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the nurses, they're the most intelligent in the hospital.
fourthyear said:Surgeons have to know the most to do their job well.
Med students and pre-meds posting here may not realize it yet, but surgeons actually do have to understand all the medical physiology behind the disease processes. Surgeons actually do make diagnoses, often when the EM and IM docs can't quite figure out what's going on, they call the surgeon - for abdominal things, vascular problems, endocrine issues that could be treated surgically, all sorts of things.
Spend a month on a surgical service with ICU patients... you will see just how much critical care management every surgeon can handle - surgery residents learn early on vent managment, how to manage fluid balance and hypo or hypertensive problems, run drips - plus they are easily the best at any critical care procedures - central lines, art lines, swans, chest tubes. Rarely will a surgeon call a consult for a critical care patient except maybe a nephrologist just b/c that's who actually gets to say a patient needs dialysis (and we already know the patient needs dialysis before we call them). Surgeons are also trained to do endoscopy, which means they can do all the GI docs do (except not usually ercp), and also operate on the patient's problems too.
Doing surgery is actually quite a fine craft to learn itself, so this takes some smarts too. Learning what to do when a case does not present like the textbook (which happens quite often), takes some quick thinking on your feet and knowlege from lots of background reading you've hopefully done about similar rare cases others may have described.
This is why we spend 80 hours a week all 5 years learning our craft...how can you say a neurologist who spends less than 40 hours a week is smarter - they sure do know more about Parkinson's disease and that sort of thing...but not much about any non-neurologic disease.
With few exception (like a clear-cut MI or CVA), if you ask me to pick one doctor to take care of me when I present to the hospital really really sick with multisystem problems, I would definitely say a surgeon.
fourthyear said:Med students and pre-meds posting here may not realize it yet, but surgeons actually do have to understand all the medical physiology behind the disease processes. Surgeons actually do make diagnoses, often when the EM and IM docs can't quite figure out what's going on, they call the surgeon - for abdominal things, vascular problems, endocrine issues that could be treated surgically, all sorts of things.
Hell yeah....I'd be all for that. Let the fleas take care of the minutia.waterski232002 said:...Personally, I think that all surgical patients should be admitted to a general medicine service and surgery should only manage their SURGERY...
QuietSylph said:I agree, there are some surgeons that are brilliant and have ice water in their veins, making them perfect to handle very sick patients. Those docs have my utmost respect.
There are many surgeons, however, who are the equivalent of the "jocks" in high school and are not the brightest -- even in fields like neurosurgery or CT surgery. At several hospitals in different regions of the country, I have been witness to many examples of a surgeon's poor understanding of disease, sometimes with disturbing consequences for the patients (who typically have no idea they underwent unnecessary surgery or are being mismanaged).
Most recently, we had the pathology attending who took 15 minutes to carefully explain the diagnosis, prognosis, and treatment options of a rare thoracic neoplasm to a CT surgeon. After being handed the diagnosis and entire management plan on a silver platter, the surgeon asked his only question: "So, is it a tumor?"
That sums up why I'm in pathology and not surgery!
fourthyear said:With few exception (like a clear-cut MI or CVA), if you ask me to pick one doctor to take care of me when I present to the hospital really really sick with multisystem problems, I would definitely say a surgeon.
yaah said:There are smart people in every field, and there are *******es in every field. No specialty has a monopoly on it, and within every specialty there are people getting by with being *****s.
I 2nd that, Gas gets no love. Anesthesiology is critical care measured by seconds and minutes instead of days and weeks. They are hella smart, and hella cool. Tough combo to find in most specialties.Beck928 said:You should've included the anesthesiologists (I'm biased here) but many, esp the critical care anesthesiologists are hella smart.
sacrament said:WOW. This is seriously one of the most baffling things I've ever seen posted on this forum. No way. Virtually the last person I'd pick would be a surgeon. In my experience, the IM doctors and subspecialists--when the stubborn surg. service finally breaks down and asks for a consult on their SICU patient circling the drain--are invariably horrified at the kind of management the patient has been receiving for the past couple weeks (hell, even as a fourth year medical student I'm frequently horrified). Thank god for surgeons, and I respect them greatly for what they do in the OR and their ability to handle the majority of post-op patients, but they frequently get in way over their heads when patients have complex multisystem medical problems. It's all fine and good to be rah-rah about your field, but patients die when physicians have a poor understanding of their own limits. Surgery is notorious for brainwashing trainees into believing that they are "internists who completed their training" and need no help, no consults, no outside input... and this is completely ridiculous, not to mention dangerous as hell. Imagine a medical specialty that focused primarily on really sick ward patients, spending countless hours managing these people... but then, at the end of day, popped into the OR for a couple hours. And now imagine these people calling themselves "surgeons who completed their training."
If I ever need major surgery then I'll kiss my surgeon's feet, but I'll also absolutely demand to be co-managed with another service post-op.
sapience8x said:anyone who is smart enough to choose a specialty that allows a life outside of the hospital and who doesn't take it out on everyone else when their life sucks because they chose a specialty where they never see the light of day.
waterski232002 said:Are you serious??? Have you ever seen a general surgical service where complicated patients are actually managed CORRECTLY! Why do you think general surgeons (just like orthopods) make every attempt to turf their patients to IM? Granted they aren't as bad as orthopods, but still, they don't care about the minutia of the patients medical problems. They can't manage a patient with multisystem disease nearly as well--that is a fact. Granted, IM docs can't manage post-op problems. People go into surgery b/c they like to operate. Yes, operating is a very fine skill, but it's like cooking. You do it the same exact way every single time. You could do it in your sleep 99% of the time (unless you're a trauma surgeon, where you actually do have to think on your feet a lot more). The other 1% are those rare cases where something goes wrong or the anatomy is extremely abnormal which was not anticipated prior to surgery (doesn't happen very often with all the CT's and MRI's that are ordered in advance.I guess the interest in the medical care of a patient may vary based on surgeon and institution you are in. Sorry, but I think at my hospitals surgeons are just as good and at times better managing critical care patients well.
You are completely wrong about surgery being routine and cookbook. So often there are cases where things aren't simple and straightforward. Most patients have had previous surgery, adhesions, there are lots of important structures like blood vessels nearby you can easily injure if you are not 100% accurate in every single move you make - you can kill patients easily if you were to take surgery so lightly as you think you can. I don't know how to explain this to you b/c obviously you haven't spent much time in the OR, but if you had you'd know this, especially if you ever tried to do anything surgical yourself.
Something else no one realizes is there is a HUGE emphasis placed on the inservice exam for surgery residents - this is unofficially used in many programs to fire residents - how many other specialties really care this much if you are performing well on the inservice exam? This test is not easy, and has nothing much to do with any surgical techniques, but everything to do with basic science and clinical managment of medical/surgical problems. So, yes, today's surgeons-in-training are expected to have a huge amount of medical knowlege.
jjackis said:My dos pesos: There are well designed studies showing that patients with even moderate cardiac problems do FAR better when being treated by a cardiologists, rather than general internists. Similarly, there are other studies showing that greater coordination of care with specialists improves care. Also, there are studies showing that doctors "extremely confident" rather than just "confident" in their decisions, actually are wrong more often. My point? Do it yourself all the time, be overconfident, and you are setting yourself up for failure. Most surgeons are excellent and know when to call for help. Same with internists. But far too many surgeons don't too. That is probably the biggest mistake--and it has nothing to do with intelligence.
As for who really is the smartest--uhh, I don't know, but the very exclusive surgical subspecialties I would assume have a pretty high baseline intelligence because they need such good test scores. However, nephrologists seem hella smart to me too. Not sure why, they just do.
placebo_B12 said:Just curious who you guys think are the smartest doctors in the hospital by specialty. I'm a resident, and we were having a discussion on what specialty we thought tended to be the brightest overall or most impressive.
PS This is meant to be fun... not a pissing war.
Wahoos said:Orthopods!!!!!!
placebo_B12 said:Just curious who you guys think are the smartest doctors in the hospital by specialty. I'm a resident, and we were having a discussion on what specialty we thought tended to be the brightest overall or most impressive.
PS This is meant to be fun... not a pissing war.
Wanna know how to keep a secret from an Orthopod?Wahoos said:Orthopods!!!!!!
automaton said:no doctor really impresses me with their intelligence.
internists watch, consult, consider, monitor, and therapeutically wait their patients to the morgue. they are good at coming up with irrelevent differentials, ordering a bunch of studies that don't matter, and ignoring obvious interventional problems until it's too hard to ignore, at which point is it too late. neurologists are the most guilty of this.
surgeons really don't give a crap about things like diabetes and hypertension. i've seen people's sugars fluctuate hundreds of points per shift, pressures over 160. kidneys sucker punched constantly with lasix dose after dose. but at least they're alive.
the smartest resident i worked with was a surgeon. smartest attending was an internist. worst resident was a psychiatrist. worst attending was a neurologist. they are all kind of mediocre though (much better than me, but still mediocre in the grand scheme of things). makes sense, why waste brilliance on medicine.
raph91 said:If I had a choice, I'd prefer the brilliant people not be in the trenches with us doctors but in the labs researching things to advance medicine. Face it, while we all get off on our clinical research and outcomes research, things like MRI, new drugs, gene therapies, etc. come from PhD physicists, biomedical engineers, chemists, mathematicians.
It doesn't take a brilliant person to become a great doctor. Just a dedicated, motivated person willing to work really really hard.
raph91 said:If I had a choice, I'd prefer the brilliant people not be in the trenches with us doctors but in the labs researching things to advance medicine. Face it, while we all get off on our clinical research and outcomes research, things like MRI, new drugs, gene therapies, etc. come from PhD physicists, biomedical engineers, chemists, mathematicians.
It doesn't take a brilliant person to become a great doctor. Just a dedicated, motivated person willing to work really really hard.
raph91 said:If I had a choice, I'd prefer the brilliant people not be in the trenches with us doctors but in the labs researching things to advance medicine. Face it, while we all get off on our clinical research and outcomes research, things like MRI, new drugs, gene therapies, etc. come from PhD physicists, biomedical engineers, chemists, mathematicians.
It doesn't take a brilliant person to become a great doctor. Just a dedicated, motivated person willing to work really really hard.
However, if your judging intelligence based on board scores, then I'd vote for dermatologists, since they need at least 260 to even think about getting an interview. Oh, and they're smart enough to pick a specialty with a good lifestyle.
infectious disease? all they ever do is recommend Zosyn.
For my money, a GOOD pulmonary/critical care doc tops the list. (and you can tell the good ones from the average ones on how quick they are to start phoning the consults)
Nephrologists are the most nerdy, for sure.
However, if your judging intelligence based on board scores, then I'd vote for dermatologists, since they need at least 260 to even think about getting an interview. Oh, and they're smart enough to pick a specialty with a good lifestyle.
If I had a choice, I'd prefer the brilliant people not be in the trenches with us doctors but in the labs researching things to advance medicine. Face it, while we all get off on our clinical research and outcomes research, things like MRI, new drugs, gene therapies, etc. come from PhD physicists, biomedical engineers, chemists, mathematicians.
It doesn't take a brilliant person to become a great doctor. Just a dedicated, motivated person willing to work really really hard.
neurologists
As for who really is the smartest--uhh, I don't know, but the very exclusive surgical subspecialties I would assume have a pretty high baseline intelligence because they need such good test scores. However, nephrologists seem hella smart to me too. Not sure why, they just do.
One of the smartest nephrologists I knew use to analyze patients' urine by tasting it. How smart could he be?