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False Divide

Luciali72x721Lucia Li -- “A physician diagnoses… and a surgeon operates on the diagnosis.”

The typical conversation about my future goes a little like this:

“Do you know what you want to do yet when you qualify?”


“Oh. Well, do you at least know whether you want to do medicine or surgery?”

Hurrumph! Why is there this divide in medical practice? And why should students know this distinction before they decide their area of interest, when this distinction is about the practice of medicine rather than its actual division –- into subject areas such as "cardiology", "gastro", etc.?

Thinking in particular about the rotation I’ve just done, neurology, the distinction seems much more a consequence of organisation rather than knowledge. To quote one of the neurology consultants, neurology is “diagnose and adios”. Much of the challenge of neurology comes in the diagnosis, the fine discrimination of possible options. In neurosurgery, the challenges seem to arise more in the management of their patients who are referred, often with diagnosis, from other areas. But they’re both dealing with problems of the nervous system. So, I kind of see medicine in general, and neurology in particular, as a coin, with one side as diagnosis and the other as management. Whereas physicians seem primarily concerned with the former, surgeons deal more with the latter.

But this sometimes seems like an arbitrary distinction. The vast majority of those in my year haven’t yet decided between surgery or medicine. And despite the pervading stereotypes of the specialties, most people would do well in either because your specialty shapes you as much as you shape it. When it comes down to it, it seems that most people will choose based more on lifestyle and work-style than on interest or competence. That really disappoints me because I didn’t go into medicine thinking “I want to be a surgeon” or “I want to be a physician” but because it’s fascinating.

Unfortunately, medicine isn’t there for my personal amusement; it’s there because the general population needs a health service. And because the practice of medicine sprang up distinct from surgery, which has its origins in a separate (more hirsute!) source, this divide has since remained both in practice and in training. Yet the body and its ills are not divided into management strategies; when will the time come for that to be recognised?

October 22, 2008 in Lucia Li | Permalink


Hi Lucia,
You bring up an issue that is often taken for granted as one of the universal truths of the practice of medicine. The divide between medicine and surgery seems to be pretty well ingrained into the scheme of things,and I doubt that will change any time soon. I agree that many of us would probably do well on either side of the fence; I am not sure, however, that it is such an arbitrary distinction. I am now about halfway through my 4th year, and my experience has been that when it comes to bipolarity of this choice, like attracts like, as they say. The people that are attracted to one specialty or the other, really seem to have personality similarities among the groups. Surgeons tend to be hands-on, shorter-term , "doers"--bright people who like a tangible result as soon as possible. Medicine Physicians tend to be talkers, longer-term, "thinkers" -- bright people who are willing to wait to see the results of their effort, and enjoy following their patients for a longer time. I am not trying to perpetuate a stereotype (of course there are outliers in both groups, and people who are a mix of traits) but stereotypes generally exist for a reason. In all honesty, sometimes the division has its benefits, as the different thought processes can generate meaningful (andsometimes heated!) discussions about cases and ultimately change the course of a patient's care for the better.
The nice thing about the medical profession in general is that regardless of whether you choose medicine or surgery, there are so many subspecialties out there that you can find one that is a perfect mix of what you enjoy. The more rotations you do, the clearer it will become that if you and your colleagues choose to pursue a path for the money or the lifestyle, it will never be enough. I hope that most of us still entered medical school not for the money, but because we wanted to be real doctors, helping real people. If you choose something based on interest and competence, find a program where you feel like you are among friends, and learn as much as you can, then the money will come eventually.

Posted by: Amber | Oct 28, 2008 5:25:51 PM

Dear Lucia,
A very erudite Professor of mine says-Its not about medicine or surgery, its just about the patient and the disease.We as medical student while trying to make our choices frequently forget this...

Posted by: Surabhi Ranjan | Oct 29, 2008 9:08:52 AM

There's so much more than JUST Medicine or Surgery! What about radiology and anaesthetics?

Posted by: Kimmy | Oct 29, 2008 8:21:26 PM

I am a resident neurologist in Italy and I don't agree with your vision of neurology "diagnose and adios"! We routinely take care of people whose diagnostic process (even if long and fascinating) is well terminated.

Posted by: Sara Gasparini | Oct 30, 2008 2:00:09 AM

im in the final year in medical school...i think that the divide is important because style of management in different although surgery includes both areas. surgery is direct, rapid, definitive intervention with scaplel medicine means medical ttt & waiting . one may like GIT but cant intervene as surgeon so he can choose to be physician while he is still in his interest.so first choose organ u want to deal with then decide whether u r physician or surgeon.

Posted by: ghadeer Said | Nov 2, 2008 3:02:30 AM

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