These are not hard-and-fast rules as there are certainly medical diseases such as asthma that are local (e.g., affecting bronchi in the lungs) and in which medicine (such as an inhaled β2 agonist) is rapidly effective. So what factors make a disease surgical vs medical? In general, a surgical disease has the following characteristics: (1) is local in extent, (2) requires rapid treatment, and (3) has a surgical intervention with a sufficiently favorable risk–benefit balance Before the advent of heart transplantation and other such circulatory support (such as left-ventricular assist devices), heart failure was largely a medically treated disease. Diseases have also made the opposite switch from the medical to the surgical size. TB is now, of course, mostly a medical disease. Some may be surprised to learn that tuberculosis (TB) was once treated by surgically excising diseased lung tissue. Also, there are some diseases that have been historically surgical that are now medical and vice versa. This concept was exemplified earlier this year with the pivotal Spine Patient Outcomes Research Trial (SPORT) where it appeared clear that patient choice was probably a more important factor in the selection of treatment modality than necessarily any hard evidence-based scientific criteria. Some conditions, such as back pain, can have either surgical or medical treatment options in which it is not definitively clear which approach is necessarily superior. Also, in many cases, the increasing realization that even localized disease can often harbor cancer stem cells throughout the body means that surgery is not uncommonly combined with more generalized medical therapies. Earlier (or more localized) tumors are often excised surgically, whereas chemotherapy is generally indicated for more advanced diseases. Cancer is another example that is treated either surgically or medically (or both). A dislocated shoulder typically requires an intervention (not necessarily surgical but at least some form of manual manipulation) as it is highly unlikely that taking a pill will do the trick. An infected abscess, however, would require a surgical approach to drain it and reduce the infectious load on the body. An infection, for example, might involve antibiotics (a medical approach). Many diseases may actually share both medical and surgical manifestations. A medical condition involves a more systemic, pharmaceutical approach to treatment. The 13th century physician Gilbertus Anglicus once exclaimed: “Why in God's name is there such a great difference between a physician and a surgeon?” A simple definition would read:Ī surgical disease is one that requires some form of localized intervention such as, of course, surgery, although various vascular interventions and radiation techniques would also fall into this category. This can often be a fairly dichotomous decision, as approaching the patient from either of these perspectives implies very different doctors (e.g., physicians vs surgeons), tools (drugs vs scalpels), and resources (clinic vs operating room). One of the most important decisions a clinician makes is whether a patient's condition requires a medical or a surgical approach.
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