Impressions of surgery?

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I've been reading SDN for a while, so I feel it necessary to say this before I elaborate on the question ... I am not trying to pick a surgical specialty. I have so much time before that question might even come up. I just find medical histories and surgeon memoirs really interesting. It's a fun hobby to read books like Walk on Water and Hot Lights, Cold Steel. The question: based on your experiences, to what extent are the following first impressions of some major surgical specialties accurate?

Neurosurgery: Sure, their residencies are some of the most selective and brutal but when it comes down to it ... all they're doing is cutting stuff out. They don't truly fix anything. And doesn't it get frustrating when their patient slips into a coma and becomes brain dead and they aren't even sure exactly why? And how do they tell a family that their loved one might wake up in a few days ... or months ... or never?

Cardiothoracic surgery: Their golden age has come and gone. There was a time when CT surgeons did the most innovative research and constantly developed new techniques but now, they spend the majority of their time doing the same few operations over and over again. Peds is a bit more exciting with a greater variety of cases, and they really do fix stuff creatively. But the major problems have all been addressed. Overall, there isn't much room left for growth, if any.

Orthopedics: These surgeons have a lot to be happy about. They do more fixing than destroying, and they're consistently met with positive results. An x-ray of a patient's leg reveals a mangled mess.They go to the operating room. Another x-ray ... the bone is exactly the way it should be. Another patient is in extreme pain. They do a hip replacement. Some physical therapy ... their patient tells them they're pain-free. Immediate satisfaction. But it seems they never directly save a life. To be fair, a severely damaged leg that isn't amputated can lead to a life-threatening infection. An open book pelvic fracture can lead to devastating blood loss. But it's nothing like knowing you opened a patient's heart, fixed something in it, and as a direct result of your actions, your patient continues to live.

General surgery: Who does this willingly? There seems to be a lot more destroying than fixing. How often do you quickly see a patient get better because of what you've done? While orthopods are hearing, "I'm pain-free, doctor," your patient has to wear a colostomy bag for the rest of his life? And how often are you not doing appendectomies or cholecystectomy?

Plastics: It's clear this field is important. They reconstruct patients horribly disfigured by aggressive disease or trauma. Not only do they restore normal appearance (or get close to it), but they also restore function. But how many plastic surgeons actually do this kind of work? How do the rest convince themselves that they're having a positive impact on the life of a patient who is coming in for his fifth rhinoplasty?

I hope I haven't offended any health care professionals in these fields or those aspiring to be. I wanted to capture how one might first perceive these specialties without in-depth knowledge. That's why I'm asking. For those of you who know more, are any of these first impressions fair? If not, how does the field actually work? And if you'd like to give some insight on a field I haven't included, either to confirm naive suspicions or disprove them, please do. Thanks!

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I think what you'll come to realize is that your perception of a specific subspecialty, no matter how many books you've read and how well informed you thing you are, will be misconstrued one way or another. That's what clinical clerkships and electives are for.
 
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Cool story, now off to the next thread.
 
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I think what you'll come to realize is that your perception of a specific subspecialty, no matter how many books you've read and how well informed you thing you are, will be misconstrued one way or another. That's what clinical clerkships and electives are for.
I understand. Hopefully some people who have done clinical clerkships and electives can share some insight.
 
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I haven't done any rotations yet, so I admit to being pretty ignorant. But these are pretty much pure stereotypes. Here are some of my thoughts

Neurosurgery: Sure, their residencies are some of the most selective and brutal but when it comes down to it ... all they're doing is cutting stuff out. They don't truly fix anything. And doesn't it get frustrating when their patient slips into a coma and becomes brain dead and they aren't even sure exactly why? And how do they tell a family that their loved one might wake up in a few days ... or months ... or never?
When I think neurosurgeon, my first thought isn't a lobotomy. I actually think high cranial pressure (for myriad reasons, but e.g. trauma). Without a neurosurgeon the patient is 100% screwed/toast/lost. Drill a hole, place a drain, BAM you have offered a cure. Very cool

General surgery: Who does this willingly? There seems to be a lot more destroying than fixing. How often do you quickly see a patient get better because of what you've done? While orthopods are hearing, "I'm pain-free, doctor," your patient has to wear a colostomy bag for the rest of his life? And how often are you not doing appendectomies or cholecystectomy?
This is overly simplistic. Is it even a serious question? Lots of people have a passion for surgery without the desire to spend the extra years training for neuro, CT, plastics, etc. Besides, general surgery offers the most freedom to specialize later on down the road, with paths to Surg-Onc, trauma surg, ortho, plastics, vascular, CT, the list goes on...

Plastics: Tis clear this field is important. They reconstruct patients horribly disfigured by aggressive disease or trauma. Not only do they restore normal appearance (or get close to it), but they also restore function. But how many plastic surgeons actually do this kind of work? How do the rest convince themselves that they're having a positive impact on the life of a patient who is coming in for his fifth rhinoplasty?
Most plastic surgeons are not going to be spending their careers doing nose and boob jobs on Hollywood stars. And you're forgetting burns. Extremely critical, life threatening situation that is expertly managed by plastics
 
Urology: Penis, penis, penis, penis, penis, penis, penis, penis, penis, penis

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Reading medical books can really skew your perspective.
Your current perceptions of the fields sound jaded and cynical, focusing on the most negative aspects.
Maybe medicine (non-chronic disease) would be a better fit than surgery. You seem to care a lot about actually fixing problems (curing?) - some fields are better suited for that than others. But most surgeons enjoy what they do, for some reason.
Have you shadowed? Even then, you won't know until ms3, and even then you'll just make a more informed decision.
 
While orthopods are hearing, "I'm pain-free, doctor," your patient has to wear a colostomy bag for the rest of his life?

FWIW, colostomies can be amazing for some people's quality of life. It beats being in 24/7/365 pain because of colitis or whatever, or for physically/neurologically impaired patients (cerebral palsy, etc) it's a bit more dignified than pooping yourself constantly and needing caretakers to come clean you off. They used to gross me out, and I suppose they still do, but having seen how much they can improve patients' lives has changed my perspective a bit.
 
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FWIW, colostomies can be amazing for some people's quality of life. It beats being in 24/7/365 pain because of colitis or whatever, or for physically/neurologically impaired patients (cerebral palsy, etc) Tis a bit more dignified than pooping yourself constantly and needing caretakers to come clean you off. They used to gross me out, and I suppose they still do, but having seen how much they can improve patients' lives has changed my perspective a bit.

Then you get fired from a job for some made up reason because you smell terrible and people didn't want to sit near you
 
As noted above, you may never know when someone has a stoma (due to a family history of UC, I've got several family members who've had them and honestly, a well fitted and cared for device is odorless and undetectable in normal clothes).

And let's not forget the increasing numbers of people who are put back into bowel continuity - either immediately or as a staged procedure.
 
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Even then, you won't know until ms3, and even then you'll just make a more informed decision.

Again, I'm not interested in making a decision.

I get that the "descriptions" are really naive and stereotypical. That was done so intentionally. As in, what are some really unfair first impressions someone might have and, having seen the real thing, how would you defend the field? The author of Walk on Water marvels at the beauty of pediatric cardiac surgery while mentioning that neurosurgeons spend a lot of time just cutting stuff out. Collins in Hot Lights, Cold Steel talks about how general surgery residents made fun of him for being the typical "dumb orthopod" and he could fire back something along the lines of "have fun removing appendices and gall bladders for the rest of your life." In King of Hearts, you see groundbreaking innovation after innovation, and Walk on Water says that even the most complex congenital deformations are taken care of nowadays. And I've read on here a few times that adult CT's do a lot of the same few operations over and over again, namely CABG's.

Have I really reduced my perspective of these fields to such a simplified, negative view? No. I respect every kind of doctor for facing the unique challenges of her specialty. My friend has UC and I'm going to be very thankful of his general surgeon one day. Out of curiosity, I went with those descriptions to set up the kind of response Entadus gave, something like "Are you kidding me? But [specialty] actually does this ..." But of course in SDN, for every 1 helpful post, you can expect 10 others who read the first line and decide you don't have the right to ask a question. :laugh:
 
Again, I'm not interested in making a decision.

I get that the "descriptions" are really naive and stereotypical. That was done so intentionally. As in, what are some really unfair first impressions someone might have and, having seen the real thing, how would you defend the field? The author of Walk on Water marvels at the beauty of pediatric cardiac surgery while mentioning that neurosurgeons spend a lot of time just cutting stuff out. Collins in Hot Lights, Cold Steel talks about how general surgery residents made fun of him for being the typical "dumb orthopod" and he could fire back something along the lines of "have fun removing appendices and gall bladders for the rest of your life." In King of Hearts, you see groundbreaking innovation after innovation, and Walk on Water says that even the most complex congenital deformations are taken care of nowadays. And I've read on here a few times that adult CT's do a lot of the same few operations over and over again, namely CABG's.

Have I really reduced my perspective of these fields to such a simplified, negative view? No. I respect every kind of doctor for facing the unique challenges of her specialty. My friend has UC and I'm going to be very thankful of his general surgeon one day. Out of curiosity, I went with those descriptions to set up the kind of response Entadus gave, something like "Are you kidding me? But [specialty] actually does this ..." But of course in SDN, for every 1 helpful post, you can expect 10 others who read the first line and decide you don't have the right to ask a question. :laugh:
When I reply to a post, I write both to the OP and to the visitors who will visit the thread in the future.
My point was, that every field is defensible, but that the people who defend it are usually those for whom it's a good fit. If you want quick, positive results, then there is something to defend in surgery. If you value other things, then it might be hard to find good things in surgery.
From your first impressions, which I read as "gut reactions", it seems that surgery might not offer what you're looking for.

pax and merry christmas :)
 
Okay, I see that I did a pretty bad job of wording this, so I'll try again in a new thread. Thanks for all the help, guys. Merry Christmas! :)
 
I think what you'll come to realize is that your perception of a specific subspecialty
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