Question about NPC specialties

[Dicey]

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To all who are familiar with medical specialties,

I have heard that the following 6 specialty have the advantage of No Patient Care (NPC)

Radiology, Anesthesiology, Pathology, Dermatology,
Ophthalmology, Psychiatry.

I totally understand why Radiology, Anesthesiology, Pathology, Dermatology have little patient contact,
but Ophthalmology and Psychiatry?


Could someone tell me more on why these two specialties have little patient contact?
And this does not mean I wish to avoid patients when, Im just clearing some doubts from a novel.
Thank You 😀

 

[deleted87716]

I have heard that the following 6 specialty have the advantage of No Patient Care (NPC)

Radiology, Anesthesiology, Pathology, Dermatology,
Ophthalmology, Psychiatry.

The only one of those with close to no patient care is pathology. Radiology has patient contact if you do interventional. The others are totally patient care fields.

 

[Winged Scapula]

To all who are familiar with medical specialties,

I have heard that the following 6 specialty have the advantage of No Patient Care (NPC)

Radiology, Anesthesiology, Pathology, Dermatology,
Ophthalmology, Psychiatry.

I totally understand why Radiology, Anesthesiology, Pathology, Dermatology have little patient contact,
but Ophthalmology and Psychiatry?


Could someone tell me more on why these two specialties have little patient contact?
And this does not mean I wish to avoid patients when, Im just clearing some doubts from a novel.
Thank You 😀

Seems like a bogus list to me.

Radiologists often do image guided procedures which not only entails reading the exam but performing it as well. Obviously this means patient contact while placing drains, doing exams under fluoro, placing catheters, etc. Interventional radiologists by nature of their work do this on a daily basis; Diagnostic Radiologists do less but are still trained to do procedures.

Anesthesiologists see patients in pre-op clinic for evaluation and meet them prior to their procedure. It is true that much of the time their patients are asleep, do not underestimate the amount of time anesthesiologists interact with patients who are having procedures under local or local with sedation, who are having pain control procedures (done by the anesthesiologist). This is not a field for someone who doesn't want patient contact. If anything, they do the most to comfort the patient about the impending procedure.

Pathology - this is a true patient deficient specialty. Most of the time you are only "meeting" pieces of them or meeting the patient after death.

Dermatology is ALL patient contact - you spend your days in the office interacting with them directly and in the OR or procedure room as well. I'm not sure where your information comes from regarding this. Same for Ophtho and Psychiatry - all patient contact, all the time.

Perhaps you are confusing "ROADs" specialties (Rads, Ophtho, Anesth, Derm) which are widely considered to be lifestyle specialties with those that have little to no patient contact?

 

[Dicey]

I see...🙂
Thank You both for the answers.
The list was something I found in the House of God by Samuel Shem anyway.

Thanks for clearing the confusion.

 

[Winged Scapula]

I see...🙂
Thank You both for the answers.
The list was something I found in the House of God by Samuel Shem anyway.

Thanks for clearing the confusion.

Ah...a 30+ year old novel is not the best place to find information about the field of medicine.😀

 

[mlw03]

I see...🙂
Thank You both for the answers.
The list was something I found in the House of God by Samuel Shem anyway.

Thanks for clearing the confusion.

yeah, as Dr. Cox said, this is just a line in the book, and in it he's comparing those fields to internal medicine. comparatively they do have less patient contact, but certainly not none aside from pathology and diagnostic radiology. and in my experience, there's also nowhere near as much sex in a real hospital as there is in House of God. certainly no crazy orgy scenes where it's 3 nurses and one horny intern.

 

[deleted162650]

"there's also nowhere near as much sex in a real hospital as there is in House of God. certainly no crazy orgy scenes where it's 3 nurses and one horny intern."

You're obviously at the wrong hospital.

 

[DarksideAllstar]

Pathologists do fine needle aspiration biopsies (and even bone marrows at some hospitals), so yes, we do in fact have some form of patient contact.

 

[Winged Scapula]

Pathologists do fine needle aspiration biopsies (and even bone marrows at some hospitals), so yes, we do in fact have some form of patient contact.

Thank you for the clarification...I was not aware of that (having always seen my attendings do them or done them myself).

 

[DarksideAllstar]

Thank you for the clarification...I was not aware of that (having always seen my attendings do them or done them myself).

I think its definitley a more regional thing, particularly with breast FNAs. Where I am currently training we have some pretty outstanding cytopathologists who are very adept at getting quality samples and making an accurate diagnosis. This may be the only place in the country where they will call invasive carcinoma by FNA and the patient goes to surgery (rather than to core bx).

 

[Winged Scapula]

I think its definitley a more regional thing, particularly with breast FNAs. Where I am currently training we have some pretty outstanding cytopathologists who are very adept at getting quality samples and making an accurate diagnosis. This may be the only place in the country where they will call invasive carcinoma by FNA and the patient goes to surgery (rather than to core bx).

How can you call it invasive without tissue edges?😕

I've taken a patient to the OR based on an FNA and other clinical and radiological parameters (as well as patient preference) because we had excellent cytopathologists but I've never had one call invasive without actual tissue margins to look at.

Besides, I'm greedy...I can bill for the FNA or biopsy if I do it myself; I can't if I let the pathologist do it. Maybe some surgeons are loaded and don't care (or are on salary).

 

[DarksideAllstar]

How can you call it invasive without tissue edges?😕

I've taken a patient to the OR based on an FNA and other clinical and radiological parameters (as well as patient preference) because we had excellent cytopathologists but I've never had one call invasive without actual tissue margins to look at.

Besides, I'm greedy...I can bill for the FNA or biopsy if I do it myself; I can't if I let the pathologist do it. Maybe some surgeons are loaded and don't care (or are on salary).

I misspoke in my previous post. Generally though we sign them out as "ductal or lobular carcinoma," and then defer to core for invasive vs in situ.One attending I've worked with said that sometimes you can favor DCIS if you can see the myoepithelial cells rimming the malignant cells (not sure if others would agree with this)-- but almost all of these patients get cores anyway. Personally, I'd like to abolish the idea of breast FNAs altogether, although they are relatively cheap and quick and work well in the underserved (read: poor) population who have a difficult time with follow up. Also good for things like FCC and FA where you know that its going to be benign, but its primarily for patient reassurance.

 

[Winged Scapula]

That makes more sense.

I find breast FNA definitely has a role when the history, clinical exam and imaging results are consistent with a benign process. They also serve a patient reassurance role as well. I worked with two attendings in my fellowship who approached these very differently...the academic one was much more likely not to do FNAs on what clearly looked benign based on the above factors, unless the patient was very anxious or essentially demanded it. The private practice surgeon, however, pretty much stuck a needle in everything she could see or feel. Turns out she had been wrong about a previous patient with what looked like a benign lesion...said it made her paranoid ever since. Can't say that I blame her.

I'll also do breast FNAs for what looks like malignant disease but only under certain conditions:
-where the patient has not been booked into a procedure slot (so there really isn't time to do local and a core),
-when the patient understands that if the FNA is equivocal that they will still need a core bx, and
-in the case of the patient who wants me to look under the microscope while they're there and give them more information (I think they're hoping I'll say its not cancer, but almost always when I do an FNA its because I'm sure it is). This may be the patient who also has a palpable axillary node or who is comfortable going to the OR for a partial mast. without a tissue diagnosis just a clinical one (uncommon but some people are nervous they can't wait for the core, core path, and then scheduling the OR procedure).

So I certainly think they have their place but almost exclusively in benign disease.

 

[yaah]

They call invasive on pap smears! I have never understood it either but there is good correlation.

Yeah, here we don't do too many breast FNAs unless it's most likely benign or a cystic lesion, or possibly for a recurrence/met.

But yes, we see patients occasionally for FNAs, blood bank issues, or maybe bone marrows, although we don't really do those here.