Tomato-Tomato: Answering some questions of distinction from the world of medicine.

Image from mentalfloss.com.

“You say tomato, I say tomato.”

You know the saying.  So, did my delightful teacher in Nuc Med, Debbie.  Except when she said the saying she pronounced tomato identically both times.

It cracked us up.

In life there are some things that sound the same but are different, some that look the same but are different and some that are indeed the same, but sound different.

Confused yet?

I have been asked a few awesome questions about some medicine-ish sorts of things by my readers and patients and family and have decided to answer some of them now.  These are answers to some of the “what is the difference between” sorts of questions.

Question 1: What is the difference between a ward clerk and a clinical clerk?

A ward clerk is the lovely person who takes care of all of the administrative things on the hospital ward.  They are the sunny face that directs people to rooms, answers phones and keeps the place organized.  They get paid for this job.  A clinical clerk, also known as a senior medical student is someone who is in their last couple of years of med school and is rotating through the hospital learning in a hands on sense how to be a doctor.  They are different from residents or interns.  They are NOT doctors (yet).

Question 2: What is the difference between an intern and a resident?

Not much and yet a fair bit.  An intern is a first year resident.  All residents are doctors.  They are doing training so that they can practice independently.  It is like another gradation of training.  You can’t just get a job working as a doctor out of medical school.  You get a job working as a resident.  In many places, there is a first year of “rotating internship” meaning the first year resident has to do rotations in a number of specialties of medicine to get well rounded before focusing on one area of medicine.  That is kind of what I am doing now.  Sometimes people say interns are off-service first year residents.  First year residents and fifth year residents are very different in that the level of training is obviously different.  You learn more as time goes on.

If I didn’t hate graphic t-shirts, I would need this shirt. Image from zazzle.com.

Question 3:  What is the difference between medical and radiation oncology?

Both are oncologists (although most people only consider their medical oncologist an “oncologist”).  Medical oncologists are doctors specialized in giving systemic treatments for cancer, like chemotherapy and hormone therapy.  Their background is internal medicine.  Radiation oncologists (not to be confused with radiologists) are doctors specialized in using radiation to treat cancers, often in a more localized fashion.  One is not better than the other.  The medical, radiation and surgical oncologists all work together to provide cancer care.  Sometimes for one cancer, it responds better to one thing and not another.  Others need all three modalities.  It depends on the cancer.

Question 4:  What is the difference between radiation oncology and radiology?

There were people in my med school class who I am pretty sure thought up to the day we graduated I was going into radiology.  Because they are clearly the same thing.  They are not, although back in the day, they were.  Then a lot more oncology started happening and things got more specialized and they branched off of each other back in the 50s and 60s.  Radiology is a field in which you read diagnostic imaging (CTs, MRIs etc).  Interventional radiology is a subspecialty of radiology in which you use radiologic imaging to do some surgical procedures, like putting in chemo lines and special drains.  Radiation oncology is a field in which you treat cancers with radiation.

Question 5: What is the difference between Hospice and Palliative Care?

At surface, there isn’t a major difference.  Often, the two are grouped together.  Hospice is a type of Palliative Medicine.  Palliative comes from the word pallium, meaning to cloak or comfort.  Pretty beautiful term, if you ask me.  Palliative medicine is a field of medicine in which you provide pain and symptom management, generally to people with life threatening illness.  Being cared for by palliative medicine does not mean death is imminent, but that cure is unlikely and comfort is important.  Palliative medicine is all about quality of life.  In a hospital, there may be a palliative care unit – an inpatient unit that provides comfort care.  In the community, there may be a Hospice house or organization.  Hospice is a type of palliative medicine and a sort of philosophy.  It is home-based palliative care.  Meaning, people are supported at home through outreach teams or they can go and live in a hospice house, which is a home like setting providing palliative supports.  Often, a palliative care unit is a bit more hospital like and can provide a bit more hospital-type supports compared to a hospice house, which is basically a home away from home.

 Question 6: What is the difference between the short white coat and the long white coat?

Good question.  My first guess would be the amount of white fabric available to get dirty (I am not a fan of white coats).  Apparently it varies from school to school.  Where I came from, the short white coat was a symbol of you not being in your clinical years.  You wore it to shadow, to clinical skills and such.  It was a sign of being a rookie.  Once you hit clerkship, you could wear the long one.  In some other places, all medical students go short.  I have no clue.  I guess it depends where you are.

This image, taken from an article in boston.com demonstrates the different styles and people wearing white coats and how although long white coats are traditionally associated with attending physicians and big accomplishments, it does not mean only attendings wear them and the reverse is true of the short white coat. Bet you can’t tell who is who.

Question 7:  What is the difference between an allergy and a sensitivity?

An allergy is an immune response.  A sensitivity is kind of like a nasty side effect or irritation.  People claim they are allergic to all sorts of things they are not.  If you vomited or itched or got constipated on morphine, you probably had side effects and may have a sensitivity.   If you develop hives, intractable vomiting or difficulty breathing, then it is an allergy.

Question 8: What is the difference between nuclear medicine and radiology?

Nuclear medicine is awesome.  That is the clear difference.  Seriously though, nuclear medicine involves imaging radioactive tracers as they behave within someone’s body (physiologic imaging).  For instance a bone scan images a tracer that acts like calcium and binds to bone.  Areas of fracture, wear and tear, infection or cancer appear brighter because that bone is turning over more quickly.  Radiology generally involves external radiation projected onto a film through the body.  It images anatomy only for the most part.   Think x-ray.

Upper left is a bone scan of a hand with a fracture of several carpal bones (with pins in place). Upper right is an x-ray of the same hand). The bottom left is an example of a fusion image with the two modalities showing how activity can be localized to an anatomic site.  Image from HERMESmedical.com.

There you go.  Eight awesome questions I get relatively often about things that seem very different or kind of the same.  Let me know if there are more questions.  Or more answers.  Either are delightful.

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4 thoughts on “Tomato-Tomato: Answering some questions of distinction from the world of medicine.

  1. Thanks Trisha, Very informative!

    One more question re palliative care and hospice. Am I right in understanding that patients who are undergoing either would be at a point where they would no longer be receiving active treatment for their disease? For example, chemotherapy for a cancer patient would not be considered palliative care, right? Palliative medicine would be more managing the symptoms of someone who has cancer rather than trying to cure them or put the cancer into remission. That’s the way I’m understanding it anyway.

    I agree, the word pallium (meaning cloak or comfort) is a beautiful word, indeed. This kind of care must be a comfort not only for people with serious illnesses but also for their loved ones who must walk through such a difficult time with them.

    God bless your tender heart toward palliative medicine!

    • Yes, you are right, most people who go into palliative care are not receiving active treatment like chemo or radiation. However, there are some types of chemo or radiation that can be more gentle and used to help relieve symptoms that people sometimes continue to receive or start while under palliative care.
      I am glad it was informative!

  2. Cool post! At our school, we can wear long or short coats, it basically comes down to personal preference. But our qualified doctors hardly ever wear the coats.
    As for interns, in South Africa, Internship is the compulsory first two years after graduation. Kind of like, “You’re qualified as a doctor, but we’re still watching you so you don’t kill anybody.”

    • Interesting. We pretty much get told not to wear the short ones once you are in clerkship. I think it should be personal preference. With our attendings, it varies. Some always wear them and some never do. Generally, it seems to be the older docs that wear them consistently.
      I find it interesting how every place has a different system for post-md training. Our minimum is two years to be a family doc, so kind of similar, but they generally call it internship only for the first year.

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