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Old 05-29-2013, 06:41 AM   #31
DouglasCole
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Default Re: What level Physician skill should an MD have?

Quote:
Originally Posted by ericthered View Post
http://www.medterms.com/script/main/...rticlekey=3997

I like how they use the word "adults" rather than "old people".
I started seeing an internal medicine specialist in my 30's. They mean adults as distinct from pediatric medicine. Geriatric medicine is the specialty for older adults.
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Old 05-29-2013, 06:43 AM   #32
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Default Re: What level Physician skill should an MD have?

Sorry, yes:

FP = family practice. By definition an FP is sort of a generalist who learned a little pediatrics, a little internal medicine, and a little obstetrics.

Internist = IM = internal medicine, or sometimes called "adult general medicine", i.e. the guy who takes over once the pediatrician has timed out. Internists don't learn pediatrics or obstetrics- they concentrate on adults ages 18 to whenever they die. Yet technically in most states pediatricians are licensed to care to people up to the age of 21, believe it or not.

OTOH, yes, an "intern" is someone who has graduated medical school and is now in the first year of a residency. After the first year you are called a "resident."

Anyway, most of you are mis-using the term GP or "general practitioner." You're using GP as a synonym for "primary care", and it is not. At least in U.S. vernacular a GP is a doctor who graduated from medical school and then went into practice- full-stop. Most significantly, he has not completed a residency (though most have done a 1-year internship somewhere). They are not board-certified, nor even board-eligible. (Or they could be someone who flunked out of residency and didn't wan to start another, or who couldn't find a residency to accept them after their internship.) This is very uncommon nowadays. Most practicing GPs are dinosaurs who are nearing retirement, if you could even find one. Perhaps in a small rural town somewhere? These old guys are sort of grandfathered in. It is otherwise nowadays (quite literally) impossible to get admitting privileges at a hospital without a residency. There really aren't that many left. It's also dangerous to just hang up your shingle and start your own clinic.

Lawyer: So, Dr. Smith, where did you do your residency?
Smith: Well, er, um, I didn't really do a residency-
Lawyer: Ka-ching! It's like a license to print money!

FWIW, GS = general surgery (e.g. me). General surgeons do all of the surgery for which you can't think of a subspecialist. So, no orthopedics, no cardiothoracic, no ENT, no GYN, no vascular, no neurosurgery, etc. Everything else is GS, which amounts to abdominal organs, hernias, skin excisions (i.e. tumors), and general trauma. Yes, there is some overlap. For instance there are specialist trauma surgeons, but they aren't common and are basically intensive care specialists. All GS surgeons learn a lot of trauma. Plus, trauma fellowships are disappearing and being replaced with "acute care surgery" fellowships, and the medical intensivists (a subspecialty of internal medicine) are starting to take over the trauma ICUs. Likewise, dermatologists excise skin cancers and just call me when it is very large. Most GS surgeons will excise varicose veins even though it's technically a vascular procedure. (And can do all sorts of cardiac and vascular repairs for trauma.) Most GS surgeons can remove a thyroid or parathyroid, even though the ENTs are the real experts. Any GS surgeons will do a VATS (sticking a scope in the chest cavity) if he has to- for instance for a lung decortication or pleurodesis- even though that's thoracic surgery. Etc.

Quote:
Originally Posted by Refplace View Post
This could make a decent Pyramid article or even fit into a few of the E23 wish list items.
This has been brought up before, in the thread that I linked. Unfortunately I don't really have the time to do it myself. Others have expressed an interest, and I offered to consult and answer questions, but I simply can't commit to more than that.

Quote:
Originally Posted by DangerousThing View Post
No, the fictitious Dr. House is a diagnostician, which is the specialty of diagnosis.
There is no such specialty as a "diagnostician." Every physician is a diagnostician, with few possible exceptions. (Radiation oncologists?) Trust me, Dr. House is an internist- albeit one who has carved himself a very specific niche in his institution. And you'll note that he also treats his patients- or at least the ones that are treatable. That's Physician skill.

Quote:
Originally Posted by Rasputin View Post
Add the extra prep time spent looking over the patient's chart. That's time a field medic doesn't and can't spend.
I was counting prep time. Primary care is freakin out of hand in the U.S. Luckily I'm a specialist, and I work for the government to boot, so I get 30 minute clinic slots. I'm not uncommonly double-booked, but it's the thought that counts, right? :)

FYI- "Primary care" means any doctor who you might see first for a problem that isn't an emergency. They are "your doc", i.e. non-specialists. So, in general: pediatricians, FPs, internists. If they can't figure it out (or if they can but you need special care) they send you to a specialist.

Quote:
Originally Posted by DouglasCole View Post
I started seeing an internal medicine specialist in my 30's. They mean adults as distinct from pediatric medicine. Geriatric medicine is the specialty for older adults.
Correct. Geriatrics is something else (usually a subspecialty of internal medicine). I don't know if there is a formal fellowship for it- I think in general if you want to do that you just take some courses, then start selecting for old patients.

FYI- pediatricians get really pissy if you try to tell them that kids are just little adults... :P

Last edited by acrosome; 05-29-2013 at 10:36 AM. Reason: spelling
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Old 05-29-2013, 06:43 AM   #33
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Default Re: What level Physician skill should an MD have?

Quote:
Originally Posted by ericthered View Post
http://www.medterms.com/script/main/...rticlekey=3997

I like how they use the word "adults" rather than "old people".
Aha, cool cheers!
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Old 05-29-2013, 07:11 AM   #34
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Default Re: What level Physician skill should an MD have?

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Originally Posted by DangerousThing View Post
I know that 12 is the normal level of skill for a professional, but does an MD need a higher skill than 12 or just more skills (Physician, Diagnosis, and maybe Surgery or Psychology)?

I'm asking because one character in my SF campaign wants to be a doctor as well as a master martial artist.

And if this is in the rules, can you tell me where?

Thanks.
The important thing is to read the GURPS skill contents rather than go by the skill name.

IMO, the main professional skill of non-surgical modern MDs is Diagnosis. I believe that the target of most residency programs is to have the majority of graduates functioning at Diagnosis 14, or for surgical residencies, Surgery 14. Physician is probably around 12, and may decay for those whose practice involves little actual treatment delivery.

Professional nursing is probably where you find more focus on the activities comprised in the GURPS Physician skill.
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Old 05-29-2013, 07:44 AM   #35
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Figleaf23 View Post
IMO, the main professional skill of non-surgical modern MDs is Diagnosis....

Professional nursing is probably where you find more focus on the activities comprised in the GURPS Physician skill.
Yes, diagnosis is used to figure out what is wrong, but you need Physician skill to know how to treat it, including knowing which medication to prescribe! Which is not a nursing function- nurses can't prescribe medications- unless one is a nurse practitioner or nurse anesthetist.

The reason that physicians can treat more and more patients around TL5-8 (B425) is due to the advent of professional nurses. But developing treatment plans is still the prerogative of the physician.

I'd say that nurses, including LPNs, have Professional Skill (Nurse). For instance- this is a wildly inaccurate way to put it in the real world, but in game terms- this skill allows one to know how to administer medications but not which medication is indicated.

Should an RN add one point in Physician? Arguable. Depends on how you look at the GURPS mechanic (not reality). In general, a nurse is not going to develop a treatment plan for someone. The doctor writes orders, and the nurses carry them out. So for instance for an inpatient the doctor prescribes a medication (using Physician skill) and the nurse administers it in the prescribed dose, manner, and schedule. However, yes, in particular regarding recovering from injuries (B424), that is mostly due to good nursing care, yet GURPS makes it a function of Physician skill. And, of course, there are a lot of sharp nurses out there who can take a reasonable stab at things even if they aren't nurse practitioners.

I'd propose that a physician probably still writes the orders to change dressings twice a day with Dakins solution (or whatever) and it's the nurse carrying out the order. OTOH, yes, if no doctor is available a nurse should make a better job of it than a layman. My answer would be to allow some degree of default to Physician from Professional Skill (Nurse).

Frankly (if I were being rigorous) regarding recovery from injury on B424, I think I'd roll against the average of Physician and Professional Skill (Nurse) for the bonus tp HP recovered, not just Physician. Or better yet, use Professional Skill (Nurse) as a adjunct skill (or whatever they are called) for Physician. I.e. the Physician gets a +1 bonus if the nurse makes her skill roll, and a penalty of some sort if the nurse critically fails. And, as in real life, since most physicians would lack Professional Skill (Nursing), they have a better chance of screwing that up if they try to do things themselves (like in an adventuring party that lacks a nurse).

Actually, knowing as I do just how useful a good nurse is, I might allow adjunct skill roles by a nurse in a lot of instances...

Last edited by acrosome; 05-29-2013 at 10:40 AM. Reason: really odd spelling mistakes
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Old 05-29-2013, 07:44 AM   #36
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Default Re: What level Physician skill should an MD have?

12 seems plenty for your average non-adventuring professional, given all those positive modifiers from routine situations, extra time taken, and plentiful high-quality gear. On the other hand, a proper MD needs several skills to be effective, so that's where their points go.

Each positive circumstance you remove means the professional in question needs more raw skill to compensate. I imagine a Doctors Without Borders member treating people in a tent on a war zone would be more skilled than the "average professional" above.
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Old 05-29-2013, 08:13 AM   #37
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Default Re: What level Physician skill should an MD have?

Quote:
Originally Posted by Bira View Post
12 seems plenty for your average non-adventuring professional, given all those positive modifiers from routine situations, extra time taken, and plentiful high-quality gear. On the other hand, a proper MD needs several skills to be effective, so that's where their points go.

Each positive circumstance you remove means the professional in question needs more raw skill to compensate. I imagine a Doctors Without Borders member treating people in a tent on a war zone would be more skilled than the "average professional" above.
Or he'd just have more complications... eh? I've done expeditionary medicine- it's a compromise.

Most MSF docs don't work there full-time. They volunteer, and take time off of their day jobs.

Last edited by acrosome; 05-29-2013 at 10:29 AM. Reason: spelling
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Old 05-29-2013, 08:26 AM   #38
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Bira View Post
12 seems plenty for your average non-adventuring professional, given all those positive modifiers from routine situations, extra time taken, and plentiful high-quality gear. On the other hand, a proper MD needs several skills to be effective, so that's where their points go.

Each positive circumstance you remove means the professional in question needs more raw skill to compensate. I imagine a Doctors Without Borders member treating people in a tent on a war zone would be more skilled than the "average professional" above.
I really, really dislike the "professional skill level=12". Among the many problems it has is: what happens when the professional skill standards change? For example:

Quote:
Originally Posted by acrosome View Post
Sorry, yes:
...
Anyway, most of you are mis-using the term GP or "general practitioner." You're using GP as a synonym for "primary care", and it is not. At least in U.S. vernacular a GP is a doctor who graduated from medical school and then went into practice- full-stop. Most significantly, he has not completed a residency (though most have done a 1-year internship somewhere). They are not board-certified, nor even board-eligible. (Or they could be someone who flunked out of residency and didn't wan to start another, or who couldn't find a residency to accept them after their internship.) This is very uncommon nowadays. Most practicing GPs are dinosaurs who are nearing retirement, if you could even find one. Perhaps in a small rural town somewhere? These old guys are sort of grandfathered in. It is otherwise nowadays (quite literally) impossible to get admitting privileges at a hospital without a residency. There really aren't that many left. It's also dangerous to just hand up your shingle and start your own clinic....
So, not too long ago, the standards for being a doctor were, um, lower. Who has skill 12? The GP era doctor, or the post-GP era doctor? Or even the pre-Flexner report doctor? Massive, massive differences in doctor quality (even after adjusting for TL), but all are "professionals".
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Old 05-29-2013, 09:43 AM   #39
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Default Re: What level Physician skill should an MD have?

I can contribute a little from personal experience as a surgical patient.

In 2001 when I was talking with my surgeon about the decompressive laminectomy he was planning on my C3-C7 to treat stenosis he gave me The Talk about possible side effects.

It became clear to me that in Gurps terms the final adjusted average for this sort of surgery was 15 or less. 95% success without complications with 5% complications with most of those being less serious (simple failure in Gurps terms) and a few really rather serious complications (Crit Fail in Gurps terms).

So, what modifiers applied? Per Basic there was a -3 for surgery on the head or Chest. Technically this was the cervical spine but I wouldn't make that easier than the head or chest.

Then (per Bio-tech) there was a possible +4 for a Specialized Operating Theater. Bonuses for sssistants with Surgery 12+ were possible but I didn't pay for any so they probably weren't there. I wouldn't count the Anethesiologist as "assisting" the surgeon. He's absolutely necessary but he's also busy doing his own thing.

So if that "average" surgeon has a Skill level of 14 and takes a -3 but then gets a +4 that's a net 15 which is what the average adjusted Skill level for at least that operation appears to be.
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Old 05-29-2013, 09:47 AM   #40
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Default Re: What level Physician skill should an MD have?

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Originally Posted by Kraydak View Post
I really, really dislike the "professional skill level=12". Among the many problems it has is: what happens when the professional skill standards change? For example:

So, not too long ago, the standards for being a doctor were, um, lower. Who has skill 12? The GP era doctor, or the post-GP era doctor? Or even the pre-Flexner report doctor? Massive, massive differences in doctor quality (even after adjusting for TL), but all are "professionals".

Physician 12 (TL 7) is not as good as Physician 12 (TL 8)
For the gaming perspective there has to be a sharp cut off, but in reality it would be a smooth-ish transition between the two.
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Last edited by Mathulhu; 05-29-2013 at 09:50 AM.
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