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mdchick

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Hey guys.... So we are holding a debate for the first and second years between Medicine and Surgery faculty hilighting the differences between the two (eg lifestyle, work style, patient interaction, etc). It should be pretty entertaining and hoping that they will take cheap shots at eachother. But what i need some help with is a case that illustrates how surgery would approach a situation vs medicine. I am drawing blanks trying to come up with a good one. Any suggestions? Or has anyone done this before and have a good idea?

thanks!
 

azzarah

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triple vessel disease/CAD. Medical therapy vs. surgical therapy
 

Samoa

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Splenomegaly
Jaundice
nausea/vomiting
Inflammatory bowel disease

The thing is, in most situations, surgeons come in after a lot of medical treatment has failed, so ideally the treatment algorithms should be the same. I mean, if we're practicing evidence based medicine, we should all be working off the same evidence, right?

However, I just read a chapter in my surgery textbook about the spleen, and it went into a great deal of detail about the kinds of splenic problems where splenectomy is the treatment of choice, whereas I don't remember my medicine textbook EVER suggesting splenectomy as the ideal treatment for anything.

For jaundice, the discussion could be about causes needing medical therapy vs. those needing surgery.

For nausea/vomiting, you could talk about the signs and symptoms that send a patient to the surgeons vs. those that send someone to the medicine service.

CAD is a good suggestion too. Although there you get into the issue of medical management vs. PTCA by interventional cardiology (a medicine subspecialty) vs. CABG by cardiothoracic surgery. And the balance of evidence is tipping toward PTCA if intervention is needed, except in some defined situations--triple vessel disease being one of them. So I don't know how much of a debate you'll get out of that unless you have die-hards on the CT surgery side.

Something you might do is ask faculty in your medicine and surgery departments for ideas. They'd probably have some good ideas.
 
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surg

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I posted this in a similar thread in Internal medicine. Not sure exactly what you are looking for, but here are a sampling of some topics that might make for good case scenarios that have medical and surgical interventions that have or had advocates for both sides. As far as debating the lifestyle and work approaches, I'm not sure how this will help you.

Chronic GERD: Surgical therapy (e.g. Nissen fundoplication) v. Medical Therapy (e.g. chronic PPI use) v. Medical specialist therapy (e.g. Stretta procedure)

Asymptomatic Primary Hyperparathyroidism: Surgical therapy (parathyroidectomy) v. Medical therapy (calcium monitoring)

Multiple thyroid nodules: Surgical therapy (thyroidectomy) v. medical therapy (suppression with Synthroid) v. watchful waiting with serial Fine needle aspiration biopsy.

Morbid obesity: surgical therapy (gastric bypass or gastric banding) v. medical therapy (diet, nutrition, anti-absorptive agents?, anti-depressives?)

Coronary Artery Disease: surgical therapy (CABG) v. medical specialist therapy (percutaneous stenting)

Carotid Stenosis: surgical therapy (carotid endarterectomy) v. medical therapy (anti-platelet agent) v. other specialist (carotid stenting)
 
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