Who are the most intelligent doctors in the hospital?

[Top Gun]

One of the smartest nephrologists I knew use to analyze patients' urine by tasting it. How smart could he be?

Dude, are you serious? I could see that sort of thing happening back in the days of ancient Greece or Rome, in fact probably earlier, when physicians didn't have the labs we do now. But in this day and age, come on!

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[sharmei17]

neurosurgeons or neurologist perhaps.

 

[EctopicFetus]

neurosurgeons or neurologist perhaps.

Nah.. I think the Critical care guys. PICU MICU SICU

 

[sharmei17]

I am recalling an old joke in my hospital:

Internists know everything but do not solve anything.
Surgeons do not know anything, but solve everything.
Psychiatrist do not know anything and do not solve anything.

This is the joke.

An internist is someone who knows everything and does nothing.
A surgeon is someone who does everything and knows nothing.
A psychiatrist is someone who knows nothing and does nothing.
A pathologist is someone who knows everything and does everything too late.

 

[somedumbDO]

obviously its anesthesia, damn those guys are soooooooo smart

 

[OTD]

Well, I don't know for sure which ones are the smartest, but I do know which ones are without a doubt the least intelligent.

Hands down the least intelligent has to be Internal Medicine.

Abdominal pain, any kind of pain for that matter consult, consult, consult, no work up, it's pain so it's an automatic consult.

Constipation, consult surgery.

Pimple consult surgery for abscess

We don't know what's wrong, let's get a full body CT scan and hope we can consult surgery.

That CT scan revealed gallstones, the patient has no symptoms of gall bladder disease, but consult surgery any way and maybe they can make the diagnosis.

Hypotension we will use pressors, no urine output and hypotension, the patient obviously needs more pressors and a nephrology consult.

GI bleeding with hypotension, place the patient on pressors and consult GI and Surgery (no fluids, no blood only pressors)

Hypotensive patient systolic in the 60's foot turns blue consult Vascular surgery for ischemic foot and ignore the hypotension.

Chest pain, follow the algorithm for chest pain then add Nicotine patch during active cardiac ischemia.

Peripheral vascular disease and diabetic, consult vascular for ischemia and continue the patient on their nicotine patch.

The life of IM is consult, consult, consult while running 5 million useless labs per day and starting everybody on statins waiting on their consultants to make the diagnosis and treat the patient.

Hell I was consulted once and I was the 5th, yes FIFTH consult on the chart and the patient had only been in house for 30 minutes, no note from the IM doc doing the consulting, only orders being admit, resume home meds and the 5 consults.

Most intelligent would probably be Derm or Rad-Onc. There is an unbelievable amount of pathophysiology derm can diagnose just from a skin exam. It's kinda spooky in a way if you are around a good one.

No if I were admitted to the hospital I definately would not want most IM docs to even see my chart let alone try and "treat" me.

I would much rather be admitted to the Family Practice or Surgery service.

 

[PeepshowJohnny]

While I don't agree 100%, I definitely agree with your sentiment.

I thought Internal Medicine was for the thinkers. Everything I've seen points otherwise. Half of their work is A) treating the stuff the consultants don't want to treat, like diabetes and hypertension (which is oh so thrilling. Oh my gosh, this guy's got Wegener's Granulomatosis? General internists get shoved aside as rheumatology/immunology, pulm, ENT, and nephrology all swarm on him.. B) Deal with stupid disposition work. Well, this guy is unsafe to go home alone, says he'll kill himself if he goes to a nursing home, and his kids hate him and refuse to take him...and he has to be out of here by 5:00 tonight because our team is going to be admitting all day tomorrow.

 

[hans19]

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?

Also, if I were getting admitted to the hospital, I sure as hell wouldn't want to get admitted to a surgical service over a medical service.

Are you in IM? If so, are you giving us a license to dump patients on you?

So when the patient has a headache or needs something to help get to sleep at 3 AM they'll call you instead of us? SWEET!!!



Seriously, though, I have friends in IM and I believe they get unfairly dumped upon. They seem to get all the BS cases from the entire hospital. I can't believe you are asking for it!

 

[Geri_Gal]

Well, I don't know for sure which ones are the smartest, but I do know which ones are without a doubt the least intelligent.

Hands down the least intelligent has to be Internal Medicine.

The life of IM is consult, consult, consult while running 5 million useless labs per day and starting everybody on statins waiting on their consultants to make the diagnosis and treat the patient.

Hell I was consulted once and I was the 5th, yes FIFTH consult on the chart and the patient had only been in house for 30 minutes, no note from the IM doc doing the consulting, only orders being admit, resume home meds and the 5 consults.

No if I were admitted to the hospital I definately would not want most IM docs to even see my chart let alone try and "treat" me.

I would much rather be admitted to the Family Practice or Surgery service.

Woah. You have to be kidding.
This is atypical for IM...at least where I've trained.
I'm sorry that you have this conception of internal medicine based on the poor quality of practice at your hospital. Unless this post was satire.

 

[OTD]

Woah. You have to be kidding.
This is atypical for IM...at least where I've trained.
I'm sorry that you have this conception of internal medicine based on the poor quality of practice at your hospital. Unless this post was satire.

No, I only wish I was kidding. That is NOT N=1 hospital either it was that way where I went to medical school too. We spent our IM rotation hoping to find something strange and testing for that but letting the consultants actually manage the patient while we tested for some rare parasite or disease that was 112th on the differential.

Where I am a resident it is standard for the IM physician to just be a consult jocky and not actually do anything for the patient, only arrange the consults with absolutely NO work up. Trouble urinating, urology or nephrology consult (sometimes both) without so much as urine lites, pain of any type is an automatic surgical consult without so much as a plain xray.

Those stories above were 100% true and even the routine consults for "abdominal pain" that turn out to only be constipation didn't piss me off as bad as the 5 consults without a note on the chart (BTW that patients ab pain was ALSO due to constipation).

I would only let about 20% of the IM docs I have been exposed to treat me or my family (those few though are very, very good and when they consult its something real with an actual work up before hand).

When I get a consult if it comes from IM it is BS until proven otherwise unless it is from one of the 20%.

Family medicine OTOH actually works thier patients up before they consult us, take care of small things themselves and actually treat the patient. Those guys can take care of me and my family any day. They are pretty damned good.

 

[McLovin]

Surgery Residents are pretty stupid, in my humble opinion.

I dont know how many consults I have gotten from them mismanaging something as easy as fluids.

"we have this guy with a hx of chf, nows he's getting hypoxic"

of course, first chest film checked is when I order it.

Of course, i'm sure everyone has stories about every specialty doing stupid stuff, so it probably averages out in the end.

 

[Winged Scapula]

Surgery Residents are pretty stupid, in my humble opinion.

I dont know how many consults I have gotten from them mismanaging something as easy as fluids.

"we have this guy with a hx of chf, nows he's getting hypoxic"

of course, first chest film checked is when I order it.

Of course, i'm sure everyone has stories about every specialty doing stupid stuff, so it probably averages out in the end.

It all averages out in the end because I can tell you stories of medicine residents consulting surgery to the MICU for hypotensive patients with pancreatitis. And when we respond that the patient is underrescuscitated, they'll respond with "but we gave him 2 250 cc boluses!!." Surgery laughs at that management just as you do our fluid management in CHF.

 

[Blade28]

Nothing good can come from this thread. Anyone who's been in residency longer than 6 months will have a ton of stories about stupid calls from other services.

 

[yaah]

Nothing good can come from this thread. Anyone who's been in residency longer than 6 months will have a ton of stories about stupid calls from other services.

I agree, I hate threads like this. And like clockwork every few weeks/months they get bumped and then people start responding again. Amazing that people actually think you can rank fields based on intelligence.

The problem with generalizations is that people use individual people/situations/anecdotes to support their opinions.

In encounters with virtually every branch of medicine during my residency training and med school, I have seen *******es and smart people in every field. And often times the same person who seems dumb one day is smart the next.

 

[Blade28]

The problem with generalizations is that people use individual people/situations/anecdotes to support their opinions.

Exactly why we're all supposed to switch from "anecdotal" medicine to EBM, no?

 

[Gasworks]

its anesthesia.. don't you idiots know anything.. lol..

The smartest doc in the hospital is the one who is confident in his abilities but understands the limits of his knowledge and training. I know when its time to bring heme, gi, cardio, nephro, id, etc. on board. Unfortunately humility is something most people learn after buying some poor schmuck a week in the ICU or permanently injuring someone.

Now from my personal experience.. the trauma surgeons who ran the sicu where i trained.. some of the most brilliant docs i have ever met in my life. Its just that kinda job were they needed to really understand every organ system and disease process plus be able to repair a bad liver lac at 3am on no sleep. General surgeons.. especially at the senior resident level have a tremendous pool of knowledge and some of them are even good enough to know how to apply it.

On the IM side.. I've met some brilliant neurologists.. presumably because they've got nothing better to do than read.. and a handful of pulm/cc docs i have met just had a way of approaching and understanding disease that looked like magic to the eyes of an intern.

Oh yeah.. anesthesia also has the coolest cars and we are the most well endowed of all docs too... lol...

 

[Winged Scapula]

Oh yeah.. anesthesia also has the coolest cars and we are the most well endowed of all docs too... lol...

TTIUWP!

 

[VentdependenT]

Ortho for sure.

Brilliant group of guys. I think they actually continued to work on and ultimately finish a total hip after the patient died on the table after 30 minutes of chest compressions.

 

[nykka3]

Ortho for sure.

Brilliant group of guys. I think they actually continued to work on and ultimately finish a total hip after the patient died on the table after 30 minutes of chest compressions.

....and this makes them intelligent. i like your sarcasm.

 

[Doowai]

The smartest one is the guy who is only there to eat the free lunch at the CEU lecture and then go back to his private practice.

 

[VentdependenT]

....and this makes them intelligent. i like your sarcasm.

They still wanted the patient to get ANCEF 2 GRAMS post mortem.

 

[SLUser11]

Nothing good can come from this thread. Anyone who's been in residency longer than 6 months will have a ton of stories about stupid calls from other services.

Agree 100% Nothing more true has even been said. It's amazing how much tunnel vision some of our co-SDNers can have....

 

[Winged Scapula]

They still wanted the patient to get ANCEF 2 GRAMS post mortem.

And up and ambulating POD #1!!

 

[Chronic Student]

And up and ambulating POD #1!!

At least get a PT consult! Good lord.

-Mike

 

[hardy]

I think it's "Pathologists know everything but they're too late."

You guys need to get this joke straight, it goes like this:
Surgeons know nothing but can do everything.
Internists know everything but can do nothing.
Psychiatrists know nothing and do nothing.
Pathologists know everything, can do everything, but are always too late.

 

[SLUser11]

This is the joke.

An internist is someone who knows everything and does nothing.
A surgeon is someone who does everything and knows nothing.
A psychiatrist is someone who knows nothing and does nothing.
A pathologist is someone who knows everything and does everything too late.

You guys need to get this joke straight, it goes like this:
Surgeons know nothing but can do everything.
Internists know everything but can do nothing.
Psychiatrists know nothing and do nothing.
Pathologists know everything, can do everything, but are always too late.

Umm.....(look up)

 

[fang]

This thread should be called "who THINKS they are the smartest docs in the hospital".

Anyway, my vote is internists. Despite the ranting in earlier threads, internists have a difficult job. It's easy to look like a star when you can focus all your attention on one body part and flaunt your knowledge to people who don't have that luxury (hear that, all you snotty cardiologists-to-be out there??), but to actually know enough to be competent in EVERYTHING that comes your way is a true challenge.

Also, notice how it's only the 1-issue patients who get admitted to other services? 65 y/o with broken hip ---> ortho. 71 y/o with MI ---> cards. But the 100 year old with an MI who fell and broke her hip and is now in renal failure? She comes to the medicine service, where, despite our piddling knowledge of arrhythmogenic RV dysplasia, she gets appropriate cardiological treatment along with her other issues (sans consult).

Every service deals with their unique blend of challenges, and I don't think any group is as a whole smarter or stupider than the rest (even ortho... they may not be thinking too much about medical issues but they do some pretty slick stuff in the OR.)

 

[Winged Scapula]

But the 100 year old with an MI who fell and broke her hip and is now in renal failure? She comes to the medicine service, where, despite our piddling knowledge of arrhythmogenic RV dysplasia, she gets appropriate cardiological treatment along with her other issues (sans consult).

Depends on the hospital. Where I trained she would have gone to Trauma with Cards, Ortho and Renal consults.

 

[hardy]

Umm.....(look up)

He left out that the pathologist can do everything. I consider that VITAL to the joke.

 

[Clio]

Over the years, I've been lucky to work with some pretty brilliant docs. I'd have to say the nephrologists were the most impressive overall. Although our heme/oncs weren't slouches by any stretch.

Hard to generalize it though. I could name some in most any specialty who were scary-smart. Even ortho

 

[doctorhouse]

Neurosurgery

 

[Green912]

Been most impressed by some Pulmonary/Critical Care Folks

 

[shocker]

Radiologists have an enormous wealth of knowledge. They must know pathology and diff dx for all specialties and be able to converse about them with the respected clinicians...I don't know if they are "the smartest" but they should not be overlooked.

 

[yaah]

 

[billclinton]

Radiologists have an enormous wealth of knowledge. They must know pathology and diff dx for all specialties and be able to converse about them with the respected clinicians...I don't know if they are "the smartest" but they should not be overlooked.

yeah, probably between radiology and pathology. both of these require the most studying from the residents. i also believe radiology has the most board exams: physics, written, and orals. these probably require the most extensive knowledge base... rads has to know how normal and abnormal anatomy presents under a number of different modalities (US, xray, mri, mra, CT, enema, and the list goes on)

 

[Hard24Get]

I think intelligence is better measured between race than medical specialties. So which specialties are the most WASPy?

 

[Blade28]

Radiologists have an enormous wealth of knowledge. They must know pathology and diff dx for all specialties and be able to converse about them with the respected clinicians...I don't know if they are "the smartest" but they should not be overlooked.

Well, to be fair, sometimes this "communication" consists of us simply reading their dictation.

 

[Blake]

They still wanted the patient to get ANCEF 2 GRAMS post mortem.

Can't stop laughing

 

[howelljolly]

One of the smartest nephrologists I knew use to analyze patients' urine by tasting it. How smart could he be?

really? that used to be the bedside test for differentiating DM from DI... but that was a loooong time ago...

 

[m1234d]

Yes DERMS are the smartest because they are smart enough to be in the hospital the least.

the smartest are the ICU-ers, EM, and hospitalists because they dont have to deal with office staff. (and most ICUs are shift work, so it's not that bad)

 

[howelljolly]

Whats the story with Derm? Why is it so competitive, and why do Derm programs have among the highest board scores? Dont mind my ignorance, but all I know about dermatology is what I remember from Pathology in MS-2. I thought skin was one of the more straightforward topics. Supposedly theres a whole lot of diseases that can be suspected or diagnosed by examining the skin, but is that what really what dermatologists do? I cant imagine that the Primary care doc will notice acanthosis, call a derm consult, and have the dermatologist make the underlying diagnosis. Do dermatologists really need to be brainiacs?

Anyway, my vote is for Pulmonary/CC

 

[doctorhouse]

One of the smartest nephrologists I knew use to analyze patients' urine by tasting it. How smart could he be?

Thats' gotta be smart.
"Hmm....sniff sniff...." sip. "The osmolality is a little high. Did I taste a bit of sweetness in the urine? Diabetic case possibly? Let me sip it again. No, that's not it. Not sweet enough. A little concentrated, slightly acidic with a hint of bitterness. An infection maybe? I'm not yet sure." sip "Whoa! Definitely blood that time. Darn it! Drank blood twice this week! But it may mean my patient has an infection..." Sip. "It's slightly cloudy and tastes bitter. Definitely an infection. "

*calls over resident doc. for teachable moment* "Hey, Dr. Camp. Come taste infected urine."

 

[Fexofenadine]

I'm a little hurt with the 1.11% for GI. I think my fiance is pretty smart!

 

[m1234d]

Thats' gotta be smart.
"Hmm....sniff sniff...." sip. "The osmolality is a little high. Did I taste a bit of sweetness in the urine? Diabetic case possibly? Let me sip it again. No, that's not it. Not sweet enough. A little concentrated, slightly acidic with a hint of bitterness. An infection maybe? I'm not yet sure." sip "Whoa! Definitely blood that time. Darn it! Drank blood twice this week! But it may mean my patient has an infection..." Sip. "It's slightly cloudy and tastes bitter. Definitely an infection. "

*calls over resident doc. for teachable moment* "Hey, Dr. Camp. Come taste infected urine."

at least now i dont have to wonder what i am eating for dinner.

 

[Medstart108]

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.

I'd argue that while surgeons do have to know critical care, they don't do critical care as well as ICU docs. They work long hours but the reality is a huge chunk of their time is spent in the OR learning surgical skills which don't help them much with management of patients.

In a completely undifferentiated case I would pick a general surgeon or ICU doc. In terms of pure knowledge it would probably be neuro, nephro or EP cardiologists who know the most minutiae.

 

[Siggy]

I'd argue that while surgeons do have to know critical care, they don't do critical care as well as ICU docs. They work long hours but the reality is a huge chunk of their time is spent in the OR learning surgical skills which don't help them much with management of patients.

In a completely undifferentiated case I would pick a general surgeon or ICU doc. In terms of pure knowledge it would probably be neuro, nephro or EP cardiologists who know the most minutiae.

I'd argue that by the time you get to 2,020 posts, you would know that a thread that almost had 10 years since the last post is a hospice patient and you shouldn't have resuscitated it.

 

[Medstart108]

I'd argue that by the time you get to 2,020 posts, you would know that a thread that almost had 10 years since the last post is a hospice patient and you shouldn't have resuscitated it.

Geez, so much sass lol. Didn't read the post's date, sorry.

 

[bannie22]

I laughed at how Trauma even was an option.

Quite surprised with Nephro tho, I think at top programs they are excellent, at so-so institutions, not so much. Big gap. Perhaps because its also an easy fellowship match, so the top is great and the bottom are fillers.

 

[jhamaican]

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.

no

 

[JB50]

I'd argue that by the time you get to 2,020 posts, you would know that a thread that almost had 10 years since the last post is a hospice patient and you shouldn't have resuscitated it.

Oh gosh I cant ahahahaha