Survey studies analyze and quantitate impressions, usually clinical, rather than hard facts. The study by Alderman and colleagues 1 Alderman AK Chung KC Kim HM Fox DA Ubel PA. Effectiveness of rheumatoid hand surgery: contrasting perceptions of hand surgeons and rheumatologists. J Hand Surg. 2003; 28A: 3-11 Abstract Full Text Full Text PDF Scopus (90) Google Scholar explores the impressions of hand surgeons and rheumatologists about the efficacy of rheumatoid hand surgery. The findings show a distinct difference between the 2 groups that is significant in its magnitude and disconcerting in its implication because of the commentary that it makes about the philosophic differences between the cultures of rheumatology and hand surgery. It suggests that the art and science of medicine may be more art and less science than we would like to think. It also suggests that the cultural differences between the subspecialities have changed less than I, for one, thought was the case during the past 2 decades. The fact that three quarters of hand surgeons and only one third of rheumatologists believe that metacarpophalangeal arthroplasty improves hand function might not have surprised me when I was a resident 20 years ago. It surprises me now. The fact that more than 90% of hand surgeons and only 50% of rheumatologists believe that extensor tenosynovectomy prevents tendon rupture might also not have surprised me 20 years ago. It surprises me now. It also surprises me that there is no difference in perception between more established and younger rheumatologists.