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In The Netherlands, in the old times specialists were divided into operating and non operating docs. Everybody understood the difference.So as a retired physician I never did operate, although I did perform diagnostic laparoscopies before the advent of CT scans.Both are docs, so need to look at the problem their patient presents themselves with, diagnose it, and think about/look for a solution of the problem, which might, or might not involve an operation. So lots of thinking involved.Since physicians don’t operate, we usually don’t have to stand for so many hours a day, also in many places our day starts 30 to 60 minutes later since surgeons usually have to round on their patients before starting their surgeries.I think the century old oversimplification isn’t true anymore:-a physician knows everything, but can’t do anything-a surgeon knows nothing, but can do anything-a GP knows nothing, and can’t do anything-the pathologist knows everything, but is too lateBy having to operate, also during out of office hours, physically a surgeon’s life is tougher that a physicians, although in these modern days with in the EU salaried docs not permitted to work more than 45 hours weeks (under exceptional circumstances up to 54 hours weeks are tolerated for a short period of time), and according to Working Conditions - Employment, Social Affairs & Inclusion - European CommissionThe EU’s Working Time Directive (2003/88/EC) requires EU countries to guarantee the following rights for all workers:a limit to weekly working hours, which must not exceed 48 hours on average, including any overtimea minimum daily rest period of 11 consecutive hours in every 24a rest break during working hours if the worker is on duty for longer than 6 hoursa minimum weekly rest period of 24 uninterrupted hours for each 7-day period, in addition to the 11 hours' daily restpaid annual leave of at least 4 weeks per yearextra protection for night work, e.g.average working hours must not exceed 8 hours per 24-hour period,night workers must not perform heavy or dangerous work for longer than 8 hours in any 24-hour period,night workers have the right to free health assessments and, under certain circumstances, to transfer to day work.the difference in the physical workload for junior docs isn’t that great anymore.These directives didn’t apply to us self employed consultant docs.

Normally I’d bypass questions like this, because the reason’s fairly obvious: Trump is a sociopathic narcissist who has to constantly assert how amazing he believes himself to be - primarily because he wants the rest of us to think so, too. Boasting is in his nature, even when it’s fairly clear that he’s flat-out lying.For example, when he visited the CDC in Atlanta, he boasted to reporters afterwards:“People are really surprised I understand this stuff. Every one of these doctors said: ‘How do you know so much about this?’ Maybe I have a natural ability.”And it’s fairly obvious that nobody would say something like that to the President of the United States. You’d either a) expect him to have been well-briefed, and therefore informed, or b) you’d expect him to know little, but therefore be prepared to provide him with advice and guidance on a topic he knows little about.One thing jumped out at me when Trump made these claims about cognitive tests: such tests don’t tend to be performed without a damn good reason. They’re not even a component of the formal White House medical assessments that the President is required to undergo: the doctors assigned to the White House Medical Unit are there to assess and treat physical health, They’re there to do regular physical assessments, provide treatment for minor ailments, but also to engage in trauma care in the event of something more serious.Put bluntly, there’s not a psychiatrist among them. There’s no reason to conduct cognitive tests on a patient that isn’t showing signs of mental confusion or cognitive decline. And I’m saying that as someone that worked in Mental Health Nursing for several years.That brings us to last November: Trump visited Walter Reed Hospital without it being on his schedule, and with staff there unaware of his presence until his pending arrival was announced - all of which suggests an unscheduled, emergency visit.I should be clear: that’s suggestive of the possibility that Trump suffered some form of injury, illness or episode, and was forced to seek assessment that the White House Medical Unit couldn’t provide. Usually, that’d mean a CT/MRI scan, or an appointment with a specialist beyond the scope of the White House’s team. The unscheduled nature suggests an emergency.Conducting a cognitive assessment under those circumstances suggests that Trump suffered from something likely to impact cognitive function: when it comes to emergencies, you’d usually be thinking aneurysm (which would likely require hospitalisation), head trauma or a stroke. In Trump’s case…the latter would seem most likely.So, put bluntly: last November, Trump clearly suffered from a physical ailment sufficient to warrant a psychiatric assessment to determine his levels of cognitive function. My money would be on a stroke - and do note, that wasn’t made public. The health of the President of the United States was concealed by the White House.Trump’s claims that he aced a cognitive assessment is actually fairly telling: it suggests that he must either be in actual cognitive decline, or at severe risk of it. Again, they don’t do cognitive assessments for no reason, and it’s not part of his annual physicals.Something to think about.

The reason there are several different tests of adrenals is that they provide different types of information, which may be complementary. Scans like CT or MRI evaluate structure, while blood tests evaluate function. The combined results may be more useful than either method in guiding therapy: a blood test may signal overproduction of a specific adrenal hormone, for example, and a scan could localize the responsible gland, allowing surgical cure.Adrenal scans and blood tests are not part of a routine health assessment (in part because testing hormone levels before and after stimulation is not easy or inexpensive), and are typically performed only in response to specific complaints whose cause cannot be attributed to more common disorders through basic examination and testing.