most common surgeries by a gen. surgeon

This is actually a pretty tough question. Each surgeon kind of specializes themselves into a certain area that they like to do most. General surgery is so broad that only in rural america do general surgeons get to be general surgeons. But if you go to podunk america and open up a practice, you would likely be doing this kind of stuff:

1. Hernia (inguinal/ventral)
2. Gallbladder
3. Breast
4. Skin lumps/bumps/nodes
5. Colon resection
6. Thyroid/Parathyroid
7. Emergencies (appys, SBO, LBO)
8. Endoscopy
9. Vascular access (Port-A-Cath, Hickmann, Central line, Dialysis access)
10. Rectal (hemorroids, prolapse, fissures, fistulas)
11. Carotids
12. Pancreas
13. Stomach
14. Esophagus
15. Liver

By the way, these are the most common operations/procedures not the most common "surgeries". It's semantics but you'll get reemed by the old school surgeons. Surgery is the broad field.

Yep...right on both issues. Call them procedures for sure...

Dr. Evil: IYHO: how many of these do you have to do to be so called expert/confident/top of your game, etc? Realize there are variables here, just want a concurring opinion. Thanks.

I wasn't trying to be an ass about the "procedures vs surgeries" thing. sorry if that came out wrong.

Who knows how many procedures it takes to be an expert or top of your game. I don't know the answer to that and the broad answer would be that it varies from individual to individual. I think the number of procedures to be an expert at something is likely directly proportional to the number of catastrophes/morbidity/mortality you have seen from that particular procedure. That way, you can avoid the mistakes in the future. I would approximate that doing 50-100 of any of these procedures would put you at the TOP of your game and make you feel very comfortable. But, I don't think you have to do that many of many procedures to feel comfortable.

My team supports the 100 number for being top of your game. we win!! Of course I believe you should be at the top of your game for each procedure, but in this game experience is the most coveteted.

In regards to experience, a quick question for you newbee surgeons. Have you ever had a patient ask you before a surgery/procedure how many of these have you done?

What do they say when you tell them "4 times". Or does this happen? Have you ever had a patient decide to go to another doc who has more experience?

Just curious

Originally posted by Goofyone
In regards to experience, a quick question for you newbee surgeons. Have you ever had a patient ask you before a surgery/procedure how many of these have you done?

What do they say when you tell them "4 times". Or does this happen? Have you ever had a patient decide to go to another doc who has more experience?

Just curious

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It happens occasionally. If the procedure is something I haven't done a lot of, I usually say something vague like "lots of them" and that I'm "comfortable doing it" or will have "supervision the entire time" or that I would have to check with the program/office for an exact number. If they persist, I usually ask them if they would prefer someone else do the procedure. This usually works for me.

Originally posted by Goofyone
In regards to experience, a quick question for you newbee surgeons. Have you ever had a patient ask you before a surgery/procedure how many of these have you done?

What do they say when you tell them "4 times". Or does this happen? Have you ever had a patient decide to go to another doc who has more experience?

Just curious

Click to expand...

Ask this question all the time...can't assume they are questioning your skill level, may be just curious as to how common the procedure is in general, may be asking about your comfort level with the procedure, like have you seen this before(noone wants to be the only one! Something like misery likes company!), or you look so YOUNG you can't possibly know how to do this yet...I take this as a compliment.

I do use humor a lot, and sometimes they get it , sometimes they don't. Like "Oh, this procedure, never saw it before, noones ever had it before. Or you're the first!!! Or I could do this with my eyes closed!

Seriously don't assume they are questioning your skills, just say a lot, average, and if they press I prefer Dr. Cox's reply: don't know the exact number but will be happy to check with the office, who keeps a record of these things, and if they insist, do just that and tell them exactly the number. Most PTs' appreciate your honesty but most are just curious as to where they are on the normalcy chart. IT'S ALL ABOUT THEM!!!

Originally posted by carddr
Ask this question all the time...can't assume they are questioning your skill level, may be just curious as to how common the procedure is in general, may be asking about your comfort level with the procedure, like have you seen this before(noone wants to be the only one! Something like misery likes company!), or you look so YOUNG you can't possibly know how to do this yet...I take this as a compliment.

I do use humor a lot, and sometimes they get it , sometimes they don't. Like "Oh, this procedure, never saw it before, noones ever had it before. Or you're the first!!! Or I could do this with my eyes closed!

Seriously don't assume they are questioning your skills, just say a lot, average, and if they press I prefer Dr. Cox's reply: don't know the exact number but will be happy to check with the office, who keeps a record of these things, and if they insist, do just that and tell them exactly the number. Most PTs' appreciate your honesty but most are just curious as to where they are on the normalcy chart. IT'S ALL ABOUT THEM!!!

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As carddr notes, humour will go a long way - if the patient appears to be the type who can take a joke, laughing and saying that you'll have the textbook and pictures the whole time to tell you what to do, often proves an effective end to the conversation.

Most patients don't really care about the exact number but rather you are comfortable with the procedure. There ARE some who do care about the number and you should stay away from those patients - they are often litiginous as well.

Originally posted by Kimberli Cox
As carddr notes, humour will go a long way - if the patient appears to be the type who can take a joke, laughing and saying that you'll have the textbook and pictures the whole time to tell you what to do, often proves an effective end to the conversation.

Most patients don't really care about the exact number but rather you are comfortable with the procedure. There ARE some who do care about the number and you should stay away from those patients - they are often litiginous as well.

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that being said, if I or any of my family was having a procedure, you can be damn sure i'd be asking how many you've done. i'm not litiginous, i have a sense of humor, but the purposefully vague answers would raise my suspicions to the point of "what do they have to hide" kinda thing, not to metnion the annoyance of you evading my question, lol. i realize for normal folks this may work, but what do you do when you have someone with medical experience asking the questions? I would much rather be a surgeons 150th case than their 7th. practice on them, perform on me

Originally posted by Homonculus
that being said, if I or any of my family was having a procedure, you can be damn sure i'd be asking how many you've done. i'm not litiginous, i have a sense of humor, but the purposefully vague answers would raise my suspicions to the point of "what do they have to hide" kinda thing, not to metnion the annoyance of you evading my question, lol. i realize for normal folks this may work, but what do you do when you have someone with medical experience asking the questions? I would much rather be a surgeons 150th case than their 7th. practice on them, perform on me

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So which number would you accept as having the greatest indicator of expertise, 10,50 100+ ? And is this number what you really want to know or the success rate? Which IMHO is of more importance.

My humor is never intented to be evasive, just a tool to put the PT at ease. I usually follow up with a conclusive statement as to the reality of the experience I have had.

In regards to litigation, it's anybody's guess, but I have had pts' which I do believe were capable of factoring this into my thinking. And usually asking a" number "question is a red flag...as in legal evidence, but a bit of insightful, and intuitive thinking may help avoid these opportunities. Personally I think you would be naive to think you are NOT going to be sued sometime in your career, or al least at the receiving end of a complaint. And personally I hate lawyers, except my father who practiced law for 35 years.

Contrary to your way of thinking, most surgeons do some of their best work in the OR during their first surgery experiences, they are focused, almost obsessive, determined, their minds are totally controlled, plus they are aware of the supervision and the requirements they need to continue. It hasn't become JUST another gall bladder, breeding too much familiarity can create a field for mistakes. It's not usually the new residenct that gets sued but the experienced physician who may have losed his touch, due to bordom, arrogance, familiarity, etc....afterall his the one with all the bucks, the new resident can hardly make the rent. Who wants to sue him/her???

Originally posted by carddr
So which number would you accept as having the greatest indicator of expertise, 10,50 100+ ? And is this number what you really want to know or the success rate? Which IMHO is of more importance.

My humor is never intented to be evasive, just a tool to put the PT at ease. I usually follow up with a conclusive statement as to the reality of the experience I have had.

In regards to litigation, it's anybody's guess, but I have had pts' which I do believe were capable of factoring this into my thinking. And usually asking a" number "question is a red flag...as in legal evidence, but a bit of insightful, and intuitive thinking may help avoid these opportunities. Personally I think you would be naive to think you are NOT going to be sued sometime in your career, or al least at the receiving end of a complaint. And personally I hate lawyers, except my father who practiced law for 35 years.

Contrary to your way of thinking, most surgeons do some of their best work in the OR during their first surgery experiences, they are focused, almost obsessive, determined, their minds are totally controlled, plus they are aware of the supervision and the requirements they need to continue. It hasn't become JUST another gall bladder, breeding too much familiarity can create a field for mistakes. It's not usually the new residenct that gets sued but the experienced physician who may have losed his touch, due to bordom, arrogance, familiarity, etc....afterall his the one with all the bucks, the new resident can hardly make the rent. Who wants to sue him/her???

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yeah, success rate would be a more useful number to know, but with more common procedures the success rate and the cases done will be pretty similar i'd think.

no argument on lawyers from me. but like i said, i personally would be put off by evasive answers, period. i ask a question because i want an answer, and being in the field i know how hard it is to pin us down on anything dealing with medical opinions. but how many cases you've done is a number, not an opinion. how do you deal with nurses, other doctors or medical professionals that ask? the layperson you can evade, but people in the field, in my experience, are often more accurate in aiming their inquiries. i think following up with conclusive comments like you state is a great idea, but i don't see the need in not answering their question-- unless, of course, in your discretion they are simply wanting reassurance.

i agree that residents on their first cases are controlled, focused, etc, etc. what i've seen, and what would concern me as a pt, would be the stuff that's not normal-- the stuff that the resident hasn't seen or prepared for. it's not the resident's fault, it's just the experience that comes from doing it so much, that eventually you learn how to see the zebras coming before you're run over by them

I agree - you have to handle different patients differently. We do give different answers to medical professionals if only because we assume they understand more or are more interested in hearing the information.

But if I were asked how many lap choles I'd done - it would have to be a vague answer - I honestly have no idea. However, its WAY more than the oft quoted "30" as the number needed to be comfortable with a procedure. The average person, medical professional or not, has no idea how many procedures it takes to become comfortable or skilled. A number like 30 might seem like enough or not to different people. After a certain number you cannot directly correlate skill with numbers done - the learning curve is steep but it eventually levels off. No one is suggesting you give patients a vague answer (which I admit was my term) to purposely confuse them or the issue. The reasons are as above - either you honestly don't know the number exactly, or you don't know WHAT number the patient wants to hear.

By the time someone has completed a residency and is in practice they've done "more than enough" (at least according to the ACGME and the RRC) of certain operations. However, there will be times when you are asked to or decide to do an operation you've never done before. In that case, its up to you whether to ask a partner to assist you until you feel comfortable.

Most patients simply want to know how comfortable you are with a procedure. Medical professionals at a teaching hospital KNOW that the surgical resident will be doing the case, at least the more senior residents - if they have a problem with that they're usually pretty upfront about it and its the attendings decision whether or not to take the case elsewhere (ie, to a non-teaching institution) or tell the patient "my resident is supervised at all times by me.") And medical professionals usually do not ask the number of procedures you've done, but rather simply want to know how comfortable you are. In my experience and the experience of others, people who insist on knowing a number, whether medical pro or not, can be difficult patients and may have other motives.

Just my two cents...

that's interesting. i figured "how many have you done" would be a common question. but you've got more experience in the field than i do, so i'll believe you thanks for the tip though-- if i ever have surgery i'll be sure to ask how comfortable they are instead of how many they've done. the last thing i need is a surgeon thinking i'm gonna sue him playing with my bowels

thanks for the discussion-- i wasn't trying to be a pain, i promise. i just took the "evasive" point wrong. you're not evasive to avoid their question, you're evasive b/c you're not sure what they're looking for when they ask, and if you answer "wrong" in their eyes (but being completely truthful) you can find yourself in a tough situation.

no biggie, just gotta work on reading comprehension a bit

Honesty is the best policy, and it's the only way to truly obtain informed consent.

For instance, when I consent a patient for a carotid endarterectomy, I'm careful to discuss the fact that fellowship trained vascular surgeons are available to them (and that I'm happy to assist with referral) and also that some data suggest that surgical volume may bear a relationship to surgical outcomes. Same way with surgery for GI carcinomas, lung carcinomas, so forth.

I can't say that I've ever had a patient defer to have me act as his or her surgeon in this scenario.