What is the most diagnostically useful specialty?

[Bonobo]

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A lot of people talk about which specialties are most able to help patients. For example, cardiology, ob/gyn, and general surgery are often mentioned as the fields that can do the most for a patient. However, oftentimes, patients go through years and years of symptoms without being diagnosed, and it is the diagnosis that makes the biggest difference in their lives.

So here is my question: what specialties in medicine offer the most opportunity to make such helpful diagnoses? In what specialties are you most likely to find patients where the diagnosis was probably missed by several doctors before?

To start off, I will make a plug for infectious diseases. My father had abdominal pain when he immigrated here to the US. After going through many different ulcer medications, a CT scan, and even an exlap, he finally saw an infectious disease specialist (who also happened to be a foreign medical graduate) who diagnosed hepatic amebiasis and cured the disease with a simple course of antimicrobials. He has had no further problem since, except a recent bowel obstruction secondary to the scar tissue from his exlap!

Clearly, general surgeons is a great field to make heroic diagnoses also (just using the example above to show how ID does it...)

Another question is what fields require the least diagnostic ability?

B

 

[Winged Scapula]

I vote for Pathology.

 

[doc05]

path.

least diagnostic ability - EM.

 

[DrBloodmoney]

Oh yeah.

We lab-dwelling formalin-monkeys might be good for something.

Our rallying cry is 'More tissue'

 

[DigableCat]

However, oftentimes, patients go through years and years of symptoms without being diagnosed, and it is the diagnosis that makes the biggest difference in their lives.

So here is my question: what specialties in medicine offer the most opportunity to make such helpful diagnoses? In what specialties are you most likely to find patients where the diagnosis was probably missed by several doctors before?

Pain Management.

 

[b&ierstiefel]

Pathology is great for achieving final diagnoses (sometimes too late though). Radiology diagnostics is useful for earlier stages of patient management.

 

[ERMudPhud]

I vote for rads.

path.

least diagnostic ability - EM.

What an ass.
Nearly every shift I diagnose something that has been missed by the patients PCP or subspecialist. I have the advantage of seeing them with a fresh perspective and after the PCP has already ruled out some things. The most recent example was a man with a chronic cough to the point of syncope and vomiting. One time he coughed, passed out, fell down the stairs and broke his arm. Symptoms had been constant for 1-2 months. He had been treated by his PCP for "Bronchitis", seen an ENT for laryngospasm and been admitted to another hospital for a syncope workup. Bottom line --Pertussis. Another recent example acute myeloblastic leukemia. PCP was working him up for anemia. I've diagnosed malaria more than once along with a variety of other unusual infections. EM is great for being the first to see and diagnose the patient or to see things others have not yet picked up on.

As for your fellow surgeons, the residents and recent grads won't even see a patient if I (along with radiology) don't already have a diagnosis. At least the older surgeons realize that not all diagnoses are made in the first 4 hours and recognize the value of an observation period. That doesn't make them better diagnosticians than me it just means they have the benefit of longitudinal data that I don't have during my short time with the patient.

 

[roja]

MudPhud- you know better. No feeding trolls!


To the OP: If you really like working people up for obscure diseases that can significantly improve their life, rheumatology is a great field. I was planning on doing Peds Rheum all through med school. Most of the disease are missed by most docs and have had extensive work ups. It requires a lot of intelligence and diligance and diagnostic skills to get these diseases.

Adult rheum is often similiar but you often have to deal with patients with teh dreaded fibromyalgia and chronic pain syndrome. most rheum docs work hand in hand with ID docs.


*all* of the specialties require clinical accumen. If you are a wise medical student/doctor, you will realize that *all* of the fields have value and require thier own brand of 'smarts' and deductive skills. You will figure out which ones appeal to you as you rotate through.

 

[Furrball]

IM: knows everything does nothing
Surgery: Knows nothing does everything
Path: knows everyting, does everything .... but too late

 

[GeneGoddess]

For the truly obscure: Medical Genetics, BABY!

Actually, I think lots of specialties can fall into this category.

Least diagnostic? I would guess surgery just because it is more of a DO versus DIAGNOSE. No jumping on me for that...I know plenty of surgeons who are excellent diagnosticians.

 

[ERMudPhud]

What an ass.
...

....As for your fellow surgeons

Sorry everybody. I was tired and grumpy last night but that's still no excuse for responding to a trolling med student. As an aside, many of doc05's previous posts have been thoughtful, including some on the EM board, so perhaps this wasn't intended as a troll

 

[Ross434]

Least diagnostic ability : orthopedics ! hah

 

[pseudoknot]

...It requires a lot of intelligence and diligance and diagnostic skills to get these diseases.

Oh. Too bad. What kind of diseases can I get if I'm lazy or not so smart?

 

[hyperbaric]

path.

least diagnostic ability - EM.

EM = stabilization

path = the people ordering whatever it is you have under the slide

sorry - i got my panties in a wad before i realized someone already defended the honor of the ER

 

[dry dre]

What's wrong with peds, family medicine, and internal medicine? The fact that things are missed doesn't mean that these specialties are wanting, but rather that the individual docs for whatever reasoned missed the big picture.

So much for primary care...

 

[Winged Scapula]

Oh. Too bad. What kind of diseases can I get if I'm lazy...?

Decubitus ulcers

 

[Apollyon]

Decubitus ulcers

"You will respect my decubiti!"

 

[doc05]

Sorry everybody. I was tired and grumpy last night but that's still no excuse for responding to a trolling med student. As an aside, many of doc05's previous posts have been thoughtful, including some on the EM board, so perhaps this wasn't intended as a troll

perhaps my opinion was biased by experiences with the EM dept at my institution. 😉