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 Blogโข ) 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. Iโve re-read it like four times just this morning.
Thank you again, young Brittany-padawan. Take it away!
Hey folks!ย Your friendly neighborhood medical student here.ย Aunt Scripty was nice enough to post my spiel on medical school, and given the awesome response, Iโm doing a follow-up to explain the different specialties and their capabilities.
First of all, before we get started, Iโll refer you to this awesome cartoon to get a brief glimpse of the personalities you run into in each:
Are they stereotypes?ย Yes.ย Your doctor character doesnโt have to follow the personalities you see there at all.ย 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.ย Sort of creates a self-fulfilling prophecy.ย 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 Scriptyโs 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 isnโt common, and theyโre calling in specialists to help, itโs often an internist who basically oversees the whole thing, while the specialist drops in to alter this or that detail.ย Occasionally, you will see an internist who decides to work in clinics instead, but that job tends to fall to yourโฆ
The classic โtown doctorโ is a family practitioner.ย 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.ย These are the doctors who form the closest relationships with their patientsโseeing them for years, delivering their babies, taking care of the rest of the familyโand 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.ย There are some who are also trained for basic surgeries such as appendectomies and C-sections, but those are becoming increasingly rare.ย 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:ย Take care of children, from the newborn babies up to the 17 years and 11 month kids.ย Can work in either hospitals or clinics and, like family practitioners, often form the longest/closest relationships with their patients.ย 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 thatโs 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 thereโs a sick kid on the line, Iโm not sure.ย My guess is a healthy combination of the three.
(Aunt Scriptyโs Addition: Neonatologists are a subset of pediatricians, who primarily look after newborns, especially premies, and typically work in NICUs. The distinction isnโt 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 handโeveryone knows theyโre the ones who operate on patientsโbut itโs also difficult because there are so many subspecialties.ย Your general surgeon is mostly in charge of basic surgeries, which almost all seem to involve the gut or skinโgallbladders, complex abscess drainage, appendectomies, small bowel obstruction, etc.ย I should point out: if your characterโs specialty is not โsurgeonโ (or a few others Iโve listed), and they have to do an emergency surgery for story purposes, they are going to be WAY in over their head.ย Which can be a good plot point, and it is possible your doctor can pull it off if thereโs a life-or-death situation happening, but itโs going to scare the bejeebers out of them.
โOrthopedics.ย Bones and joints and muscles.ย Think of them like Thor: they think they can solve all problems with a mighty hammer blow.
โPlastics.ย The closest Iโve seen medicine come to art; Iโve 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.ย Basically, if itโs anything to do with making a patient look better, itโs in their scope.
โTrauma.ย Thereโs sometimes confusion between a trauma surgeon and an ER doctor.ย Both are trained to help stabilize/evaluate a trauma patient, perform basic procedures, and decide if they need surgery.ย If a full-blown surgery is needed, though, the trauma surgeon has to take over and head to the operating room.ย The parts in Doctor Strange where the ER doctorโs assisting in/performing operations as a routine thing?ย No.ย Not in her wheelhouse.
Basically, anything that deals with the female anatomy is in their scope of practiceโPap smears, STD exams, pregnancy, C-sections, fertility issues, and a lot more.ย Theyโre 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.*ย No, in all seriousness, this is kind of the โjack of all tradesโ specialtyโif someoneโs having a crisis that involves any specialty (psychiatric, ob/gyn, infectious, neurologic, etc.)โthey come to the ER, and the doctors have to be able to treat them.ย Their job basically involves the most exciting fifteen minutes out of any specialty.ย That said, I should point out that a good half (at least) of what ER doctors see is not really an โemergency.โ (Aunt Scriptyโs Note: This is actually closer to 90+%. Thereโs a developing subspecialty of ER/ICU combinations for docs who want to JUST deal with CRITICALLY ILL PEOPLE until they go upstairs.)ย Itโs either something thatโs serious, but can be managed outpatient with the right medications and follow-up, or itโs simply not serious at all (often because a patient canโt tell the difference; PSA that if youโre not sure if itโs serious or not, please do come and have us check it out!)
*Note that this description may be biased by the authorโs experience. (Aunt Scriptyโs note: donโt worry, paramedics are all like this too. The plural of anecdotes is data, right?)
Intensive Care: (Note: this section in Aunt Scriptyโs 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. Theyโre very, very good with tweaking esoteric machines, but theyโre also very, very good at talking about dyingโbecause a lot of their patients willย die, and they do a lot of resuscitating, intubating, and other โemergencyโ and anesthetic procedures. There are various different ICUs out there: medical, cardiothoracic, pediatric, neonatal, coronary, neuro, neurosurgical, etc.
Neurology:ย Treat any disorders of the brain, spine, or peripheral nervous system.ย 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.ย 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.ย Psychiatrists treat things like depression, anxiety, schizophrenia, and so onโdiseases that primarily affect behavior, and where we canโt quite see what the cause and pathology are.ย Like a neurologist, though, psychiatrists can either work with hospital patients or in a clinic, or in a nice mix of the two.
Lightning Round:
Hematology/Oncology: Treat blood disorders and cancer.ย Note: broken up into surgical and non-surgical groups.
Dermatology: Treat skin disorders
PM&R: (Aunt Scriptyโs 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 patientsโ vital signs and keeping them under during the procedure.ย 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.ย Usually thatโs cells, but also includes autopsies; if youโre doing a crime/mystery story, a forensic pathologist is your best choice for a doctor.
Side Notes:
โThis isnโt an exhaustive list, just the most common ones I can think of off the top of my head.ย If anyone wants more details on a specialty or thinks somethingโs missing, let me know!
โSo, the age old question: in a post-apocalyptic setting, what kind of doctor do I want?ย (Ok, ok, no one asks this question but me.ย Whatever.)ย Still, in answer: Iโd most want an old school family medicine doctor with experience in global health.ย Second choice would be an emergency medicine doctor, and if I couldnโt have global health, Iโd at least ask for a military background.ย A nurse practitioner with EM experience would also be pretty awesome.ย Why?ย Versatility.ย These practitioners treat all patients, with all diseases.ย The family medicine doc is better with chronic complaints (asthma, and a. fib wonโt 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 theyโll both be able to cross over.ย But the kicker for me is global health.ย That means the doctorโs been trained to work in a resource limited setting, and so instead of panicking that they canโt get a lab result or imaging, theyโll be able to figure out a workaround.
โIโve left out a lot of the surgical subspecialties (neurosurgery, hand surgery, etc.) for space.ย Just know that there are a lot, and google for a list if you need a specific one.ย Same for pediatrics; you can pretty much add โpediatricโ in front of anything in the lightning roundโpediatric cardiologist, for instanceโand itโs its own specialty.ย
โGender dynamics: there are now an equal number of men and women entering medical school, and have been for the past few years.ย 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.ย 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.ย That also means more men in leadership positions, still.
So thatโs it for this post! Thanks again to Brittany, who will surely make an excellent EM doc some day.
xoxo, Aunt Scripty