Accurate insight of Surgery?

[DrA]

The thread which mentioned that working as a scrub nurse is not an accurate feel for surgery got me thinking. I have been shadowing a general surgeon for about 3 months now. I see patients with him in clinic and at the hospital, I assist (aka retract) during surgeries, and basically followed him around 5 days a week during the first 2 months. While doing this, I fell in love with surgery which I previously had no interest in. Now I wonder if I have an accurate view of what surgery is really like, since many have said that being a scrub nurse does not even come close. What can I do as a soon-to-be med student to get a more realistic perspective even before rotations? Do I already have one?

---

Members don't see this ad.

 

[Blade28]

Do you see how busy he is during a typical day? Do you get to go on rounds with him in the hospital? What kind of practice does he have?

It's always tough to know until your MS-III rotation, unfortunately.

 

[DrA]

Do you see how busy he is during a typical day? Do you get to go on rounds with him in the hospital? What kind of practice does he have?

It's always tough to know until your MS-III rotation, unfortunately.

I am literally his shadow from morning until he goes home, so I do get to see everything he does, although I still get the sense that I am not seeing the whole picture. As a measly premed, everything is just too amusing.

 

[Winged Scapula]

You are not seeing the whole picture unless you are going home with him at night. You don't know how much time he does doing paperwork, keeping up with reading articles, etc. Most students and even residents underestimate this (see other thread where it was apparent that students thought surgeons didn't do anything outside of the hospital).

BUT you are getting about as close a picture as you can without being a med student or resident.

 

[Pilot Doc]

BUT you are getting about as close a picture as you can without being a med student or resident.

Agreed. You're seeing the thought process that goes into deciding who gets what operation, preparing them for surgery, taking care of them after the operation, etc.

Those are some of the major things that make a surgeon a physician and not just a technician.

That said, at this point you don't need to know if being a surgeon is you goal, you need to know if being a physician is right for you. And my assumption is that your experience is helping with that.

 

[Pir8DeacDoc]

IMHO you can never really know until you're the one driving the bus. I'm early in residency and I still don't know what it's like. I have a better idea that you do (I imagine) but still nothing replaces being in those attending shoes. However, at some point you have to trust the sum of your experiences and make a leap of faith and go for it. You'll have a gut feeling after/during your MS-3 rotation if you fit with the surgeons and see yourself doing what they do.

Good luck!

 

[TXSurgResident]

BUT you are getting about as close a picture as you can without being a med student or resident.

Yup... sort of???

The reason I say that is because this experience could potentially be a better perspective on the life of a praticing surgeon than most med students and many residents ever get.

I have spent a lot of time trying to explain to third year students that how they see things at our county hospital/VA or even our "private" hospitals, has very little to do with the world of private practice. Many students seem discouraged by resident squabbling, the inefficiencies of these hospitals and the overall level of severe disease we see, and I can't say I blame them. If Dr A did this week in a truly private practice (like the week we get in our second year of residency), then I would say this is more like the majority of practices than the uniquely academic view which the average student gets.

I'm not saying that private practice is always the land of milk and honey (billing, partner squabbles, malpractice etc.), but giving premed and med students an opportunity like this may help explain why surgery can be a great job. If we don't encourage this, then all most students see are the other physicians in the academic institutions going home at 4pm while GS, CVTS, Neurosurg, IM and OB/GYN are left keeping the party going.

 

[smq123]

The thread which mentioned that working as a scrub nurse is not an accurate feel for surgery got me thinking. I have been shadowing a general surgeon for about 3 months now. I see patients with him in clinic and at the hospital, I assist (aka retract) during surgeries, and basically followed him around 5 days a week during the first 2 months. While doing this, I fell in love with surgery which I previously had no interest in. Now I wonder if I have an accurate view of what surgery is really like, since many have said that being a scrub nurse does not even come close. What can I do as a soon-to-be med student to get a more realistic perspective even before rotations? Do I already have one?

The difference between a scrub nurse, and even an MS-3, is that, while the scrub nurse can just watch and memorize the motions, the MS-3 is expected to know WHY the surgeon is doing something. That involves studying after you get home from the hospital, which is actually the hardest part of the med student rotation.

The most interesting part of the rotation, for me, was to watch the surgeon look at the patient's records, the patient's physical exam, and the CT/MRI scans, and then, from those, develop a plan of action. That involves a good knowledge of anatomy, physiology, pharmacology, and pathology. It's scary to think that, in a few years, I will have to start thinking that way on my own. I think that's what sets the med student apart from the scrub tech or even the PA - the need to start developing your own treatment plans, based on what you know and what the patient presents with.

Why do you necessarily need a "more realistic perspective" before rotations? Just get into med school and see if you like the first 2 years. If so, and if you think you'd like to be a doctor, you'll get plenty of perspective DURING your rotation. (How realistic that perspective is, though, is debateable.)

A lot of med students love the surgical part of surgery - it's very entertaining and "cool" to watch. But taking care of the patients after that (in the SICU, especially) is the part that a lot of med students hated.

 

[DrA]

You are not seeing the whole picture unless you are going home with him at night. You don't know how much time he does doing paperwork, keeping up with reading articles, etc. Most students and even residents underestimate this (see other thread where it was apparent that students thought surgeons didn't do anything outside of the hospital).

BUT you are getting about as close a picture as you can without being a med student or resident.

Would you say the vastness of paperwork and reading articles plays a significant role in making surgery what it is? Isn’t that present in other specialties as well? I have to admit that paperwork is one thing I don’t get to learn much about while shadowing.

Why do you necessarily need a "more realistic perspective" before rotations? Just get into med school and see if you like the first 2 years. If so, and if you think you'd like to be a doctor, you'll get plenty of perspective DURING your rotation. (How realistic that perspective is, though, is debateable.)

A lot of med students love the surgical part of surgery - it's very entertaining and "cool" to watch. But taking care of the patients after that (in the SICU, especially) is the part that a lot of med students hated.

That is precisely the reason I want to have a more realistic perspective; because I don’t want to be a premed walking around thinking surgery is just “cool”, I want to indulge into the real thing as much as is feasible at my current status. It may not be necessary at this point; I just wondered if what I am perceiving comes close to reality. I am 6 months away from beginning med school and you could say just cannot wait to jump on the wagon.

Still, I am pleased to hear that my experience is as good as it gets for now, as some of you have suggested.


I the surgery forum. Great replies from experienced people.

 

[smq123]

That is precisely the reason I want to have a more realistic perspective; because I don’t want to be a premed walking around thinking surgery is just “cool”, I want to indulge into the real thing as much as is feasible at my current status. It may not be necessary at this point; I just wondered if what I am perceiving comes close to reality. I am 6 months away from beginning med school and you could say just cannot wait to jump on the wagon.

It's hard to indulge in the real thing, I think, when you're a pre-med. One of the things that amazed me most about surgery was the opportunity to use both physiology (which is traditionally thought of as part of internal medicine) and surgery/anatomy. But if you don't know very much about physiology and pharm, it can be hard to see things from that perspective.

I think the best thing you can do to "jump on the wagon" is to prepare to study for your first 2 years of medical school as hard as you can. The best surgeons that I have met have an almost encyclopedic knowledge of physiology - certainly on par with most good internal medicine doctors. The actual surgical part you will learn during your rotation and during residency - but the physio part is really important.

 

[SocialistMD]

Why do you necessarily need a "more realistic perspective" before rotations?

Exactly. Why do you already need to know what it is like? If you've been accepted to medical school, you have at least three years to decide what you want to do. Who cares if you are just a premed walking around thinking surgery is cool? Many 1st and 2nd year medical students do the same thing. There is no harm in changing your mind once you experience what it is like as a clinical med student.

You are wishing your life away. Go into school with eyes wide open and full of hope and let med school beat that out of you and chisel you into what you are to become; don't try to do that on your own before you are even there.

 

[DrDawg]

Yup... sort of???

The reason I say that is because this experience could potentially be a better perspective on the life of a praticing surgeon than most med students and many residents ever get.

I have spent a lot of time trying to explain to third year students that how they see things at our county hospital/VA or even our "private" hospitals, has very little to do with the world of private practice. Many students seem discouraged by resident squabbling, the inefficiencies of these hospitals and the overall level of severe disease we see, and I can't say I blame them. If Dr A did this week in a truly private practice (like the week we get in our second year of residency), then I would say this is more like the majority of practices than the uniquely academic view which the average student gets.

I'm not saying that private practice is always the land of milk and honey (billing, partner squabbles, malpractice etc.), but giving premed and med students an opportunity like this may help explain why surgery can be a great job. If we don't encourage this, then all most students see are the other physicians in the academic institutions going home at 4pm while GS, CVTS, Neurosurg, IM and OB/GYN are left keeping the party going.

Agree with Tex. Most students get more of an idea what is like to be a resident. Shaddowing one doc gives you an impression of his day, but you miss out on call shift, and administrative stuff which you will see more of a medical student.

 

[Blade28]

Another plea here for the OP to keep an open mind going through med school.

It's always fine to have certain interests and preferences, but try to keep your options open. You never know what will pique your interest.

 

[smq123]

Another plea here for the OP to keep an open mind going through med school.

It's always fine to have certain interests and preferences, but try to keep your options open. You never know what will pique your interest.

As a third year med student, I also have to ask you to keep an open mind. I didn't (not really), and I hope that I didn't shoot myself in the foot. I swore, all through 1st and 2nd year, that I'd NEVER do surgery and that I'd hate the OR - and then I did OB/gyn and surgery, and was hooked on surgical onc. I was totally convinced that I wanted to do Med/Peds, and then subspecialize in Infectious Diseases. I know that Winged Scapula had a similar experience - thought she'd wanted to do Internal Medicine, until she did the rotation. You honestly never know what you'll like until you do it.

 

[SocialistMD]

As a third year med student, I also have to ask you to keep an open mind. I didn't (not really), and I hope that I didn't shoot myself in the foot. I swore, all through 1st and 2nd year, that I'd NEVER do surgery and that I'd hate the OR - and then I did OB/gyn and surgery, and was hooked on surgical onc. I was totally convinced that I wanted to do Med/Peds, and then subspecialize in Infectious Diseases. I know that Winged Scapula had a similar experience - thought she'd wanted to do Internal Medicine, until she did the rotation. You honestly never know what you'll like until you do it.

I'd bet the pendulum swings more towards the other side, though (as in people come in wanting to be surgeons and then change their mind; I know my med school class was like that).

 

[Blade28]

I'd bet the pendulum swings more towards the other side, though (as in people come in wanting to be surgeons and then change their mind; I know my med school class was like that).

Usually there are three major groups of new MS-Is who "absolutely know" what they want to specialize in:

*Those wanting to go into Peds Heme-Onc (usually females)
*Those wanting to go into Cardiology (even more pronounced after their MS-III rotation)
*Those wanting to become bad-ass surgeons (most quickly change their minds)

Needless to say, most changes their minds after a while.

 

[Anka]

Just to give the opposing point of view on that whole "keep your mind open" schtik. There are a lot of advantages to knowing what you want to do early. Granted, you have to be flexible on some level just in case you really hate it, but the truth is at some point you're going to make a decision. And at that point, you will be making it on limited information, as the rest of this thread points out (your view as a medical student is different from your view as a resident is different from your view as an attending). The advantage to keeping your mind open diminishes over time; the advantage to knowing what you want to do increases as you progress. I'm not exactly sure where the lines intersect, but it isn't infinitly in the future.

In particular, if you know as an MS1 you want to be a surgeon, you can start getting to know the faculty and residents. They know you, so they'll let you do more (the extent to which this is true probably institution specific, but you won't know until you try). You can start getting involved in relevant research and publish. And lets say you wind up changing your mind? No harm, you are still published, you got to do some cool stuff as a medical student. And if you don't change your mind? You got to do some cool stuff as a med student, have publications relevant to the field, have some good mentors.

Anyway, something to be said for both ways of approaching life. The keep your mind open thing gets a lot of voice these days, though.

Anka

 

[smq123]

I'd bet the pendulum swings more towards the other side, though (as in people come in wanting to be surgeons and then change their mind; I know my med school class was like that).

I totally agree - I think that people who wanted to do medicine, and then switch into surgery, are in the minority in many schools. I think that the opposite is much more likely. There are definitely many people in my school who fit your description - heck, that described 3/4 of the boys on my surgery rotation!

Just to give the opposing point of view on that whole "keep your mind open" schtik. There are a lot of advantages to knowing what you want to do early. Granted, you have to be flexible on some level just in case you really hate it, but the truth is at some point you're going to make a decision.

True - but I think that the advice of "getting published early, make mentors early, etc." is valuable to all students, regardless of the specialty. As they say, it's better to shoot for derm, and then love peds, than the reverse. I'm still grateful for the advice I got from the internal med and family med mentors that I met during first year.

But going into medical school fairly convinced that you're going to do one specialty can bite you in the butt, too - I actually think that it can be much worse than the reverse. Lots of people who remain open-minded until halfway through third year manage to match well - but there are a surprising number of people who remain stubbornly fixated on one specialty, and DON'T match well.

I think the biggest danger (for me, anyway) of fixating on one specialty is that I kept trying to talk myself out of other specialties, or try to convince myself that, no, I REALLY DID love internal med/family med - that my enjoyment of surgery was "just a phase".

It didn't dawn on me that I was lying to myself until I was scrubbed in on a case, and I was disappointed that the case was over. That's when I realized that, actually, I didn't want to do internal med or peds.

The same thing is true for the opposite. There's a guy on his medicine rotation who kept insisting (half-heartedly) that he truly loved surgery. Halfway through, though, he realized how much he loved medicine, and had to admit that maybe he isn't meant for surgery after all.

 

[Blade28]

I agree. But I think it's very possible to initially pursue one path while keeping your mind (and other options) open.

I started looking for research openings during the summer after the MS-I year - even though I was interested in Surgery, I did a bunch of projects in a variety of fields. In the end, the important thing was the learning experience - "research is research," as they say, and the subject matter isn't quite as important as the method and process.

I do agree that it's important to make contacts early on, especially if you're considering a competitive field, and I tried to do this from the beginning. But I always knew not to rule anything out until at least I'd tried it during my MS-III rotations.