CRINGEPOCALYPSE: I dont want to apply for surgery if I end up like these residents

[dpmd]

---

Members don't see this ad.

The idea that surgeons can manage ANY medical disease is laughable. The next time I get consulted because they misread an EKG, can’t manage cardiogenic shock, miss an acute coronary event, don’t give antibiotics for several hours in sepsis, mismanage heart failure, give beta blockers to treat tachycardia in distributive shock, hold diabetes meds and send patients into a DKA or HHNK state, I’ll keep that in mind. Let’s not kid ourselves- I can’t do a lap chole or lap appy nor can I manage the associated postop complications that require surgery, but I can guarantee from experience that the can manage these problems better. We all have our strengths - let’s be honest.

I can find examples for all of those thing you complain of where the medicine doctor taking care of the patient was the one who dropped the ball and surgery stepped in to try to keep the patient from dying. If you have this happening all the time with general surgeons I would expect they came from a program that didn't focus on training their residents to appropriately manage medical conditions related to or exacerbated by the perioperative state of the patient (or they are well out of training and have checked out of anything besides the technical aspect of surgical care).

 

[dpmd]

Any practicing surgeon would agree with my original post

Incorrect.

You are evaluating statements written for the purpose of praising the residency program and assuming it defines their approach to surgery overall.

I trained at a program where consultants were not easily available for many issues so managing cardiac, neuological, renal, endocrine, and other medical issues was very much a requirement. In the 5 years of doing that I felt capable of managing a variety of issues adequately. Doesn't mean that I considered myself better or equal to a medicine subspecialty (though immediately after my chief year I would have considered myself pretty good in comparison to a no specialty trained internal medicine doctor that manages nothing and just consults for everything like some hospitalists I work with). I however consider it a selling point of the program and would comment on this.

The person who proudly states the program strive to dominate the surgical landscape is letting people know that the program tries to advance surgery and do it's best to train good surgeons. Where is the problem in that.

You completely ignore the statement about the incredible gift that patients give us when they allow us to hurt them in order to heal. Maybe you didn't understand the sentence and thought they were saying they were the gift. Regardless it is the ultimate statement of trust when the patient says do what you have to do to fix me doc and it is a really beautiful thing when you develop that kind of rapport with a patient with a complex problem and what will happen in the operating room isn't necessarily known but they feel comfortable to let you proceed anyway.

As for the giving more of yourself than you ever knew and battle tested friends part you scoff at so, all I can say is that you haven't been through it so you don't know what it is like. Sure, you aren't getting shot at but the work, missed meals, missed sleep, stress about sick patients, and all of that adds up and takes strength and teamwork to get through. Ask anyone who has done a difficult residency and I think you will get similar comments.

 

[Aerus]

The most cringey part of this thread is CRINGEPOCALYPSE

 

[doc05]

I'm actually very curious about surgeons opinions on this. Do you guys think you could manage all of the medical needs of a patient if you had the time and interest? How is it possible to be able to do that as well as an internist that trained specifically for this purpose? Are non surgeons really inferior in your eyes? I'm not judging, I honestly want to know. I haven't even made up my mind about this myself.

Of course I can. It's pretty easy. I just have zero interest.

 

[Kpw101]

Their statements actually made me really excited to be trained in a high quality program.

No disrespect intended - You feeling like you're higher than the surgeons on some moral compass because they'd talked about their technical prowess rather than altruistic patient care calls for some self-reflection on your own ego.

 

[RNtoMD87]

Maybe simple altruistic motives don't usually propel someone to do something as difficult and precise as surgery. I feel like it probably takes a bit of a competitive nature/pride in ones abilities to make it as a surgeon. And there's nothing wrong with that. I mean you can be altruistic and do much less. For the most part, nurses are altruistic. Social workers are altruistic. CNAs are altruistic. But something else drives physicians further. It isn't pure altruism. Its a drive, to do and be more.

You seem really naïve, egotistical or both.

 

[IMreshopeful]

I will say that my experience with general surgeons has always been there are much better at managing medical conditions than any of the other kinds of Surgeons out there.

Your experience may be different, but I've never been consulted by general surgery for stable hypertension or Diet controlled diabetes like I have by ortho.

And at least an academic places, the surgical ICU is usually run entirely by surgeons, and med school I don't remember them Consulting the intensivist more than maybe once a month.

Is a surgeon my equal in managing most chronic diseases? Of course not. Are they usually good enough in the short-term while their patients are in the hospital? Frequently.

So where I work surgeons don’t operate on stable patients all that often because of the patient population. They often do operate on patients with uncontrolled DM, poorly managed HF, etc. I’m a cardiology fellow so at least from my vantage point the surgeons are not good at managing basic cardiac issues - and often treat things inappropriately or don’t treat them at all.

All I’m saying is that we all have our roles. But let’s not lie to ourselves that we are experts in everything

 

[IMreshopeful]

I can find examples for all of those thing you complain of where the medicine doctor taking care of the patient was the one who dropped the ball and surgery stepped in to try to keep the patient from dying. If you have this happening all the time with general surgeons I would expect they came from a program that didn't focus on training their residents to appropriately manage medical conditions related to or exacerbated by the perioperative state of the patient (or they are well out of training and have checked out of anything besides the technical aspect of surgical care).

I never said that I was an expert at managing surgical problems. At least in my residency I could recognize an acute abdomen and/or ischemic bowel early enough to get surgery involved, so I would typically call early to err on the side of caution if I wasn’t sure. But nowhere did I claim that we were superior in this regard. If we’re gonna go there, last week alone I had surgical residents mismanaging cardiogenic shock and giving beta blockers to a septic patient. So it goes both ways.

Let’s just always keep in mind that all of us have our strengths and that we all have our place in patient care. But pretending that we are experts at everything is silly.

 

[Dr. Scribe]

FWIW, my cousin is a bariatric surgeon and immediately after finishing his GenSurg residency he started acting like he was God’s gift to medicine/the world.

I don’t judge him though because I know how hard he had to work to get to where he is and how many people he has helped along the way.

 

[RNtoMD87]

Its probably hard to remain modest after achieving so much.

 

[IMreshopeful]

Its probably hard to remain modest after achieving so much.

It’s really not.

All I have to do is remember that I have a life outside of my work.

 

[dpmd]

I never said that I was an expert at managing surgical problems. At least in my residency I could recognize an acute abdomen and/or ischemic bowel early enough to get surgery involved, so I would typically call early to err on the side of caution if I wasn’t sure. But nowhere did I claim that we were superior in this regard. If we’re gonna go there, last week alone I had surgical residents mismanaging cardiogenic shock and giving beta blockers to a septic patient. So it goes both ways.

Let’s just always keep in mind that all of us have our strengths and that we all have our place in patient care. But pretending that we are experts at everything is silly.

You misunderstood. I am saying I have seen medicine doctors giving beta blockers to septic or dry patients, and giving just sliding scale insulin to diabetic patients with glucose levels in the 400s. Let's not pretend the bad examples define a field.

 

[RNtoMD87]

Ive seen people in most fields do STUPID things. People are human. Ive seen CNAs wipe patients faces with bleachwipes (Im still shaking my head over this one though). Ive seen nurses stand there and not code a patient waiting on the code team.

I argued with an ENT resident last night who wanted me to crush Dabigatran to put through a patients red rubber catheter. I explained you should never crush it because it rapidly increases absorption and can lead to adverse affect and she got mad and told me to do it anyway. I didn't feel comfortable so I called pharmacy and they told me not to crush it, as well as the attending. She got really pissy afterwards with me, because I didn't just do it.

Long story short, there are idiots in every field as well as outstanding people in every field, and we're all stupid sometimes.

 

[Blackdogue]

Of course I can. It's pretty easy. I just have zero interest.

And you're not trolling, right?

 

[Tenk]

Bro if that shocks you just wait til you talk to said surgeon at 2 am on the phone.

 

[Blackdogue]

Bro if that shocks you just wait til you talk to said surgeon at 2 am on the phone.

What am I likely to hear him say?

 

[dpmd]

And you're not trolling, right?

If we are talking about the type of medicine doc who maybe restarts home meds then proceeds to panconsult for all the chronic medical issues the patient has and waits for their recommendations before doing anything, yeah we can do at least that for surgical patients who happen to also have medical problems.

 

[RNtoMD87]

What am I likely to hear him say?

I've heard them yell through the phone before quite often. Also had a pulmonologist yell at a patients family who didn't understand what he was trying to say "HES F*^%ING DYING!!"

Had another pulmonologist yell "DO NOT LET ANOTHER F*^%ING RESIDENT GET NEAR ME TONIGHT! DO YOU UNDERSTAND?!" To us on SICU. (After they couldn't make up their minds whether to intubate a patient when he was strongly hinting they needed to).

 

[IMreshopeful]

You misunderstood. I am saying I have seen medicine doctors giving beta blockers to septic or dry patients, and giving just sliding scale insulin to diabetic patients with glucose levels in the 400s. Let's not pretend the bad examples define a field.

Sliding scale insulin if dosed appropriately is fine for hyperglycemia if a patient isn’t hyperosmolar or in DKA. But that’s neither here nor there.

Of course there’s bad medicine doctors. We get terrible mismanaged dumps from community hospitals all the time. But saying that a surgical resident or attending on average is AS GOOD as the medicine docs who have trained somewhere decent at managing, say, CHF, arrhythmias, or acute coronary syndrome - that ain’t true. Nor should it be - it isn’t within the scope of practice. And that’s fine. What I find dangerous is when the surgical docs THINK they know how to manage something medical so confidently and they clearly don’t, and call us only after the patient has had a complication. This doesn’t happen a ton but it does occur with some regularity.

 

[IMreshopeful]

I've heard them yell through the phone before quite often. Also had a pulmonologist yell at a patients family who didn't understand what he was trying to say "HES F*^%ING DYING!!"

Had another pulmonologist yell "DO NOT LET ANOTHER F*^%ING RESIDENT GET NEAR ME TONIGHT! DO YOU UNDERSTAND?!" To us on SICU. (After they couldn't make up their minds whether to intubate a patient when he was strongly hinting they needed to).

Then that person is a bad medical intensivist. Anybody can be trained to drop in central lines and arterial lines and do procedures. With some training many folks can train how to manage a ventilator. But the mark of a good intensivist is by and large how they conduct themselves with a dying patient and manage composure with the patients family. Being medically competent should be a given.

 

[MSTPlease]

Are you talking about me or them?

them

 

[anbuitachi]

There's a huge difference between knowing how to manage patients based on evidence vs having those patients on your service and you put in orders. Many surgeons tell themselves they are good at managing when it's just not true. That's why we have different specialties and each take years of training .

We had surgeon try to do non emergent surgeries on patient with a potassium of 7 and give pushback when we tell them no the patient isn't optimized.

 

[Tenk]

What am I likely to hear him say?

Don’t wanna spoil the surprise.

 

[dpmd]

There's a huge difference between knowing how to manage patients based on evidence vs having those patients on your service and you put in orders. Many surgeons tell themselves they are good at managing when it's just not true. That's why we have different specialties and each take years of training .

We had surgeon try to do non emergent surgeries on patient with a potassium of 7 and give pushback when we tell them no the patient isn't optimized.

I have had medicine consult me for non emergent cases all the time where the patient is not optimized.

 

[anbuitachi]

I have had medicine consult me for non emergent cases all the time where the patient is not optimized.

I'm not targeting surgeons I'm saying everyone got their specialty of expertise.

Though to address your statement there's a huge difference between consulting (it means they realize it isn't their expertise) and pushing to get your case started in a patient who's clearly not optimized.

 

[dpmd]

I'm not targeting surgeons I'm saying everyone got their specialty of expertise.

Though to address your statement there's a huge difference between consulting (it means they realize it isn't their expertise) and pushing to get your case started in a patient who's clearly not optimized.

I am merely pointing out there are bad providers in every specialty and that shouldn't be what we use to judge the entire specialty.

 

[radsisrad]

The posts on that site give the distinct impression that the residents at that program have been huffing institutional self-congratulation for several years and are high on the fumes. I'd be embarrassed to have such over-the-top comments attributed to me.

 

[Psai]

The posts on that site give the distinct impression that the residents at that program have been huffing institutional self-congratulation for several years and are high on the fumes. I'd be embarrassed to have such over-the-top comments attributed to me.

That's easy to say when you haven't accomplished anything.

 

[radsisrad]

That's easy to say when you haven't accomplished anything.

You might want to change that "when" to an "if." Odds are that my academic performance in med school was superior to most of theirs.

 

[RNtoMD87]

I don't understand why people care so much what others perceive. Surgeons tend to be pretty high intensity. What's wrong with that? They're kind of the lead singer/lead guitarist of the band. The bassist/drummers job is still very important, but the surgeon is the rock star. High risk, high reward, huge competition etc.

 

[deleted547631]

You might want to change that "when" to an "if." Odds are that my academic performance in med school was superior to most of theirs.

r/iamverysmart

 

[PhillyMed777]

I don't understand why people care so much what others perceive. Surgeons tend to be pretty high intensity. What's wrong with that? They're kind of the lead singer/lead guitarist of the band. The bassist/drummers job is still very important, but the surgeon is the rock star. High risk, high reward, huge competition etc.

There's no such thing as huge competition in getting a general surgery spot. Neither is the reward that high.

With the exception of a few high revenue makers for the hospital, most cant be classified as "lead singer."

I guess when you are living under a rock for 7+ years of training it's easy to think the world revolves around you when you haven't stepped out much.

 

[RNtoMD87]

There's no such thing as huge competition in getting a general surgery spot. Neither is the reward that high.

With the exception of a few high revenue makers for the hospital, most cant be classified as "lead singer."

I guess when you are living under a rock for 7+ years of training it's easy to think the world revolves around you when you haven't stepped out much.

Well I'm shadowing a bariatric/general surgeon and he seems to do quite well for himself.

Also my testosterone hook up is a cardio thoracic surgeon at the hospital I work at (and aesthetic medicine clinic on the side) and he does very well for himself.

 

[Oso]

You might want to change that "when" to an "if." Odds are that my academic performance in med school was superior to most of theirs.

lol nice

 

[RNthenDoc]

In my experience, surgery can handle 75% of the medical cases as attending. They typically consult medicine when the complexity becomes too time consuming, not beyond their abilities.

Just my anecdotes from my career as an ICU nurse.

Also, almost every surgeon I work with has been reasonable and wasn’t wearing a cape. A good group of folks... But dang do they get ridden hard and put away wet. Idk if that lifestyle is for me.

 

[Psai]

In my experience, surgery can handle 75% of the medical cases as attending. They typically consult medicine when the complexity becomes too time consuming, not beyond their abilities.

Just my anecdotes from my career as an ICU nurse.

Also, almost every surgeon I work with has been reasonable and wasn’t wearing a cape. A good group of folks... But dang do they get ridden hard and put away wet. Idk if that lifestyle is for me.

You're not exactly the world's leading expert in judging people's abilities. Also, you're incorrect.

 

[IMreshopeful]

In my experience, surgery can handle 75% of the medical cases as attending. They typically consult medicine when the complexity becomes too time consuming, not beyond their abilities.

Just my anecdotes from my career as an ICU nurse.

Also, almost every surgeon I work with has been reasonable and wasn’t wearing a cape. A good group of folks... But dang do they get ridden hard and put away wet. Idk if that lifestyle is for me.

Yeah, no. They often just don’t know what they are doing. They might think they do, but they don’t.

I’m currently at an institution that is known for their surgical critical care and I find their management of non surgical issues appalling at times. But it’s all part of the circle jerk that reinforces that they THINK they’re doing the appropriate thing. Giving short acting metoprolol q6h to someone in decomp HF, trying to pace someone at high rates to “improve the cardiac output” (so so wrong), nitro infusion to someone on pressors due to a troponin leak (from a type 2 NSTEMI), asking for mechanical support in distributive shock, over reliance on devices like the vigileo to give hemodynamics over an actual physical exam/POC ultrasound, giving continuous fluids to everyone and wondering why the severe AS guy is having recurrent flash pulmonary edema etc. This is just a drop in the bucket. And when confronted, the response is “you think I don’t know how to manage this? How dare you” instead of gratitude. But that might just be the academic ego speaking and I’m sure it’s not like that in the real world.

Yes I get that everyone makes mistakes. But the biggest mistake is hubris - assuming you know what you’re doing when you don’t.

 

[Blackdogue]

In my experience, surgery can handle 75% of the medical cases as attending. They typically consult medicine when the complexity becomes too time consuming, not beyond their abilities.

Just my anecdotes from my career as an ICU nurse.

Also, almost every surgeon I work with has been reasonable and wasn’t wearing a cape. A good group of folks... But dang do they get ridden hard and put away wet. Idk if that lifestyle is for me.

I still don't understand how it is possible that someone with surgical training is able to handle medical problems as well as someone who dedicated his entire training to handling medical problems. It doesn't compute. This could only be true if people going into surgery were vastly more intelligent than the people going into medicine, or if medical training doesn't actually teach you anything. Both cases are impossible. If you do something more than another person, you get better at it. If that wasn't the case, why would we even have other specialties? If everyone was a surgeon, surely we would have enough surgeons to deal with the other 25% percent of problems that current surgeons don't have time for. Then we can also stop paying the other useless medicine people.

 

[VA Hopeful Dr]

I still don't understand how it is possible that someone with surgical training is able to handle medical problems as well as someone who dedicated his entire training to handling medical problems. It doesn't compute. This could only be true if people going into surgery were vastly more intelligent than the people going into medicine, or if medical training doesn't actually teach you anything. Both cases are impossible. If you do something more than another person, you get better at it. If that wasn't the case, why would we even have other specialties? If everyone was a surgeon, surely we would have enough surgeons to deal with the other 25% percent of problems that current surgeons don't have time for. Then we can also stop paying the other useless medicine people.

It amounts to different levels of treatment necessary. If you got someone recovering from surgery, sliding scale insulin that prevents hyperglycemia is more than sufficient. That sort of the thing is not going to fly for the outpatient management of diabetes, however.

 

[Blackdogue]

It amounts to different levels of treatment necessary. If you got someone recovering from surgery, sliding scale insulin that prevents hyperglycemia is more than sufficient. That sort of the thing is not going to fly for the outpatient management of diabetes, however.

So how does a trained surgeon not get this? Although, I'm sure it's just a minority that don't know realize this. Could it be that surgeons are trained to be confident, and that confidence can sometimes escalate into full blown arrogance, depending on one's character? Afterall, saving someone's life with your hands can definitely build up your ego. In medicine, on the other hand, you're dealing with problems that aren't simple enough to be solved by cutting, so failure is common and treatments are not as immediately impactful. It's probably more humbling than surgery. That could somehow explain it for me, but I could be completely wrong, since I'm not even a resident yet.

 

[dpmd]

It amounts to different levels of treatment necessary. If you got someone recovering from surgery, sliding scale insulin that prevents hyperglycemia is more than sufficient. That sort of the thing is not going to fly for the outpatient management of diabetes, however.

You mean basal-prandial, right? Or maybe you don't since a lot of hospitalists don't use it despite the deleterious effects of hyperglycemia on postop recovery.

 

[DrMcLovin]

So how does a trained surgeon not get this? Although, I'm sure it's just a minority that don't know realize this. Could it be that surgeons are trained to be confident, and that confidence can sometimes escalate into full blown arrogance, depending on one's character? Afterall, saving someone's life with your hands can definitely build up your ego. In medicine, on the other hand, you're dealing with problems that aren't simple enough to be solved by cutting, so failure is common and treatments are not as immediately impactful. It's probably more humbling than surgery. That could somehow explain it for me, but I could be completely wrong, since I'm not even a resident yet.

I’m not sure what hospital you’re training in but IM & ED doctors don’t send patients to the general surgeon with a prescription for a particular surgery...

The acutely ill patients admitted to the general surgery service tend to be very sick medically in addition to having a surgical problem/potentially surgical problem. The general surgery service at my hospital primarily manages all medical problems in the patients they admit. They obviously consult medical specialists when necessary, but they basically function as a hospitalist for their patients in addition to managing the surgical issue.

General surgery has a lot of medicine involved due to the nature of the conditions they treat which is why they are well qualified to staff surgical ICU’s with a 1 yr critical care fellowship post residency.

Specialty of Surgical Critical Care Defined | American Board of Surgery

 

[Psai]

I’m not sure what hospital you’re training in but IM & ED doctors don’t send patients to the general surgeon with a prescription for a particular surgery...

The acutely ill patients admitted to the general surgery service tend to be very sick medically in addition to having a surgical problem/potentially surgical problem. The general surgery service at my hospital primarily manages all medical problems in the patients they admit. They obviously consult medical specialists when necessary, but they basically function as a hospitalist for their patients in addition to managing the surgical issue.

General surgery has a lot of medicine involved due to the nature of the conditions they treat which is why they are well qualified to staff surgical ICU’s with a 1 yr critical care fellowship post residency.

Specialty of Surgical Critical Care Defined | American Board of Surgery

The funniest thing about this post is that you haven't even started your do ortho residency and you're trying to tell us how it works between general surgery and medicine

 

[Blackdogue]

I’m not sure what hospital you’re training in but IM & ED doctors don’t send patients to the general surgeon with a prescription for a particular surgery...

The acutely ill patients admitted to the general surgery service tend to be very sick medically in addition to having a surgical problem/potentially surgical problem. The general surgery service at my hospital primarily manages all medical problems in the patients they admit. They obviously consult medical specialists when necessary, but they basically function as a hospitalist for their patients in addition to managing the surgical issue.

General surgery has a lot of medicine involved due to the nature of the conditions they treat which is why they are well qualified to staff surgical ICU’s with a 1 yr critical care fellowship post residency.

Specialty of Surgical Critical Care Defined | American Board of Surgery

I'm not a resident, I just graduated a couple of weeks ago. But I never questioned whether a surgical intensivist is able to manage surgical ICU patients. But, this is hardly evidence that all surgeons can manage any medical problem non-surgeons can. Surgical patients have specific critical care needs, and input from other specialists is still needed, as you mentioned. I think the issue here is whether surgeons think that they could do everyone else's job if they had the time. Not if a trained surgical intensivist can run an SICU. Of course he can.

 

[VA Hopeful Dr]

You mean basal-prandial, right? Or maybe you don't since a lot of hospitalists don't use it despite the deleterious effects of hyperglycemia on postop recovery.

Yes and no. I was originally referring to the roughly eight to ten different classes of non insulin medications for diabetics that we use in the outpatient world and I would be astounded if there's a surgeon who knows those as well as I do.

But I also would suspect that I'm better at dosing insulin in general than most surgeons are as well. Are most of y'all good enough at it in the post-op period? Undoubtedly. Would I want a surgeon managing my diabetes for the next decade? Absolutely not.

 

[DrMcLovin]

The funniest thing about this post is that you haven't even started your do ortho residency and you're trying to tell us how it works between general surgery and medicine

Do you not think general surgery does a lot of medical management and what parts do you disagree with? When the chief resident at Hopkins says he’s comfortable managing medical problems I tend to agree. I certainly believe him over an anesthesia intern with a history of trollish posts and ad hominem attacks on posters. I also saw the general surgery residents and attendings doing just that in the hospital where I did rotations.

In case you missed the link to the definition of surgery critical care in my last post:

“Surgical critical care not only incorporates knowledge and skills of nonoperative techniques for supportive care for critically ill patients but also a broad understanding of the relationship between critical surgical illness and surgical procedures. Although much of this knowledge and skills is common to critical care specialists from a variety of medical disciplines, the diplomate in surgical critical care has specialized expertise relating both to the physiologic responses to tissue injury from trauma, burns, operation, infections, acute inflammation, or ischemia and to the ways these responses interact with other disease processes.......the specialist in surgical critical care must have a broad knowledge base and expertise concerning the biology of the critically ill surgical patient and the support of organ system function.”

I'm not advocating that I know everything about medicine and surgery like you are implying, but it is pretty clear general surgery does a lot of medical management for their patients. I was pointing this out to the poster who made it sound like patients are merely sent to the general surgeon so they can do an operation and send them right back.

I'm not a resident, I just graduated a couple of weeks ago. But I never questioned whether a surgical intensivist is able to manage surgical ICU patients. But, this is hardly evidence that all surgeons can manage any medical problem non-surgeons can. Surgical patients have specific critical care needs, and input from other specialists is still needed, as you mentioned. I think the issue here is whether surgeons think that they could do everyone else's job if they had the time. Not if a trained surgical intensivist can run an SICU. Of course he can.

Of course they couldn't do everyone else's jobs. I agree with you. I was just pointing out that general surgery does a lot of medical management with their patients.

If I'm ever hospitalized I certainly wouldn't want a general surgeon as my cardiologist, but I'm just surprised at the outrage in this thread about the chief resident saying they are comfortable medically and surgically managing any patient in the hospital. The personal statement was written in the context of being a general surgeon and it would be ridiculous for anyone to assert they meant they could replace a cardiologist, family medicine doc, or anesthesiologist etc.

 

[Blackdogue]

Do you not think general surgery does a lot of medical management and what parts do you disagree with? When the chief resident at Hopkins says he’s comfortable managing medical problems I tend to agree. I certainly believe him over an anesthesia intern with a history of trollish posts and ad hominem attacks on posters. I also saw the general surgery residents and attendings doing just that in the hospital where I did rotations.

In case you missed the link to the definition of surgery critical care in my last post:

“Surgical critical care not only incorporates knowledge and skills of nonoperative techniques for supportive care for critically ill patients but also a broad understanding of the relationship between critical surgical illness and surgical procedures. Although much of this knowledge and skills is common to critical care specialists from a variety of medical disciplines, the diplomate in surgical critical care has specialized expertise relating both to the physiologic responses to tissue injury from trauma, burns, operation, infections, acute inflammation, or ischemia and to the ways these responses interact with other disease processes.......the specialist in surgical critical care must have a broad knowledge base and expertise concerning the biology of the critically ill surgical patient and the support of organ system function.”

I'm not advocating that I know everything about medicine and surgery like you are implying, but it is pretty clear general surgery does a lot of medical management for their patients. I was pointing this out to the poster who made it sound like patients are merely sent to the general surgeon so they can do an operation and send them right back.



Of course they couldn't do everyone else's jobs. I agree with you. I was just pointing out that general surgery does a lot of medical management with their patients.

If I'm ever hospitalized I certainly wouldn't want a general surgeon as my cardiologist, but I'm just surprised at the outrage in this thread about the chief resident saying they are comfortable medically and surgically managing any patient in the hospital. The personal statement was written in the context of being a general surgeon and it would be ridiculous for anyone to assert they meant they could replace a cardiologist, family medicine doc, or anesthesiologist etc.

I'm sorry, maybe I misunderstood, but I was definitely given the impression that some of the surgeons were claiming exactly that. The chief resident also did make it sound like he was superman, "bring me any patient, I will cure him!". I'm actually glad that I'm wrong.

 

[dpmd]

Yes and no. I was originally referring to the roughly eight to ten different classes of non insulin medications for diabetics that we use in the outpatient world and I would be astounded if there's a surgeon who knows those as well as I do.

But I also would suspect that I'm better at dosing insulin in general than most surgeons are as well. Are most of y'all good enough at it in the post-op period? Undoubtedly. Would I want a surgeon managing my diabetes for the next decade? Absolutely not.

Fair point. You haven't even been one of the folks saying surgeons are doing ****ty jobs. I think some folks are thinking we are saying we can manage stuff chronically just as good as those that do it all the time instead of just that in programs where we spend 5 years taking short term care of the medical issues of surgical patients we can do it pretty damn good (maybe not as good as a really good hospitalist who has been taking care of surgical patients for years, but probably better than some of the yahoos out there who rarely encounter surgical patients and whose idea of managing stuff is to just consult the associated specialist even if the issue is totally stable). But really, given the time and interest you guys could learn to operate and we could learn all the outpatient chronic management stuff (with some exceptions I suppose, but more true than not).

 

[nimbus]

It would be interesting to ask the quoted surgical chiefs 5-10 years down the road if they stand by their quotes. I’m willing to bet the most self aware ones would cringe a bit themselves. I’ve yet to meet a newly minted surgeon who is nearly as confident and adept as the best experienced surgeons. They just haven’t had enough experience and haven’t experienced enough concomitant f***ups by the time they are chief residents. Despite their long and arduous journey, a surgical chief resident is still a beginner. The job is that difficult. A significant minority make it to the point where they make it look easy. Not only confident but calm and efficient. Some never do. But it takes more than 7 years to become a truly great surgeon.

 

[Shambere]

I invite SDn users to read a summary biography of Halsted. Mind blowing, the old times were indeed "unique". He would not have lasted 5 minutes in any residency in the present. I say any residency.