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usuk-omg:

nowaitstop:

You have been visited by Baljeet, the Failed Test. If you do not reblog within ten seconds, you will fail your finals.

too risky man

populationpensive:

pre-pa-girl:

mddiaries:

Words to live by.

And again, I Reblog…..

Truth. Totes.

tatercat:

Via Pinterest

bajangalc:

I love this quote.

surgeonator:

Made rebloggable by request from this post

Thank you for your question. I’ve combined the two parts of your question so as to address them in a single post.

Surgeons are often stereotyped as the dumb jocks of medicine who only want to operate and don’t care about the nonsurgical problems of their patient, and the further subspecialized they get, the less they care about the patient’s other issues. Based on my experience, I would say that that characterization is unfair, but I understand where it comes from. Surgeons do tend to focus on the surgical issues of the patient, and every surgeon LOVES to operate – why else would we go into surgery? – and some of us are abrupt and rude and, yes, consult-happy. But the majority of us do care about our patients as people, including their medical problems, even if we aren’t equipped to deal with them beyond the scope of their effect on the surgical problem.

A few months ago I saw an attending neurosurgeon become absolutely incensed when a trainee alluded to the fact that he (the trainee) didn’t know the ventilator settings of one of the neurocritical care patients, saying, “You have to know about what is going on with your patient. That is a person. You are not just caring for a brain in a jar.”

Most surgical patients also have medical problems. To not know at least the basics of those medical issues would be a disservice to these patients and tantamount to neglect. But, the human body is incredibly complex even when functioning 100% correctly (we still don’t know everything about how it works, and we probably never will), and even moreso when things go awry. While theoretically we are taught everything that is known about it in medical school, realistically it is not possible to retain and use that knowledge reliably unless it is what you do every day. That is why medical students choose specialties. There is already too much to know in, say, gastroenterology, without also having to know everything about cardiology and radiology and pediatrics and so on. Would you want your plumber to also be an electrician? No. I don’t know about you, but I would want my plumber to be the best damn plumber I could find. The plumber has years of training and experience in plumbing, not electricity. They may know some of the basics of electrical wiring insofar as it relates to plumbing, but I wouldn’t expect them to also fix my electrical problems. It doesn’t mean the plumber doesn’t care that you also have electrical issues. But being a responsible practitioner (and a responsible person in general) means knowing what you can do well, and knowing when you need to call for help.

One attending surgeon I know goes so far as to say that surgeons are actually SMARTER than internists because internists are just doctors, but surgeons are doctors who also know how to operate. I find that a somewhat arrogant way to express that, but I agree with the sentiment. (Also, sidenote, in my experience the smartest healthcare professionals are pharmacists. I cannot think of a single instance in which I asked a pharmacist a question where they answered “I don’t know”, or have somebody ask me a question in which the pharmacist did not add something relevant to my answer that I was not aware of.)

That said, it is true that doctors often jump the gun to call consults to other specialities (emergency physicians are seen as the extreme example of this), but I would argue that is due in large part to the fear of litigation and not to ignorance. If I have a young, otherwise healthy patient who comes in with a strictly surgical disease such as appendicitis, and happens to have had a heart murmur since birth but that has never affected their lifestyle, the majority of attendings I work with would probably call a cardiology consult or refer them to cardiology as an outpatient after discharge, on the 0.01% chance that the patient experiences an adverse heart-related event while under their care and the patient sues.

To be frank, if diseases like heart failure, COPD and hypertension interest you more than surgery and you are somebody who always needs a comfort break when fatigued, then it sounds like surgery is not for you. And that is ok. We need good doctors in every specialty, and if surgery is not your bag, you’re not helping anybody. It’s not that surgeons are FORBIDDEN from scrubbing out in order to use the toilet or have a snack in the middle of a long operation. Most of it is self-imposed, because we are stubborn, and NOTHING is more interesting or important than the patient who is lying on the table and needs you to fix them.

I did know a vascular surgeon who would routinely scrub out to have a cigarette break. I don’t condone that, and I see the irony dripping from the notion of a chain-smoking surgeon who operates on people who have destroyed their blood vessels by smoking, but the fact is that that person was a brilliant surgeon, and maybe it was because they knew when they were stressed out and that they needed a cigarette to help them focus. Doctors are human too.

In a practical sense, though, I try to remember the six Ps: Prior Planning Prevents Piss-Poor Performance. If I know I’m about to go into the operating room, no matter how urgent or emergent the case is, I will take five minutes to use the washroom, eat a granola bar, whatever. As a junior resident I initially relied on my will and my resolve and would go without eating or going to the bathroom, but I very quickly learned that in order to take care of patients, you have to take care of yourself first, and that kind of “heroic suffering in silence” is often unnecessary and ultimately only detrimental to yourself.

The longest surgical experience I had was as a medical student on transplant surgery. We left for a procurement around 9 pm, took a plane to the donor’s hospital and were operating by 11 pm, flew back to our home institution with the organ by 5 am, and were still transplanting the organ around noon. At 8 am, the attending surgeon told me I should go home, but I stayed, and it was because I wanted to. When your options are going home to sleep, versus staying awake for another few hours in order to put a life-saving organ that you just removed from another person hundreds of miles away (who had the good graces to donate it and is now deceased) into another person who will die without that organ, I cannot fathom choosing sleep. The thing is, my job is not an office job. I don’t wake up at 8 o’clock and hit the snooze alarm because I don’t want to go to work and I don’t watch the clock and wait for 5 pm so I can go home. I jump out of bed at 5 am and run around all day and sometimes all night if I’m on call, to the point of exhaustion, and then I go and do it again, because I love it. Surgery is a career and an identity. It is one of the biggest commitments you can make. And I am not saying surgeons are more ambitious or more committed than anyone else. The only difference is that it is surgery that makes us tick. I love to sleep and I love to eat and surgery is literally the only profession in the world for which I would give up a regular sleeping and eating schedule, because surgery is the only thing that is worth it for me.

Anyhow, I have digressed to the point of writing a behemoth of an essay, as I too often do. I infer from the second sentence of your question that you are either in medical school or very close to starting it. In my experience, there are many students who enjoy the surgery rotation. That is because surgery is cool, and as a student you see all the cool stuff (i.e., in the operating room). The mistake people make, and one of the reasons why attrition is so high for surgical trainees, is that they think just because surgery is cool and fun that it is something they want to do for the rest of their lives. Your only career goal should be to find the thing that makes you leap out of bed at 5 am no matter how tired you are, that thing that makes you never want to retire. If it’s surgery, that’s awesome. If it’s not, that’s awesome too. Society becomes a better place when its inhabitants are happy, not when everybody is a doctor.

Best wishes to you.

Sometimes motivation comes with a cup of hot chocolate (with cayenne pepper)!