- If you're 3D modeller, then yes, you're operate in terms of splines, surfaces, NURBS curves, etc. 3D model is your product.
- If you're mechanical engineer (and CAD usually appear in engineering context), then in most cases 3D model is just a tool to produce something useful for manufacturing. Engineer models manufacturing process by applying specific primitive operations in specific order(order is important) which will emulate available manufacturing operations (like sweeping, drilling). In other words, when I need to add hole in a part, I don't create surface (or bunch of these - in case if hole intersects other surfaces), I just add extrusion operation; an operation tree will log info "extrusion with diameter 6 at this coordinates from base A and B", not "surface a,b and c". CAD will build all necessary surfaces for me as well as will have all necessary parameter for CNC machine. In 99%* you don't interact directly with surfaces/meshes. At least that's what you do if you work with Autodesk Mechanical Desktop/Autodesk Inventor/SolidWorks/CATIA/Unigraphics.
* 1% are rare cases when you have to deliver something really complex like auto body parts (though making those is a whole new story).