Which specialties allow you to best improve patients' quality of life?

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giraffesuptop

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It really depends on what you mean. For example, we could look at QALYs and DALYs. There's also the patient's subjective experience. Etc.

But generally speaking, I would think many if not most specialties can "best improve" a patient's QOL, depending on what the patient has or needs (e.g. various surgical specialties, occupational medicine, PM&R).
 
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Psai said:
pm&r, allergy, ophtho, derm, plastics, ent
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yeah I've been looking at PRS for a bit and it seriously interests me


lazymed said:
Hospice. All about quality of life. Nothing you offer the patient has a purpos other than to improve their quality.
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Never thought of hospice care before but I definitely see what you mean. I don't think I'm cut out for hospice care though, just too depressing
 
Don't have the study, but I've heard it said that from a patient's perspective, ortho is second to cardiothoracic/cardiovascular.
 
Nothing like restoring someone's vision... till they complain its just not as perfect as they had expected.
 
Generally surgical specialties are going to have the biggest impact on QoL. Femur fracture before nailing was treated with full body cast and bed rest for 6 months, and even then most people didn't have a straight leg and many couldn't walk without equipment. Now they're out of the hospital by the time they can walk on crutches.

People with terrible, intractable GERD get a Nissen and 90% of them get substantial relief.

Patients who can't walk anymore because of knee osteoarthritis get about as much an improvement in QoL as you can get from knee replacement.

If you want to have the biggest impact on QoL in terms of pre- versus post-treatment, you're looking at surgical specialties (especially general and ortho).
 
IR

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If you don't want to go surgical, maybe rheum? Biologics are magical things.
 
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DubVille said:
...... But fibromyalgia.

I have no room to talk in PM&R.
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Hmm true. I'm in Canada so here fibromyalgia would be dealt with by the family docs.

Still, nothing's perfect. Most things in rheum are really treatable.
 
Pacna said:
Don't have the study, but I've heard it said that from a patient's perspective, ortho is second to cardiothoracic/cardiovascular.
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Aah yes CTS. We get to take you from actively trying to die on ECMO to trach/peg/pec flapped in an LTAC.

I'm assuming that study meant nice things like isolated P2 prolapse repair or AVR...
 
Cards and ortho
 
How about palliative care??? Sure they're dying, but everything you are doing is improving their quality of life.
 
can any residents or attendings give further insight on ortho and plastics? Of the fields mentioned, these interest me the most
 
amichel said:
If you don't want to go surgical, maybe rheum? Biologics are magical things.
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Rheum are only good with a diagnosis. They are worse than oncology in this regard and often represent the lowest form of IM sub-specialty life.

For every biologic they hand out they probably easy turn away a patient who doesn't have a specific antibody and is to they have nothing rbeumatological going on and nothing to treat.

Really guys??

Um no. Hell I'll hand out biologics sometimes too. Maybe pulm should make the list??
 
I always felt outside of surgery that actual fixed the problem and didn't turn into a misadventure that geriatrics does the most to "improve" the life of elderly patients by freeing them from chronic meds that give them side effects and make them feel bad. It's almost like giving people back their right to feel good again.
 
jdh71 said:
Rheum are only good with a diagnosis. They are worse than oncology in this regard and often represent the lowest form of IM sub-specialty life.

For every biologic they hand out they probably easy turn away a patient who doesn't have a specific antibody and is to they have nothing rbeumatological going on and nothing to treat.

Really guys??

Um no. Hell I'll hand out biologics sometimes too. Maybe pulm should make the list??
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Hmmm. Hasn't been my experience. Almost all of the compliant rheum patients I've seen have been well controlled.

Maybe it's different here.
 
amichel said:
Hmmm. Hasn't been my experience. Almost all of the compliant rheum patients I've seen have been well controlled.

Maybe it's different here.
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It's not a compliance issue I'm referring to. Rheum has an expectation that their specialty gets to fit in a neat little box complete with specific autoantibodies or the most specific inclusion criteria and they turn away everyone ends who is clearly on a spectrum checking their brains at the door. I can't believe the amount of patients I've had with a clear rbeumatological ILD only to be told by the rheumatologist they didn't have anything rbeumatological going on. I often skip them now. When some can't be bothered to be a doctor others need be. At least I think so.

A thoughtful rheumatologist is worth his or her weight in GOLD.
 
jdh71 said:
It's not a compliance issue I'm referring to. Rheum has an expectation that their specialty gets to fit in a neat little box complete with specific autoantibodies or the most specific inclusion criteria and they turn away everyone ends who is clearly on a spectrum checking twit brains at the door. I can't believe the amount of patients I've had with a clear rbeumatological ILD only to be told by the rheumatologist they didn't have angry kg rbeumatological going on. I often skip them now. When some can't be bothered to be a doctor others need be. At least I think so.

A thoughtful rheumatologist is worth his or her weight in GOLD.
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Well yah, there are terrible docs in every specialty.

The very specific inclusion criteria actually hasn't been my experience here. If there's no clinical/lab/imaging evidence of swelling/inflammation/whatever then yah they don't treat, but that's true of every speciality.

There just aren't that many diseases I medicine that are as responsive to therapy as the common rheumatological ones.

Maybe I've just been lucky in the rheumatologists I've worked with. It might also be because I'm going into peds so that's who I've worked with. I think there's an expectation that kids present differently so no one is fixated on the textbook definitions. Something adult medicine could probably learn from, I've always thought.
 
amichel said:
Well yah, there are terrible docs in every specialty.

The very specific inclusion criteria actually hasn't been my experience here. If there's no clinical/lab/imaging evidence of swelling/inflammation/whatever then yah they don't treat, but that's true of every speciality.

There just aren't that many diseases I medicine that are as responsive to therapy as the common rheumatological ones.

Maybe I've just been lucky in the rheumatologists I've worked with. It might also be because I'm going into peds so that's who I've worked with. I think there's an expectation that kids present differently so no one is fixated on the textbook definitions. Something adult medicine could probably learn from, I've always thought.
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"Every specialty has bad docs." A truth that can't really be argued against but it hardly helpful. Yes. True. But *not* my point.

As a rule, not the exception, rheum is terribly unhelpful unless it can be painstakingly spelled out for them. This is tedious and frustrating.

I do hope the peds world is better in this respect than the adult.
 
At least for procedures, this has been studied (I'm too lazy to find the reference, sorry bruh).

Greatest QUALYs gained per procedure performed is cataract surgery followed closely by total joint arthroplasty. Haters gonna hate, but the data shows that Ophtho and Ortho are at the top of this list.
 
KinasePro said:
At least for procedures, this has been studied (I'm too lazy to find the reference, sorry bruh).

Greatest QUALYs gained per procedure performed is cataract surgery followed closely by total joint arthroplasty. Haters gonna hate, but the data shows that Ophtho and Ortho are at the top of this list.
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Breast reduction is up there as well.
 
I think most specialties can impact quality of life to a certain extent, so it depends on how you want to contribute to that. I'm biased in that I'm PM&R trained, going into spinal cord injury medicine, and we tend to pride ourselves on our focus on function and quality of life for our patients and their families, often after devastating neurological injuries (stroke, tbi, sci), which we cannot cure, but help them adapt to a new way of living and hopefully thriving. We tend to have extended relationships with our patients, and it's certainly challenging, especially the initial period of adapting to a disability. I love what I do, but it's not for everyone.
 
Radiology, you don't even have to see the patients!

Oh wait, I read the question wrong. I thought it was how to best improve your quality of life.
 
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