Differential Diagnosis in Urology

[Pkboi24]

I really love Urology but I also love the brain work associated diagnosing illnesses in medicine. Can anyone tell me whether Urologists have to do much diagnosing?

I feel like I have the personality that suits both IM and Urology but I love the procedures of Urology. I haven't done an away rotation yet but I'm just wondering how much "thinking" does an average urologist do?

Thanks in advance for your help.

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[Its_MurDAH]

I really love Urology but I also love the brain work associated diagnosing illnesses in medicine. Can anyone tell me whether Urologists have to do much diagnosing?

I feel like I have the personality that suits both IM and Urology but I love the procedures of Urology. I haven't done an away rotation yet but I'm just wondering how much "thinking" does an average urologist do?

Thanks in advance for your help.

Great question.
I will preface the answer with the following: I hated internal medicine my 3rd year. Every minute I was on the wards either actively admitting a patient or rounding (mental masturbation) with the team, I was miserable.
The thing that you will start to realize soon enough is that there isn't much House-like brain work involved in medicine anymore. Most of your management no matter what specialty you go into is gonna be guided by radiological or serologic diagnoses. There are, of course, odd entities that you will encounter now and then that require one to step back and see the whole picture and tie in physical findings with the lab tests to arrive at a plausible diagnosis. These are few and far between. Even then, most of the time the IM doc will be consulting other services (ID, pulm, endo) if an exotic or rare dz is suspected. As an IM doc, 90% (I really do mean 90%) of the time you are dealing with chronic illnesses: DM, CHF, HTN, COPD, Chronic Pain, Morbid Obesity.

Similarly, with urology, you can arrive at most diagnoses based on the scans alone. I say most because again there are times when you see a huge renal mass on CT and you have no idea whether it is cancer or not. Urologists probably do put more thought into their diagnosing compared to general surgery simply because urologic procedures and surgeries are more involved, from a technical stand-point. Moreover, there are several ways you can approach any given urologic problem. With renal masses you can freeze them, apply heat, take them out, or observe. With prostate ca. you can give pts radioactive seeds, perform robotic surgery, do an open surgery, cryo, or xrt. Management options are vast and depend largely on the patient. Even "small" stone procedures have multiple management options - shockwave vs. extraction vs. observation etc. etc. This is where the thinking usually comes in - in the managing of urologic issues rather than the actual diagnosing.

I am obviously biased but I would urge you to definitely look more into urology. Hope somewhere in the above rant I atleast attempted to answer your question.

 

[drivesmecraazee]

Great question.
I will preface the answer with the following: I hated internal medicine my 3rd year. Every minute I was on the wards either actively admitting a patient or rounding (mental masturbation) with the team, I was miserable.
The thing that you will start to realize soon enough is that there isn't much House-like brain work involved in medicine anymore. Most of your management no matter what specialty you go into is gonna be guided by radiological or serologic diagnoses. There are, of course, odd entities that you will encounter now and then that require one to step back and see the whole picture and tie in physical findings with the lab tests to arrive at a plausible diagnosis. These are few and far between. Even then, most of the time the IM doc will be consulting other services (ID, pulm, endo) if an exotic or rare dz is suspected. As an IM doc, 90% (I really do mean 90%) of the time you are dealing with chronic illnesses: DM, CHF, HTN, COPD, Chronic Pain, Morbid Obesity.

Similarly, with urology, you can arrive at most diagnoses based on the scans alone. I say most because again there are times when you see a huge renal mass on CT and you have no idea whether it is cancer or not. Urologists probably do put more thought into their diagnosing compared to general surgery simply because urologic procedures and surgeries are more involved, from a technical stand-point. Moreover, there are several ways you can approach any given urologic problem. With renal masses you can freeze them, apply heat, take them out, or observe. With prostate ca. you can give pts radioactive seeds, perform robotic surgery, do an open surgery, cryo, or xrt. Management options are vast and depend largely on the patient. Even "small" stone procedures have multiple management options - shockwave vs. extraction vs. observation etc. etc. This is where the thinking usually comes in - in the managing of urologic issues rather than the actual diagnosing.

I am obviously biased but I would urge you to definitely look more into urology. Hope somewhere in the above rant I atleast attempted to answer your question.

I think the OP was talking about IM AND SUBSPECIALITIES, not exactly pure IM docs.
Sure there a lots of diagnostic methods but the physician must have some clinical knowledge and abilities in order to know which test/study needs to be ordered, at least that's how it works in a system with socialized medicine, we can't just exploit the state ordering every lab test on the planet.

 

[Moonglow]

Hey, even House only gets one of those zebra cases a week. A great IM attending is worth double his weight in gold, and we all have seen why.

 

[drivesmecraazee]

hey, even house only gets one of those zebra cases a week. a great im attending is worth double his weight in gold, and we all have seen why.

lol

 

[Its_MurDAH]

I think the OP was talking about IM AND SUBSPECIALITIES, not exactly pure IM docs.
Sure there a lots of diagnostic methods but the physician must have some clinical knowledge and abilities in order to know which test/study needs to be ordered, at least that's how it works in a system with socialized medicine, we can't just exploit the state ordering every lab test on the planet.

OF course we all need "clinical knowledge" in order to know which "test/study needs to be ordered". Isn't that the whole point of the Step 2 CS. I mean it is something that every M.D. needs to know, it isn't specific to medicine or any of its sub-specialties. Sure you need to know the odd test to order for specific rare illnesses but I think most docs (med or surg) have a pretty good general idea about most entities.

I was simply addressing the OPs question about COMPARING urology to medicine and how the "thinking" differs between the two. My initial response, as I already pointed out, is obviously biased in favor of urology since I am going into that field.

 

[Wrigleyville]

Urologists do plenty of diagnosing. The difference is that patients show up for specific issues, and much of the diagnostic work and decision-making is algorithmic. More importantly, for your sanity, there is an end-point for each particular problem, as opposed to an open-ended parade of chronic medical problems to juggle that you would deal with as an internist.