Medical Specialties: AKA Not All Fictional Doctors Are Surgeons
Ahoy, keyboard pirates!! The Mysterious Stranger, AKA Brittany (author of our beloved Guide to Medical School and official Friend of the Blog™ ) has come back, like a thief in the night, to give a run-down on the different medical specialties. For anyone not intimately familiar with the structure of medicine, this post is invaluable. I’ve re-read it like four times just this morning.
Thank you again, young Brittany-padawan. Take it away!
Hey folks! Your friendly neighborhood medical student here. Aunt Scripty was nice enough to post my spiel on medical school, and given the awesome response, I’m doing a follow-up to explain the different specialties and their capabilities.
First of all, before we get started, I’ll refer you to this awesome cartoon to get a brief glimpse of the personalities you run into in each:
http://theunderweardrawer.blogspot.com/2011/03/12-medical-specialty-stereotypes-2011.html
Are they stereotypes? Yes. Your doctor character doesn’t have to follow the personalities you see there at all. But a lot of doctors who go into those specialties have those traits; it makes sense if you remember that medical students rotate through, or at least see, most of these specialties, and we gravitate towards the specialty where we see similar personalities to our own. Sort of creates a self-fulfilling prophecy. Without further ado, these are the major specialties:
Internists are the work horses of the hospital; if you get admitted for something relatively common, like pneumonia or heart failure, odds are the internist will take care of you. (Aunt Scripty’s Note: for an insight into the world of an internist, see A Day in the Life of Pocket-Anon) Heck, even if what you have isn’t common, and they’re calling in specialists to help, it’s often an internist who basically oversees the whole thing, while the specialist drops in to alter this or that detail. Occasionally, you will see an internist who decides to work in clinics instead, but that job tends to fall to your…
The classic ‘town doctor’ is a family practitioner. They work in clinics mostly (some do work in hospital like an internist, though, or go to the hospital if one of their patients has to be admitted), and see every kind of patient, including kids and ob/gyn visits if the town is small/their practice is comprehensive enough. These are the doctors who form the closest relationships with their patients—seeing them for years, delivering their babies, taking care of the rest of the family—and tend to treat either chronic conditions (high blood pressure, diabetes, that kind of thing) or not-too-serious acute issues like mild infection or muscle sprains. There are some who are also trained for basic surgeries such as appendectomies and C-sections, but those are becoming increasingly rare. Still, if I had to choose a doctor for the zombie apocalypse, one of those old-school surgery-trained family docs would be among my top choices.
Pediatrics: Take care of children, from the newborn babies up to the 17 years and 11 month kids. Can work in either hospitals or clinics and, like family practitioners, often form the longest/closest relationships with their patients. I try not to go into too much of the personalities of practitioners here, but I will say that pediatricians have among the lowest salaries, but the highest job satisfaction; whether that’s the kind of people the specialty attracts, the patients, or just the fact that even big bad bureaucracies tend to be a little better when there’s a sick kid on the line, I’m not sure. My guess is a healthy combination of the three.
(Aunt Scripty’s Addition: Neonatologists are a subset of pediatricians, who primarily look after newborns, especially premies, and typically work in NICUs. The distinction isn’t actually splitting hairs; humans have exited the womb weighing as little as 1lb (500g), and neonatologists are the ones keeping them going.)
Surgery is easy on the one hand—everyone knows they’re the ones who operate on patients—but it’s also difficult because there are so many subspecialties. Your general surgeon is mostly in charge of basic surgeries, which almost all seem to involve the gut or skin—gallbladders, complex abscess drainage, appendectomies, small bowel obstruction, etc. I should point out: if your character’s specialty is not ‘surgeon’ (or a few others I’ve listed), and they have to do an emergency surgery for story purposes, they are going to be WAY in over their head. Which can be a good plot point, and it is possible your doctor can pull it off if there’s a life-or-death situation happening, but it’s going to scare the bejeebers out of them.
—Orthopedics. Bones and joints and muscles. Think of them like Thor: they think they can solve all problems with a mighty hammer blow.
—Plastics. The closest I’ve seen medicine come to art; I’ve seen patients who have just had half their face taken off to remove a cancer, and then plastics comes along and gives them a teeny tiny scar instead. Basically, if it’s anything to do with making a patient look better, it’s in their scope.
—Trauma. There’s sometimes confusion between a trauma surgeon and an ER doctor. Both are trained to help stabilize/evaluate a trauma patient, perform basic procedures, and decide if they need surgery. If a full-blown surgery is needed, though, the trauma surgeon has to take over and head to the operating room. The parts in Doctor Strange where the ER doctor’s assisting in/performing operations as a routine thing? No. Not in her wheelhouse.
Basically, anything that deals with the female anatomy is in their scope of practice—Pap smears, STD exams, pregnancy, C-sections, fertility issues, and a lot more. They’re one of the few specialties that really mixes both surgical and medical work; most others pick one or the other and stick to it religiously, but ob/gyn can flip between surgery (c-section, removing the uterus, tying tubes, and so on) and non-surgical work, so long as it pertains to the same anatomical system.
Emergency Medicine: The most badass of all specialties, which only the exceptionally intelligent, charming, and good-looking can aspire to.* No, in all seriousness, this is kind of the ‘jack of all trades’ specialty—if someone’s having a crisis that involves any specialty (psychiatric, ob/gyn, infectious, neurologic, etc.)—they come to the ER, and the doctors have to be able to treat them. Their job basically involves the most exciting fifteen minutes out of any specialty. That said, I should point out that a good half (at least) of what ER doctors see is not really an ‘emergency.’ (Aunt Scripty’s Note: This is actually closer to 90+%. There’s a developing subspecialty of ER/ICU combinations for docs who want to JUST deal with CRITICALLY ILL PEOPLE until they go upstairs.) It’s either something that’s serious, but can be managed outpatient with the right medications and follow-up, or it’s simply not serious at all (often because a patient can’t tell the difference; PSA that if you’re not sure if it’s serious or not, please do come and have us check it out!)
*Note that this description may be biased by the author’s experience. (Aunt Scripty’s note: don’t worry, paramedics are all like this too. The plural of anecdotes is data, right?)
Intensive Care: (Note: this section in Aunt Scripty’s addition.) Intensive care is where hospitals store the really, really sick patients. Intensivists are sort of a combination of internal medicine, emergency medicine, and anesthesiology. They’re very, very good with tweaking esoteric machines, but they’re also very, very good at talking about dying–because a lot of their patients will die, and they do a lot of resuscitating, intubating, and other “emergency” and anesthetic procedures. There are various different ICUs out there: medical, cardiothoracic, pediatric, neonatal, coronary, neuro, neurosurgical, etc.
Neurology: Treat any disorders of the brain, spine, or peripheral nervous system. These doctors can work in clinics, treating patients with chronic neurological disorders, or in the hospital, treating more severe/acute problems (mostly strokes, but also including other problems like MS, spinal cord issues, etc.).
Psychiatry: Ok, just to be clear here, psychiatry =/= neurology. Those are very different things, even though there are sometimes occasions when people will incorrectly send a psych patient to a neurologist or vice versa. Psychiatrists treat things like depression, anxiety, schizophrenia, and so on—diseases that primarily affect behavior, and where we can’t quite see what the cause and pathology are. Like a neurologist, though, psychiatrists can either work with hospital patients or in a clinic, or in a nice mix of the two.
Hematology/Oncology: Treat blood disorders and cancer. Note: broken up into surgical and non-surgical groups.
Dermatology: Treat skin disorders
PM&R: (Aunt Scripty’s Note: Physical Medicine & Rehabilitation; I had to look it up.) Help patients with physical rehab and recovery-oriented problems (wound care, chronic spinal cord damage, that kind of thing).
Anesthesiology: Manage anesthesia during surgery; responsible for monitoring/managing surgical patients’ vital signs and keeping them under during the procedure. Can also be involved in pain management.
Radiology: Interpret imaging of patients (X-rays, CT scans, MRIs, etc.)
Cardiology: Treat the heart
Pulmonology: Treat the lungs
Nephrology: Treat the kidneys
Gastroenterology: Treat the digestive system
Infectious disease: please tell me this is obvious
Urology: Treat urinary tract issues and male reproductive system
Endocrinologist: Treat hormone disorders
Immunologist: Treat immune disorders
Rheumatologist: Treat autoimmune disorders
Pathologists: Interpret tissue samples for disease/disorders. Usually that’s cells, but also includes autopsies; if you’re doing a crime/mystery story, a forensic pathologist is your best choice for a doctor.
—This isn’t an exhaustive list, just the most common ones I can think of off the top of my head. If anyone wants more details on a specialty or thinks something’s missing, let me know!
—So, the age old question: in a post-apocalyptic setting, what kind of doctor do I want? (Ok, ok, no one asks this question but me. Whatever.) Still, in answer: I’d most want an old school family medicine doctor with experience in global health. Second choice would be an emergency medicine doctor, and if I couldn’t have global health, I’d at least ask for a military background. A nurse practitioner with EM experience would also be pretty awesome. Why? Versatility. These practitioners treat all patients, with all diseases. The family medicine doc is better with chronic complaints (asthma, and a. fib won’t disappear with the apocalypse) and may have surgical experience, while the EM doc will be better with acute issues like heart attack, trauma, or infection, but they’ll both be able to cross over. But the kicker for me is global health. That means the doctor’s been trained to work in a resource limited setting, and so instead of panicking that they can’t get a lab result or imaging, they’ll be able to figure out a workaround.
—I’ve left out a lot of the surgical subspecialties (neurosurgery, hand surgery, etc.) for space. Just know that there are a lot, and google for a list if you need a specific one. Same for pediatrics; you can pretty much add ‘pediatric’ in front of anything in the lightning round—pediatric cardiologist, for instance—and it’s its own specialty.
—Gender dynamics: there are now an equal number of men and women entering medical school, and have been for the past few years. That said, the genders often go into different specialties: women are more common in ob/gyn and pediatrics, while men are more common in surgery (particularly orthopedics), urology, and to a lesser extent, ER. Other specialties tend to be more even, but the older a physician is, the more likely they are to be male, simply because fewer women entered medicine as little as a decade ago. That also means more men in leadership positions, still.
So that’s it for this post! Thanks again to Brittany, who will surely make an excellent EM doc some day.
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