What’s My Line?

Dr. Brian Johnston, medical director of the Emergency Department at White Memorial Medical Center, bounds out of his office, apologizing that he’s running late for the interview.

His desk, visible behind him, is piled with paperwork, but it’s downright orderly compared to the desk in his other office on the hospital’s ground floor. Amid three dozen precariously stacked Journals of Trauma is so much paper that it’s difficult to determine the desktop’s color.

Johnston’s Desk Tour ’96 continues to the office of Dr. Ramsay Nucho, a cardiac surgeon at the hospital. He’s not in, but office manager Judie Natividad opens the door to reveal a desk that looks almost shrine-like.

A 3-D model of a heart sits at one end of Nucho’s polished cherrywood desk. Nearby, a telephone and a framed picture. Nucho’s computer and printer, dust-free, are off to the side. Next to his immaculate desk blotter is a neat, short stack of Manila folders containing medical charts of the patients to be seen this particular afternoon.

It’s no coincidence that the heart surgeon’s office is spotless and the ER doc’s is, well, not. And it’s no mistake that your orthopedic surgeon isn’t a pediatrician and your brain surgeon isn’t a plastic surgeon.

The dissimilar personalities of medical specialists can make the differences between cats and dogs seem blurred. These differences--the subject of good-natured ribbing among the specialties--go back to the days when Adam’s endocrinologist first quipped, “How many psychiatrists does it take to screw in a lightbulb?”

But what are the forces at play? Why do cardiac surgeons have a reputation for being precise neatniks? Why are emergency medicine doctors known for thriving in chaos? Do certain personality types gravitate toward specific specialties or do the demands of the specialties mold personality?

Thomas G. Grandy, a psychologist at Creighton University, Omaha, and his colleagues have conducted career counseling with medical students. They have also researched the personality traits of dentists.

Medical students who like action and crises often go into emergency medicine, Grandy says. Students who enjoy figuring things out often end up in psychiatry.

Students with a “feeling” type personality, as determined by the Myers-Briggs Type Indicator--a psychological measure to determine personality preferences and other data--”like developing a relationship with their patients,” Grandy says. “Internal medicine and pediatrics would be a possibility, and so would public health.”

Med students who like routines and dealing in details are likely to be found in general medicine and family practice, he says, “and, to some extent, maybe surgery.”

And the introverted lovers of reason and structure are likely to move to dental school. “True, true, true,” says Huntington Beach dentist David Meirovitz. “Dentists are nit-pickers and live in their own little environment. How big is a mouth--4 inches by 3? We’re very similar to CPAs.”

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An informal polling of Southern California-area doctors shows that it’s clear which personality type is headed toward which specialty during the first few weeks of medical school:

* The future orthopedists were the ones in “muscle beach” attire, says Dr. Richard Wright, a cardiologist and director of the Heart Institute at St. John’s Hospital and Health Center. They were probably playing basketball or rounding up dorm mates for flag football.

* Looking for the internists-in-training? Try the library. They’re known for gathering as much information as possible (and knowing how to spell “compulsive”).

* Pediatricians-to-be? Look in the video arcade for these perpetual adolescents.

* And med students “who were a little odd,” says a physician who asked to remain nameless, “went into psychiatry.”

As medical school progresses and students become practitioners, the stereotypes crystallize. Among those offered up anonymously:

* Cardiac surgeons, driven and dedicated, tend to see things in yes or no terms, says a physician in another specialty. “Fish or cut bait. They tend to be pushy.” When a cardiac surgeon decides it’s time to head to the operating room, stand back.

* General surgeons are characterized as medicine’s spoiled brats, the prima donnas who throw instruments around the operating room when things don’t go their way.

* Anesthesiologists are philosophical and get along with the world. What choice do they have? They live with surgeons, who constantly give them grief.

* Plastic surgeons are labeled “narcissistic,” especially if they focus on cosmetic rather than reconstructive surgery.

* Neurologists and neurosurgeons win the “most arrogant” award. Some doctors complain that these brain gurus talk only about gray matter, referring to the rest of the body as “supporting structures.”

* Dermatologists “love the bucks,” a fact often reflected in their high-volume practices. Along with allergists, dermatologists rarely, if ever, know the agony of emergency calls at 2 a.m.

* Obstetrician / gynecologists, who know all about wee-hour awakenings, are nonetheless seen as happy, joyful types. They’re people persons, along with pediatricians and family practice doctors.

* Pathologists are often described as the strangest specialty. “Especially the forensic pathologists,” says one internist. “They spend their time at airplane crashes and crime scenes.”

* In dentistry, orthodontists are the stereotypical kid-lovers, says one Los Angeles general dentist. He labels endodontists, who spend their days doing root canals, as the “nerds” of the profession.

In a study published earlier this year in the Journal of the American Dental Assn., Grandy, of Creighton University, found little personality differences between general dentists and dental specialists. He acknowledges that the findings should be interpreted cautiously since all of the 1,117 dentists surveyed graduated from the same dental school. But, in general, he finds that dentists tend to be introverts who are rational thinkers and prefer structure and organization.

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The choice of a dental or medical specialty can also be driven by a person’s preferred working pace.

“As I got to know my personality better, I realized I needed immediate results,” Meirovitz says. “Physicians say, ‘Take these pills and call back in two weeks,’ but with most dentists, even if it’s only a simple cleaning, you have immediate results. Everyone who leaves my office is better off than when they came in.”

“Orthodontists have to wait a couple of years for results,” says Dr. Robert Nolan, a Playa del Rey general dentist. “I wait a month or so for results.”

Dr. Joan Feltman, who practices in Santa Monica, went into internal medicine because “I thought psychiatry would be too slow.”

Whatever their specialty, most doctors are keenly aware of their reputation--and sometimes their nickname.

Urologists are often called “the stream team,” says Dr. Cappy Rothman, a urologist-turned-andrologist (a physician who specializes in the study of men) at Century City Hospital.

There’s an old saying about orthopedists, says Dr. Kevin Ehrhart, an orthopedic surgeon at St. John’s Hospital and Health Center: “Strong as an ox and half as smart.”

Internists are called “fleas”--because they sometimes hop from one diagnosis to another.

But the characteristics that build stereotypes and fuel nicknames can make them better practitioners, say some doctors.

Being told that pediatricians were termed immature was no news to Dr. Kip Tulin, a pediatrician at Kaiser Permanente, Bakersfield.

“We know how to be kids,” he agrees. And he sees that as a good thing. When he picks a hat from his collection (86 and counting) and plops it on before entering an exam room, he can be pretty sure of breaking the ice quickly.

Nucho, the White Memorial cardiac surgeon who prefers his desk-top clean, says his careful attention to detail becomes a matter of life and death in the operating room. “Every move--every suture--is potentially lethal,” he says.

Some specialists say they’re just misunderstood.

“We’re the thinkers,” says Dr. Cleotilde Jose, a neurologist at Brotman Medical Center. When a brain specialist looks arrogant, she says, she might just be deep in thought.

Of course, there are exceptions to ingrained stereotypes.

Dr. Steven Zax, a plastic surgeon on staff at Century City Hospital, prefers to describe his profession as aesthetic and artistic, not narcissistic. In his Los Angeles office, there are plenty of mirrors, but also fresh lilacs, French editions of Vogue, fine sculptures, a glass-block entry wall, an Oriental rug and potted palms.

Cardiac surgeons are supposed to be emotionless mechanics, but then Johnston, medical director of White Memorial Emergency Department and president-elect of the Los Angeles County Medical Assn., tells of a cardiac surgeon staying at the hospital for days until a patient pulls through.

And sometimes, the stereotyped trait is balanced by other redeeming qualities.

Emergency physicians tend to have “a short attention span,” Johnston says. But they also have an ability to “keep a lot of balls in the air.”

A neurosurgeon’s arrogance is balanced by “a certain degree of patience and not panicking out,” says Dr. Frank Vertosick Jr., associate chief of neurosurgery at Western Pennsylvania Hospital in Pittsburgh.

Good qualities, he says, considering the average brain operation can last four or five hours.