Why all the hate on general surgery?

[hydro5]

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I'm a first year surgical resident at a large academic institution. I've noticed that the off service interns, as well as other specialties, have a lot of hate for GS. Why the hate?

General surgeons are the ones that everyone in the hospital needs when things go wrong. We take sick medical patients to the OR for their ischemic bowel. We do emergent ex laps, trauma splenectomies, and ED thoracotomies. We are the ones everyone calls to put in central lines and chest tubes on their tanking patients.

It's not just "dead bowel" and ostomies, or lap choles/appys and hernias. General surgery does esophagectomies, Nissens, hepatectomies, pancreaticuduodenectomies, thyroidectomies, adrenalectomies, mastectomies, burns, melanoma, to name a few. Our in house GS trauma attendings do VATS and pericardial windows, neck explorations, and if need be, nephrectomies.

We are masters of the critically ill patient. Saying that it is badass is an understatement. So why the hate?

 

[biophysicianai]

I don't think the hate is universal, and sorry if your local culture is adversarial.

Where I am, I actually see GS hate on medicine more than the other way around. Sometimes it's deserved, but not always. GS is at the top of my list right now, with a surgical sub right underneath it, so I'm not biased against GS by any means, but I do think that bad attitudes beget bad attitudes, and that surgeons are as guilty of it as other MDs.

 

[survivordo]

Have not run into this myself. In fact I would say our relationship with medicine is almost TOO good. They seem to feel free to consult us on just about anything. I have always felt appreciated when doing a procedure for a medical service and we have a good relationship with them when we want their opinion on a medical issue.

Survivor DO

 

[Pir8DeacDoc]

Your hospital sucks. Never saw any hate to GS when I was training. Good folks. Hard workers. All of us are just trying to get by. No room for hate.

 

[neusu]

Depends on the program, attending, day of the week.

I'm a neurosurgery senior, take chief call on occasion. We have policies in place on who goes where, who gets a repeat CT, who a hole in the head, when to give mannitol or HTS, nonetheless certain GS attendings or residents feel the need to re-invent the wheel every time. I don't hate GS. I don't even hate these people. I just don't understand the need to make it difficult.

 

[DrNick Riviera]

So i just feel the need to comment here.....i have not always found the consulting services "thankful for the help" sentiment. I just drove in from home to the VA to see a 430pm on a Friday consult for a gluteal "abscess" in a pt who has a fungating anal SCC, on Nigro now. This is a pt who the medicine team has basically found a reason to call us about every few days for the last 3 weeks, despite having told them that we are never touching the guy with a 10 foot pole until his anal SCC is treated properly. Anyway, i saw the guy, i&d'd him, called the consulting team to communicate my recs and explain to them my thoughts, and i basically got a "ok, sure" response. Not even really a thank-you......this is why GS residents can be taken as frustrated and angry sometimes....often feels like we are the dumping grounds for teams that "dont feel comfortable" doing something.....

 

[Pir8DeacDoc]

All surgeons get that from IM. Not just general surgeons. But you guys probably get it more from them than most. They are scared of their own shadows.

 

[SLUser11]

So i just feel the need to comment here.....i have not always found the consulting services "thankful for the help" sentiment. I just drove in from home to the VA to see a 430pm on a Friday consult for a gluteal "abscess" in a pt who has a fungating anal SCC, on Nigro now. This is a pt who the medicine team has basically found a reason to call us about every few days for the last 3 weeks, despite having told them that we are never touching the guy with a 10 foot pole until his anal SCC is treated properly. Anyway, i saw the guy, i&d'd him, called the consulting team to communicate my recs and explain to them my thoughts, and i basically got a "ok, sure" response. Not even really a thank-you......this is why GS residents can be taken as frustrated and angry sometimes....often feels like we are the dumping grounds for teams that "dont feel comfortable" doing something.....

Just playing devil's advocate here, but a locally advanced anal cancer could certainly cause fistulization and abscess requiring drainage. I'm not sure one could withhold treatment until the SCC is "treated properly" in my hypothetical scenario.

I've found that its when general surgery residents walk around with this attitude that they get in trouble. The "badass heroes of the hospital, we're the only ones who can take care of sick patients " mindset that some GS residents adopt invites the hate.

Quoted for truth. "Don't hate me because I'm awesome" won't win over any internists....

 

[DrNick Riviera]

Just playing devil's advocate here, but a locally advanced anal cancer could certainly cause fistulization and abscess requiring drainage. I'm not sure one could withhold treatment until the SCC is "treated properly" in my hypothetical scenario.

agreed.. not arguing with that aspect. what i meant was that we have been consulted several times over the last couple weeks for first....surgical management of the anal cancer, which, having seen the guy multiple times in the past in clinic etc, we have explained the proper management of anal SCC. then we got consulted on his chronically incarcerated fat-containing inguinal hernia that they wanted repaired...while he is getting chemo/xrt.

it was more that after patient hand-holding through all of this, still didnt get any respect after trying to fix a problem for them.

 

[Pir8DeacDoc]

agreed.. not arguing with that aspect. what i meant was that we have been consulted several times over the last couple weeks for first....surgical management of the anal cancer, which, having seen the guy multiple times in the past in clinic etc, we have explained the proper management of anal SCC. then we got consulted on his chronically incarcerated fat-containing inguinal hernia that they wanted repaired...while he is getting chemo/xrt.

it was more that after patient hand-holding through all of this, still didnt get any respect after trying to fix a problem for them.

They see it as your job. You don't see it that way because you understand the situation better than they do. Most folks won't throw around respect for doing your job. Plus they think you are just hanging out all day like they are waiting for a consult to complete you. We know the reality that a consult is rarely educational after a certain point and becomes annoying very quickly. But for IM guys it's a/the only money maker and so they happily consult everyone in sight, whether needed or not.

 

[dynx]

Depends on the program, attending, day of the week.

I'm a neurosurgery senior, take chief call on occasion. We have policies in place on who goes where, who gets a repeat CT, who a hole in the head, when to give mannitol or HTS, nonetheless certain GS attendings or residents feel the need to re-invent the wheel every time. I don't hate GS. I don't even hate these people. I just don't understand the need to make it difficult.

Just to play devil's advocate here. A lot of time treatment based on "policies" don't take into account patient specifics. So occasionally, rarely, every once in a blue moon some critical thinking may be involved and you might have to alter the policy. I mean ussually we just go on policy, let the nurse go through the algorithm and check on our patients every 48-72 hours as well so I get what you're saying.

 

[anonperson]

I'm a first year surgical resident at a large academic institution. I've noticed that the off service interns, as well as other specialties, have a lot of hate for GS. Why the hate?

General surgeons are the ones that everyone in the hospital needs when things go wrong. We take sick medical patients to the OR for their ischemic bowel. We do emergent ex laps, trauma splenectomies, and ED thoracotomies. We are the ones everyone calls to put in central lines and chest tubes on their tanking patients.

It's not just "dead bowel" and ostomies, or lap choles/appys and hernias. General surgery does esophagectomies, Nissens, hepatectomies, pancreaticuduodenectomies, thyroidectomies, adrenalectomies, mastectomies, burns, melanoma, to name a few. Our in house GS trauma attendings do VATS and pericardial windows, neck explorations, and if need be, nephrectomies.

We are masters of the critically ill patient. Saying that it is badass is an understatement. So why the hate?

I honestly haven't seen what you are talking about. It could be related to the surgical attendings or even your own attitude. I'm sure it doesn't go over well if you are consulted and come in saying how great you are and how you are going to save this patient that the primary team is killing (not saying you are doing this but this is a possibility).

I'm at a community program in OBGYN and get along well with the general surgery residents and attendings. We consult them on occasion and vice versa. Somehow everyone seems to get along quite well. We all have different areas of expertise and at the end of the day are just trying to do our jobs.

 

[SLUser11]

Just to play devil's advocate here. A lot of time treatment based on "policies" don't take into account patient specifics. So occasionally, rarely, every once in a blue moon some critical thinking may be involved and you might have to alter the policy. I mean ussually we just go on policy, let the nurse go through the algorithm and check on our patients every 48-72 hours as well so I get what you're saying.

Love it.👍

 

[Winged Scapula]

Just to play devil's advocate here. A lot of time treatment based on "policies" don't take into account patient specifics. So occasionally, rarely, every once in a blue moon some critical thinking may be involved and you might have to alter the policy. I mean ussually we just go on policy, let the nurse go through the algorithm and check on our patients every 48-72 hours as well so I get what you're saying.

 

[poorracerkid]

Or better yet, wait a few years and more "healthcare reform" and there won't be the need for doctors because the computers will treat patients based on what's programed into them from D.C. Then we will be obsolete.

 

[neusu]

Just to play devil's advocate here. A lot of time treatment based on "policies" don't take into account patient specifics. So occasionally, rarely, every once in a blue moon some critical thinking may be involved and you might have to alter the policy. I mean ussually we just go on policy, let the nurse go through the algorithm and check on our patients every 48-72 hours as well so I get what you're saying.

I can relate to where you are coming from, and in circumstances where things are not clear-cut they tend to be reasonable. My rant was a bit vague and perhaps your sarcasm is warranted.

 

[45408]

Just to play devil's advocate here. A lot of time treatment based on "policies" don't take into account patient specifics. So occasionally, rarely, every once in a blue moon some critical thinking may be involved and you might have to alter the policy. I mean ussually we just go on policy, let the nurse go through the algorithm and check on our patients every 48-72 hours as well so I get what you're saying.

Took me a second...

 

[JayDoc06]

Wait a minute, how is this scenario even possible? The foolproof electronic record should convey everyone's thoughts, plans, emotions, and perceptions in a clear concise manner. The plan for this hypothetical patient should have been easy to find by anyone with a CPRS login. Clearly there were not enough pop-up windows, alerts or warnings about this patient. We need a Department of Homeland Medical Information!