What specialty offers services that most improve their patient’s quality of life?

[Kardio]

Not necessarily live longer, but live a higher quality of life.

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[jamaica jan sun princess]

Hospice and palliative medicine.

 

[DOVinciRobot]

Ortho, palliative care, PMR are some of the ones that instantly come to mind

 

[deleted1100659]

psychiatry; people can accomplish a lot more when they're not depressed or their psychosis is controlled.

 

[Maximus2020]

Pain medicine/anesthesiology. Nothing beats being pain-free.

 

[Crayola227]

Kind of a silly question. It's very subjective and relative. A case can be made for many, many specialties.

 

[jstwannagraduaaate!!!]

ENT, Urology, pain medicine, allergy medicine, optho, and ortho are the first fields I think of when I think of quality of life; and I think anyone of these fields are very good choices to go into (from an M2 perspective)

 

[CyrilFiggis]

Valet. Trying to find parking has taken years off my life and caused terrible mental stress.

 

[lanzhou_lamian]

Ophthalmology. Losing your vision steals a lot of independence. Being able to prevent/reverse this can give someone their life back.

 

[ortnakas]

Shout out to rheum.

 

[deleted1100659]

Shout out to rheum.

steroids reduce quality of life! no one likes gaining weight and feeling depressed. But I suppose they prescribe immunomodulators. But still.

Kind of a silly question. It's very subjective and relative. A case can be made for many, many specialties.

in psychiatry we make someone happy or less psychotic. That seems like a solid QOL improvement to me ; ) ; ).

 

[mistafab]

Psychiatry is so frikkin cool, You can take a perfectly healthy and “functional“ person, and still improve their QOL with therapy.

 

[Darrow O'Lykos]

As someone who worked in stroke research before med school, I think vascular neurologists deserve a mention here. Have you seen the before and after on a LMCA stroke patient that receives a successful TICI2+ re-canalization via thrombectomy? If you want to talk about the highest ratio of impact on quality of life to time expended (~20mins), there’s very few that come close to that level of intervention.

 

[Ganon]

Palliative, pain, addiction med

 

[sloop]

Has to be psychiatry. I’m obviously biased, but I think that there’s a relatively good objective case that it is the top specialty on this dimension.

Other specialties deal with maladies that negatively impact some aspect of a person’s life. Psychiatry is the one specialty that is primarily focused on issues that negatively impact an individual’s experience of life itself. Fundamentally, “quality of life” in this context relates to the mental experience of a condition or illness. That is most squarely the domain of psychiatry.

 

[stickgirl390]

FPMRS! So many women go through life thinking that pelvic organ prolapse and/or urinary incontinence is just a result of old age that they have to live with. They are so greatful when they learn how many treatment options there are to improve their QOL.

 

[Kardio]

Ortho, palliative care, PMR are some of the ones that instantly come to mind

PMR came to my mind. I’ve heard them drop the slogan ‘life to your years’ lol.

Could you describe the ways you’ve seen GS improve QOL? I’m an M2 without any exposure to the field yet.

As someone who worked in stroke research before med school, I think vascular neurologists deserve a mention here. Have you seen the before and after on a LMCA stroke patient that receives a successful TICI2+ re-canalization via thrombectomy? If you want to talk about the highest ratio of impact on quality of life to time expended (~20mins), there’s very few that come close to that level of intervention.

That’s very interesting and I hadn’t thought much about that. Are those procedures also done by IR?

 

[Goro]

Not necessarily live longer, but live a higher quality of life.

All of them

 

[Darrow O'Lykos]

That’s very interesting and I hadn’t thought much about that. Are those procedures also done by IR?

I think it varies across the country. There are multiple pathways to get to that profession. The docs I worked with were Neurology trained and had completed vascular/endovascular fellowships, which would be a 3-year neurology residency + 1 or 2 year fellowship in endovascular, but I imagine IR trained docs would be fully able to perform them as well. They are amazing procedures.

 

[mrbreakfast]

There are lots of good answers. I'm biased as well, but I'd say neurology, because symptoms of neurological diseases often affect movement or thought process and thus are often very apparent to the patient.

Neurologists can take patients who literally can barely move and give them decades more of relatively normal life, often with just a single medication. This applies to many diseases, but what got me into neurology was Parkinsons. Go look up some DBS on/off videos.

Neurologists can take people who are so disabled by migraines that they can't leave their homes and make the migraines go away. Migraine/headache treatment is the bread-and-butter for neurology, and considering how common those disorders are (30-40% of Americans), it's definitely a quality of life issue. Just last week I had a 20-something in tears because of how much a monthly CGRP antagonist improved her life.

And, of course, there's stroke treatment. It was already mentioned in this thread, but we can take someone who is going to be completely paralyzed on half of their body and unable to speak for the rest of their life and turn them "back to normal" with an injection and a 20-minute surgical procedure. It's basically magic.


All that is to say there's plenty of opportunity in every specialty. You just have to learn more about each one, and determine what pathology you enjoy seeing and treating.

Are those procedures also done by IR?

I think it varies across the country. There are multiple pathways to get to that profession. The docs I worked with were Neurology trained and had completed vascular/endovascular fellowships, which would be a 3-year neurology residency + 1 or 2 year fellowship in endovascular, but I imagine IR trained docs would be fully able to perform them as well. They are amazing procedures.

Neuro-interventional cases are done by neurosurgery, neurology, or IR, probably in that approximate order of frequency. You will need advanced fellowship training to do it, but FYI as far as I know the shortest possible training is 7 years: 4 years of neurology (it's a 4-year residency) + 1 year vascular fellowship + 2 year endovascular fellowship.

 

[Smurfette]

Almost every field has something to offer, as so many conditions cause suffering---mentally, physically, or both.
Don't underestimate how many things that don't sound transformational can really improve a patient's life.

 

[ChordaEpiphany]

Agree with ortho and PM&R. Then psych for certain disorders, especially people who need antipsychotics. I'm seeing a lot of neurology here, and I think that's interesting because my impression was always "diagnose and adios," but maybe times are changing.

Another place to look is people who treat congenital problems, peds specialists in particular. HGH deficiency, for instance, is completely treatable, but identifying the problem and treating the kid throughout childhood completely changes their life by adding about a foot to their height.

 

[Gilakend]

Ortho

 

[longhaul3]

Pain medicine/anesthesiology. Nothing beats being pain-free.

This is true...but how often does a pain patient actually attain freedom from pain? In my experience almost never, which is what makes it so challenging and frustrating.

As someone who worked in stroke research before med school, I think vascular neurologists deserve a mention here. Have you seen the before and after on a LMCA stroke patient that receives a successful TICI2+ re-canalization via thrombectomy? If you want to talk about the highest ratio of impact on quality of life to time expended (~20mins), there’s very few that come close to that level of intervention.

Thrombectomy has among the lowest NNT of any treatment in medicine except for insulin for T1D. But for every successful LVO thrombectomy there are a zillion small vessel thalamic strokes with a severe deficit and no recourse. And reperfusion complications of thrombectomy are common...increasingly so as they become more prevalent.

 

[mvenus929]

It's very person dependent. To someone with diabetes, an endocrinologist can radically improve their quality of life. To someone with MS, a neurologist can radically improve their quality of life. Anyone who diagnoses a rare disease can dramatically improve someone's quality of life.

Overall, though, palliative, PM&R, to some degree ortho (joint replacements), and psychiatry are probably the top fields for this.

 

[ahnonemoose]

The specialty for which you are most passionate about.

 

[GoSpursGo]

So I'm thinking about this from a different perspective than the rest of you all, and it clearly isn't the same thing from an instant gratification standpont. But a good FM doc or general internist who is really able to connect with their patients and is able to help them attain good control of basic medical problems like hypertension, hyperlipidemia, obesity, diabetes, etc, I think blows all of these other specialties out of the water. Sure you need a neurosurgeon if you have a stroke, or a cardiologist if you have an MI, or a knee replacement from osteoarthritis from being obese, or a surgeon to wash out your gangrenous diabetic foot... but never dealing with those problems in the first place is clearly much, much better. Not sexy, and you won't get a ton of credit, but an ounce of prevention is really worth a pound of therapy.

If I'm letting my own biases show, I do think that basically any pediatric subspecialist is hugely important for their patients' QOL. Cure their cancer or congenital heart disease, treat their diabetes, etc... and you really add MANY years to their life, most of which will be good

 

[snooper]

dermatology --- e.g. blistering diseases cause painful and socially debilitating diseases, also because they are disfiguring but can be relatively easily treated.

 

[mcat_taker]

This is true...but how often does a pain patient actually attain freedom from pain? In my experience almost never, which is what makes it so challenging and frustrating.


Thrombectomy has among the lowest NNT of any treatment in medicine except for insulin for T1D. But for every successful LVO thrombectomy there are a zillion small vessel thalamic strokes with a severe deficit and no recourse. And reperfusion complications of thrombectomy are common...increasingly so as they become more prevalent.

Agreed. Was going to comment on this naive post but you beat me to it. Vascular neurologists w neuro IR training don’t just pull clots out all day. A majority of their patient load is bleeds w no recourse and little to offer in terms of management or therapy besides months of PT and pray and place on aspirin

 

[Darrow O'Lykos]

Vascular neurologists w neuro IR training don’t just pull clots out all day.

No duh. Almost no speciality does a hallmark life-saving intervention constantly. You're being obtuse. My point was that it is roughly frequent procedure that has a dramatic impact on QoL of a patient. IIRC, our team performed like ~30-40 thrombectomies a month. So if you do a 3rd of those rotating call, you're likely to see a decent number of memorable cases that you dramatically impact QoL in a way few other speciality interventions provide, which was the OP's question. No one said it was the bread and butter.

A majority of their patient load is bleeds w no recourse and little to offer in terms of management or therapy besides months of PT and pray and place on aspirin

This is just factually false. Hemorrhagic strokes make up like 10% of total stroke volume. Are LVOs the majority of patient load? No, but that wasn't what I said at all either.

Contextualize before calling someone's post naive.

 

[Chelsea FC]

Easy, PM&R.

 

[Taddy Mason]

psychiatry; people can accomplish a lot more when they're not depressed or their psychosis is controlled.

Or when they have right combo of Addys, Z-bars, and K-pins.

 

[Dr G Oogle]

Any reconstructive specialty improves QOL: plastics, ortho, FPMRS, male recon, facial recon with ENT, ophthalmology

Mostly treating otherwise healthy people with one specific impairment, fix that: bad hip, knee, congenital deformity, prolapse, incontinence, etc and they are back to normal”. A lot of these other mentions neuro IR, psych stroke neuro, rheum are treating a disease, and arguably providing a valuable life altering treatment.