Both patients and providers realize that an internist is different from a surgeon, but specifically how they differ and how this affects their approaches to patient care is largely under-appreciated. Over the last four years, I have conducted over 250 interviews with physicians across specialties and institutions about what they do and why they do what they do. With each project, I continue finding remarkably distinct, specialty-specific values, perceptions, and ways of thinking that seem to directly impact how physicians interpret medical evidence and, ultimately, care for patients.
Medical specialties, like other academic disciplines, are distinct cultures with their own jargon, journals, meetings, practice guidelines, uniforms, idols, tools, and rituals. During medical school, students “try on” specialty identities through their rotations, often choosing a specialty where they “fit in.” Professional values then diverge further during the intense socialization process of residency and fellowship, reinforcing distinct values and perceptions. Although institutions also have distinct cultures, this seems secondary to physicians’ specialty identity. Academic cardiologists in the Midwest and private practice cardiologists in California use considerably more similar language and thought processes than interventional cardiologists and interventional radiologists at the same institution.
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