other assorted general surgery stuff). And our GI guys would pass off the minute it looked like a surgical problem...the exception would be the IBD patients and liver failures.

So depends on your ED and the culture of your hospital, as ours generally came fairly unworked up.

http://en.wikipedia.org/wiki/Vascular_Medicine

I'm not sure why it exists (I think interventional cards, CT surgery, vascular surgery, and interventional radiology have a pretty good handle on things), but it does.

We have a fellowship here and it can be confusing when to consult them and why, since you'll eventually have to get interventionalists or surgeons involved and vascular medicine is not an interventional field.

 

[Winged Scapula]

http://en.wikipedia.org/wiki/Vascular_Medicine

Interesting...there's even a Vascular Medicine Board.

I'm not sure why it exists (I think interventional cards, CT surgery, vascular surgery, and interventional radiology have a pretty good handle on things), but it does.

According to Wiki there's a dearth of practitioners and people fail to realize the importance and increasing problem of vascular disease. Sounds like ti was written by the makers of Plavix!

We have a fellowship here and it can be confusing when to consult them and why, since you'll eventually have to get interventionalists or surgeons involved and vascular medicine is not an interventional field.

Yeah, that would be confusing.