Tuesday, June 07, 2005

Are Surgeons "Real Docs?"

Cut to Cure and Orac posted about this contemptible comment on Pharyngula:
Surgeons and other medical staff are the equivalent of technicians, engineers, plumbers or carpenters. They are not scientists. They are not studying the details of the relevant science. They don't have to understand it - just carry out procedures by rote. Though the ones who do have a clue will be a lot better at adapting to new circumstances because they'll make more correct guesses based on their understanding than the clueless ones will.

Orac said:
I'm sure that my fellow surgeon-bloggers Dr. Bard Parker and Aggravated DocSurg will back me up on this if they see this post, but there are few things you can say that will royally piss off a surgeon faster than a statement like this, which, whether the commenter realizes it or not, relegates surgeons to the realm of not being doctors, but rather to the realm of skilled tradesmen.
Yes, a lot of what we do is procedure-oriented, but to understand how to do those procedures and, more importantly, whom to do them on and whom not to do them on requires a pretty strong understanding of physiology. We have scrub techs and surgical assistants who can "carry out procedures by rote." Sometimes, they're even technically better than the surgeons with whom they operate, but they cannot take care of the whole patient. That is the role of a surgeon.

Cut To Cure said:
Or as one of my attendings would tell us :Operating is easy, surgery is hard.The decision to operate requires a knowledge of anatomy, physiology, pathology, biochemistry,ect...because if you don't you are likely to end up with a dead patient. Operations have consequences, and a surgeon needs to know what they might be so that they may be addressed.
So I am technical, but not a technician.

I started my medical training in a surgery internship. I have the greatest respect for the staff and residents with whom I trained, and many I have run across in practice.

However, as an ER doc, I have too many interactions with surgeons who are not interested in helping to figure out what is going on with the patient. They don't want to listen to me unless I have a clearly defined diagnosis that requires surgery. As a hospitalist, I am frequently asked, by the ER doc, to evaluate and admit abdominal pain patients because the ER doc already talked to the surgeon who wasn't willing to admit the pt because the CT scan was normal, "so there is no surgical disease."

I recently had one patient admitted for abdominal pain who ended up diagnosed with cholelithiasis and underwent cholecystectomy. This patient stayed on my service, even after the surgery, even though he had no medical problems not related to his surgery.

I was consulted once by an orthopedist for a woman with a hip fracture to "write the nursing home orders." This woman had no medical problems and was on no medications.

When I trained, abdominal pain patients were often admitted by the surgeons for serial exams. This isn't the case, frequently, at the community hospital where I work.

I have heard surgeons, especially orthopedists, remark that the only reason to have clinic is to find surgical cases. Even the post-surgical follow up is only tolerated as a necessary evil.

I do, however, constantly defend surgeons from the "technician" label. I find that the fresher the surgeon is from training, the more likely they are to participate in the eval of the pt. The older docs are more likely to give me grief when I call them for help with a patient.


I should have noted that my answer to the question in the title is, "Yes."