internal medicine in surgery

[adjsmj]

I was wondering which area of surgery had the most internal medicine. I really like interpreting lab values, and the problem solving involved in medicine, but I want to do some surgery also.

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[GTMD2Bee]

Trauma/Critical Care is an area that often requires a lot of medical mgmt, mostly in the ICU setting. There is some surgery, but that is one of the knocks on trauma is that they really don't go to the OR that much unless you're in a city with a high enrollment in the knife and gun club. However, I do know of some traumatologists who also practice a little general surgery on the side.

 

[droliver]

Surgical critical care & transplant are hands down the most flea areas in surgery. The majority of your time in both is complex medical mgt., acute & chronic (with transplant). The critical care area has become surprisingly lucrative as attention to billing has in many cases allowed them to surpass their colleagues in general,oncology, & vascular in revenue

 

[task]

Not to take away anything from my surgical colleagues <img src="graemlins/laughy.gif" border="0" alt="[Laughy]" /> but if you enjoy a good mix of the cognitive challenge and intellecutal rigor of medicine and enjoy procedures for their tangible sense of accomplishment, you might also consider Cardiology or GI.

 

[adjsmj]

what about general surgery? How much internal med do they perform?

 

[droliver]

Probably about 80-90% of your time is related to patient care issues during your training. About the only thing I've ever gotten a medical consult for on a University are for dialysis or cardiac related issues (MI requiring cath., disecting aorta, myocardial contusion, & complex malignant arrythmias). When you work with private practice doctors all bets are off. Because of hospital politics @ many places you end up with renal, ID, GI, endocrine, cardiology,etc... all at the same time making for very inefficient & disjointed care

 

[task]

I think what droliver says is true to some extent, but will vary from institution to institution and case to case. Being a CCU resident now, I have two cases on my service that were transfers to our Unit from the Trauma Service (one had a NQWMI in the context of a vfib arrest after a MVC, and the other Trauma patient had an ST elevation MI and required emergent intervention). Trauma follows along, but don't really offer a whole lot. One required cath/PTCA, and one requires a watch and wait stance. If it were me, I wouldn't want a surgeon managing me if I had an MI, cath lab or not. Here, surgeons are VERY reluctant to manage even fairly straightforward medical issues. When on CCU call, I get calls from my counterparts on the SICU and Burn ICU asking for management tips for things like afib with RVR all the time, or even questions like "why is this patient in Afib?". I don't consider rate controlled afib a malignant arrhythmia. ESRD patients, no matter what their primary problem and stability, are admitted to a medicine service. Being a Louisville grad, I know that General Surgeons there do manage a whole range of medical issues -- much more so than most places in the country. Part of this is the fact that Dr. Polk encourages his residents to be complete doctors, but part of it is because Medicine there is comparatively weak to surgery, so it's incumbent upon the GS there to be more on the ball with medical issues. Now whether or not this is appropriate is up for debate, but in most cases the surgeons do appropriate things. Where I train, on the medicine consult service we are inundated with consults from all the surgical services for both complex and stupid issues, with the occasional intention to dump. We get asked about which antibiotics are best to use in a particular situation to questions like "why is this patients creatinine 3 when it was 1.2 four days ago?". I don't know that the experience of having to get other medical consult services involved at Jewish and Norton (the Louisville privates) is so much political as it is medicolegal and on some level the right thing to do with patients with medical issues.

Again, this is not to say that general surgeons can't manage basic (and some complex) medical issues well. They do. That is only common sense. But there are just as many basic (and complex) issues that they can't/don't, and where calling a Medicine person or subspecialist is also commone sense.