Gastroenterology vs surgery

[rapid]

How do GI and surgery compare as fields? Specifically in terms of work hours, interesting procedures, job opportunities and salary? Would surgeons rather do GI if they didn't have to get through an internal medicine residency first?

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[Winged Scapula]

How do GI and surgery compare as fields? Specifically in terms of work hours, interesting procedures, job opportunities and salary? Would surgeons rather do GI if they didn't have to get through an internal medicine residency first?

What field are you a fellow in? GI? If you are not currently a fellow, please change your designation as it confuses people.

Despite the fact that these "Surgery vs Field X" threads are a bit tiresome, I'll attempt to answer some of your questions.

First, I and most others here have no idea about how many hours GI docs work per week, what their job opportunities are or salaries. You would be best advised to ask those questions in the IM Gastroenterology sub-forum.

I would venture however that the reason most surgeons would NOT do GI has nothing to do with the IM residency (ok, maybe a little bit) but rather because we want to be in the OR. There is a huge difference between doing procedures (like GI does) and doing operations. A day here and there doing procedures is nice, but most of us want to actually be cutting and sewing, listening to the beep beep beep of the anesthesia machine and spending as little time in clinic/office and rounding on patients as possible.

Its not an unreasonable compromise for those who are *really* torn between IM and Surgery, but since that is so few people, I'm sure most surgeons don't want to be gastroenterologists anymore than gastroenterologists want to be surgeons.

 

[Castro Viejo]

How do GI and surgery compare as fields? Specifically in terms of work hours, interesting procedures, job opportunities and salary? Would surgeons rather do GI if they didn't have to get through an internal medicine residency first?

🙄

 

[doc02]

GI and Surgery have practically nothing to do with one another. They're complimentary fields. It's like we both live in the same neighborhood (the colon), but in different houses. And also in our house there are a lot of hot, naked chicks.

 

[rapid]

What field are you a fellow in? GI? If you are not currently a fellow, please change your designation as it confuses people.

Despite the fact that these "Surgery vs Field X" threads are a bit tiresome, I'll attempt to answer some of your questions.

First, I and most others here have no idea about how many hours GI docs work per week, what their job opportunities are or salaries. You would be best advised to ask those questions in the IM Gastroenterology sub-forum.

I would venture however that the reason most surgeons would NOT do GI has nothing to do with the IM residency (ok, maybe a little bit) but rather because we want to be in the OR. There is a huge difference between doing procedures (like GI does) and doing operations. A day here and there doing procedures is nice, but most of us want to actually be cutting and sewing, listening to the beep beep beep of the anesthesia machine and spending as little time in clinic/office and rounding on patients as possible.

Its not an unreasonable compromise for those who are *really* torn between IM and Surgery, but since that is so few people, I'm sure most surgeons don't want to be gastroenterologists anymore than gastroenterologists want to be surgeons.

I think that there is much more of an overlap than you think (you said above that there is a "huge difference between doing procedures and operations"). Have you ever heard of "NOTES?" Basically, it is intraperitoneal surgery done with standard GI endoscopes. For example, a GI doctor can take and upper endoscpe, pass it into the stomach and use a needle knife to make and incision in the antrum and enter the peritoneal cavity. At that point, any organ is up for grabs....there are multiple case reports of appendectomies and cholecystectomies being done this way. This is the wave of the future. And it doesn't even require the "beeping" of the anaesthesia machine as the procedure can be done with relatively low doses of propofol (so no intubation). Surgeons round on patients just as much as GI docs, and are possibly even more involved in their care (getting called for low blood sugar, low mag etc....) as patients are usually on a surgical inpatient service whereas GI docs are usually just consultants. I am sorry that I started a "tiresome" thread as you mentioned above.

 

[doc02]

Have you ever heard of "NOTES?"

OH SWEET LORD, STOP THE PAIN!!! It burns!

 

[smq123]

I think that there is much more of an overlap than you think (you said above that there is a "huge difference between doing procedures and operations"). Have you ever heard of "NOTES?" Basically, it is intraperitoneal surgery done with standard GI endoscopes. For example, a GI doctor can take and upper endoscpe, pass it into the stomach and use a needle knife to make and incision in the antrum and enter the peritoneal cavity. At that point, any organ is up for grabs....there are multiple case reports of appendectomies and cholecystectomies being done this way. This is the wave of the future. And it doesn't even require the "beeping" of the anaesthesia machine as the procedure can be done with relatively low doses of propofol (so no intubation). Surgeons round on patients just as much as GI docs, and are possibly even more involved in their care (getting called for low blood sugar, low mag etc....) as patients are usually on a surgical inpatient service whereas GI docs are usually just consultants.

Kimberli Cox answered your question in a perfectly reasonable (and pretty nice) way. And you respond by, basically, attacking everything she says? ("Have you ever heard of NOTES?" No, she's just an attending. I doubt she's heard of it.) Nice. Real nice. 🙄

 

[tussy]

First of all, most "NOTES" surgery would be performed by a surgeon, not a gastroenterologist!!!

I started medical school with plans to be a gastroenterologist. Then i discovered surgery. It was then that i realized that surgery was the right field for me. I'm not a colorectal surgeon, which does overlap somewhat with GI (we work closely together). I prefer to be on the surgery side of things. It avoids all the IBS patients. We see the Crohn's patients when they need surgery and then send them back to GI once they've recovered from their surgery. GI calls me when them find a tumour on endoscopy and then i get to be the one to cut it out.

I have the upmost respect for gastroenterologists, but i'm very thankful i decided to be a surgeon.

 

[Winged Scapula]

I think that there is much more of an overlap than you think (you said above that there is a "huge difference between doing procedures and operations"). Have you ever heard of "NOTES?" Basically, it is intraperitoneal surgery done with standard GI endoscopes. For example, a GI doctor can take and upper endoscpe, pass it into the stomach and use a needle knife to make and incision in the antrum and enter the peritoneal cavity. At that point, any organ is up for grabs....there are multiple case reports of appendectomies and cholecystectomies being done this way. This is the wave of the future.

Thank you for the lesson on NOTES. I am well aware of its existence. Whether or not NOTES is the "wave of the future" is a HUGE conjecture. The procedures have not been well accepted by the medical or lay community; it remains to be seen whether or not it will become so. If it does, NOTES will be done by surgeons, not gastroenterologists.

And it doesn't even require the "beeping" of the anaesthesia machine as the procedure can be done with relatively low doses of propofol (so no intubation).

Obviously. However, you have missed my point. Yes, there are is some overlap between these procedures and operations. But they are still procedures and not "real" operations. Surgeons do not want to be endoscopists for the most part. You asked a question about would surgeons want to be gastroenterologists and I gave you my answer which is based on years of experience.

Surgeons round on patients just as much as GI docs, and are possibly even more involved in their care (getting called for low blood sugar, low mag etc....) as patients are usually on a surgical inpatient service whereas GI docs are usually just consultants.

I never said surgeons do not round on patients. However, to claim that we spend as much time rounding as an internist is ludicrous. Our gastroenterolgy service are consultants but they have plenty of patients which they are the primary on. I've worked in hospitals where all pancreatitis and diverticulitis, as well as GI bleeds and numerous other problems were admitted directly to GI service, not the IM or Surgical services for GI to consult on.

I am sorry that I started a "tiresome" thread as you mentioned above.

My comment was a bit curt but this forum has been inundated with threads from users we've never heard of before coming in and asking if "Specialty X is better than Surgery". They all seem to have some underlying motive, which is mostly to bash surgeons and try and convince us that "NOTES/IR/Interventional Cards/etc" are the wave of the future and that open surgery is a dying field. I apologize if this was not your intent, but I'm sure how you can see it would be tiresome to us to be attacked so frequently.

 

[doc02]

Ha ha, look at Kimberli, she's on her period.

 

[Winged Scapula]

Ha ha, look at Kimberli, she's on her period.

Silly, surgeons don't have periods.

I'm just naturally cranky these days (prolly something about all these new users coming into "our" forum and trying to insult us).😡😡😡😡

 

[doc02]

I'm just naturally cranky these days (prolly something about all these new users coming into "our" forum and trying to insult us).

The questions may be tiresome, but I don't perceive them as insults. If people want NOTES, it'll happen. If GI wants to start doing NOTES, they will at some point. I actually don't mind because the more people get into procedures, the more they'll realize that they'd better be able to do them. People will stop criticizing surgeons for being all anal about technique and they'll have to start doing M&Ms. Basically, everyone will turn into surgeons, whether they want to call themselves something else or not. MWAH HA HA HA HA!!! Also, if the ER calls, I can always refer them to GI and have them give their two-second presentation of nonsense to them. FTW!!!

 

[Castro Viejo]

My comment was a bit curt but this forum has been inundated with threads from users we've never heard of before coming in and asking if "Specialty X is better than Surgery". They all seem to have some underlying motive, which is mostly to bash surgeons and try and convince us that "NOTES/IR/Interventional Cards/etc" are the wave of the future and that open surgery is a dying field. I apologize if this was not your intent, but I'm sure how you can see it would be tiresome to us to be attacked so frequently.

I do have to agree and find this intrusive and annoying.

It seems that the two most recent threads have been started by users who already are leaning toward IM, so why even bother asking the question? Is it just to stir up a hornet's nest? If you guys like medicine, great! Go for it! For most of us here, it wasn't (and will never be) our thing. I don't like it. I never liked it, and can't possibly imagine how you guys survive all that nonsense for so long. But kudos to you!

We'll never agree. So go back to your IM forum and continue discussing the relative benefits of one beta-blocker over another, or which nursing home is the best place for your patients to heal, and we'll stick to discussing how ridiculous the majority of reasons for surgical consults are.

 

[rapid]

Silly, surgeons don't have periods.

I'm just naturally cranky these days (prolly something about all these new users coming into "our" forum and trying to insult us).😡😡😡😡

No one is trying to insult you. All I did was post a few questions and the immediate response was that my inquiries were "tiresome" and that the surgeons will do all the "stuff" in the OR and the "internists" can round on the patients. I do not have a "motive," I was just curious. I also didn't look at your profile carefully and didn't realize you were an attending. In any event, I am a PGY-6 and have some experience under my belt. Sorry if I stirred things up, it certainly was not my intent. By the way, outside of the U.S., GI doctors do perform the NOTES procedures.

 

[rapid]

I do have to agree and find this intrusive and annoying.

It seems that the two most recent threads have been started by users who already are leaning toward IM, so why even bother asking the question? Is it just to stir up a hornet's nest? If you guys like medicine, great! Go for it! For most of us here, it wasn't (and will never be) our thing. I don't like it. I never liked it, and can't possibly imagine how you guys survive all that nonsense for so long. But kudos to you!

We'll never agree. So go back to your IM forum and continue discussing the relative benefits of one beta-blocker over another, or which nursing home is the best place for your patients to heal, and we'll stick to discussing how ridiculous the majority of reasons for surgical consults are.

Wow, you are quite defensive!! I haven't prescribed a beta blocker or arranged nursing home placement in 3 years! I have been busy taking out polyps, treating bleeding ulcers, removing stones from the common bile duct and performing FNA of pancreatic lesions (admittedly, some of these procedures were done on nursing home patients....sorry, I know you don't see those patients as they are all on the medicine service).

 

[Winged Scapula]

No one is trying to insult you.

I wasn't taking it personally nor was my comment meant to be directed at you specifically.

All I did was post a few questions and the immediate response was that my inquiries were "tiresome"

The topic was tiresome not your inquiry. It is basic BB etiquette to either do a search or look for posts on the same topic; its all we ask.

and that the surgeons will do all the "stuff" in the OR and the "internists" can round on the patients.

I think you misinterpreted my response. I never said that internists should only round on patients while surgeons do work in the OR. You asked if surgeons would want to be gastroenterologists and I responded negatively and with some reasons why. Surgeons do round on patients but I think even you would agree that most internists have a higher degree of tolerance for lengthy rounds than surgeons do. And most internists will tell you they have no interest in being a surgeon.

I do not have a "motive," I was just curious. I also didn't look at your profile carefully and didn't realize you were an attending. In any event, I am a PGY-6 and have some experience under my belt. Sorry if I stirred things up, it certainly was not my intent. By the way, outside of the U.S., GI doctors do perform the NOTES procedures.

I apologize if you do not have an ulterior motive and we misinterpreted your actions. However, I am sure you can understand that we might be a little suspicious when in our usually quiet little forum we get 3 fairly new users in as many days asking about "IM specialty X vs Surgery" and all of them seem intent on bashing surgeons or at the very least, crowing about their field and how its taking over surgery. And yes, I am aware that NOTES is being done by gastroenterologists but stlll take issue with your contention that it is the wave of the future.

I still admit to being confused why a GI fellow would be interested in surgeon income, job opportunities, etc and how it compares to GI? We are much better behaved when a user posts something like, "I'm a GI fellow and am starting to look for a job and was discussing opportunities, incomes, hours worked with a surgeon friend of mine. He does a lot of scopes and says that if he didn't have to do IM first, he would have liked GI. What do you guys think?" or something like that.

Most of us who post here have been around SDN for years and we see what these kinds of posts generate. The expected outcome is that someone from IM specialty X who does procdures (ie, Cards, GI) will post about how they trained for less years, work fewer hours and make more money. Basically, implying surgeons are stupid for enduring the training, only to work more, earn less and "do the same thing". Since we understand the unusual attraction of surgery and that we do different things than Cards or GI guys, these types of queries (as in your first post) almost always end up a debacle of insults.

 

[SLUser11]

GI and Surgery have practically nothing to do with one another. They're complimentary fields. It's like we both live in the same neighborhood (the colon), but in different houses. And also in our house there are a lot of hot, naked chicks.

Smartest thing you've ever said.

Wow, you are quite defensive!! I haven't prescribed a beta blocker or arranged nursing home placement in 3 years! I have been busy taking out polyps, treating bleeding ulcers, removing stones from the common bile duct and performing FNA of pancreatic lesions (admittedly, some of these procedures were done on nursing home patients....sorry, I know you don't see those patients as they are all on the medicine service).

Seeing this post and your original post brings it all together. Thanks. "Everybody look at me! I'm doing cool procedures and making a difference! YAY! Let me go start some S#$t on the surgery forums now that I'm such a hero..."

 

[smq123]

How do GI and surgery compare as fields? Specifically in terms of work hours, interesting procedures, job opportunities and salary? Would surgeons rather do GI if they didn't have to get through an internal medicine residency first?

In any event, I am a PGY-6 and have some experience under my belt.

You're a PGY-6, and you still don't have a vague idea of how GI and surgery compare? 😕

 

[doc02]

By the way, outside of the U.S., GI doctors do perform the NOTES procedures.

Yeah, but here in America, we have actual medical care and stuff so people don't have to drag themselves around to random physicians going "can you replace my hip, please?"

 

[doc02]

Smartest thing you've ever said.

Since everything I say is smart, you should instead have worded this "smartest thing anyone has ever said."

 

[Castro Viejo]

Wow, you are quite defensive!! I haven't prescribed a beta blocker or arranged nursing home placement in 3 years! I have been busy taking out polyps, treating bleeding ulcers, removing stones from the common bile duct and performing FNA of pancreatic lesions (admittedly, some of these procedures were done on nursing home patients....sorry, I know you don't see those patients as they are all on the medicine service).

Who's defensive?

All I've read over the last several days are medicine bleeding hearts who try to justify why they're as qualified to do something that they're obviously not qualified to do in the first place! All I've been writing is that you guys don't really belong in the realm of doing invasive things and to do so is irresponsible, unethical, and certainly not in the best interest of patients at all. Or perhaps it's some desire to fulfill your latent dream of being a "surgeon" without putting in the time to train, which is what I truly believe... Oh, and that money thing. That gosh-darn money thing that leads GI docs to think a scope is the be-all and end-all of therapy and that if they can read 70 CT colonographies and have correlative colonoscopies, they'll be as qualified as a radiologist to be a "colonographer." Care about patients my ass.

I know what I can do. I know you will need me. I know your patient will need me. But I don't need you. A surgeon would get along fine without a gastroenterologist or a cardiologist, but tolerate your kind because of some stupid political game you guys like to play. Can you get by in this world without a surgeon to bail you out? Nope. Don't think so.

 

[rapid]

Who's defensive?

All I've read over the last several days are medicine bleeding hearts who try to justify why they're as qualified to do something that they're obviously not qualified to do in the first place! All I've been writing is that you guys don't really belong in the realm of doing invasive things and to do so is irresponsible, unethical, and certainly not in the best interest of patients at all. Or perhaps it's some desire to fulfill your latent dream of being a "surgeon" without putting in the time to train, which is what I truly believe... Oh, and that money thing. That gosh-darn money thing that leads GI docs to think a scope is the be-all and end-all of therapy and that if they can read 70 CT colonographies and have correlative colonoscopies, they'll be as qualified as a radiologist to be a "colonographer." Care about patients my ass.

I know what I can do. I know you will need me. I know your patient will need me. But I don't need you. A surgeon would get along fine without a gastroenterologist or a cardiologist, but tolerate your kind because of some stupid political game you guys like to play. Can you get by in this world without a surgeon to bail you out? Nope. Don't think so.

What hospital do you work at sunshine?? I have a lot of friends who are surgical residents in NYC. You are quite hostile and bitter. I don't want to be a surgeon, sorry to disappoint you. I will also be doing an advanced procedure year (PGY7)....is that enough training for you? Or is it still "unethical" for me to do "invasive procedures?" And you don't need me to stent your bile leaks after cholecystectomies or take out CBD stones (try to get those out in the operating room) or drain pseudocysts so you don't have to take the patient to the OR? Please, think before you write....you are displaying your ignorance.

 

[doc02]

And you don't need me to stent your bile leaks after cholecystectomies or take out CBD stones (try to get those out in the operating room) or drain pseudocysts so you don't have to take the patient to the OR?

Not really, if you don't want to. You're like an appendix. You just happen to be there, so we let you live. Until you act up, then we remove you.

 

[Castro Viejo]

What hospital do you work at sunshine?? I have a lot of friends who are surgical residents in NYC. You are quite hostile and bitter. I don't want to be a surgeon, sorry to disappoint you. I will also be doing an advanced procedure year (PGY7)....is that enough training for you? Or is it still "unethical" for me to do "invasive procedures?" And you don't need me to stent your bile leaks after cholecystectomies or take out CBD stones (try to get those out in the operating room) or drain pseudocysts so you don't have to take the patient to the OR? Please, think before you write....you are displaying your ignorance.

No, it's not enough training. It's not enough training beacuse all the training in the world that you undergo will never equip you to handle the complications of your interventions. Sorry to break it to you. You may not think you want to be a surgeon, but you certainly will try hard to play one in the hospital.

So again, NO, your training isn't enough. And, YES, I believe it's unethical.

As has been explained before on this very thread, you're confusing "need" with "prefer."

I don't NEED you to stent the CBD for my cystic duct leaks after a cholecystectomy, though I would PREFER that you do. I can handle that complication on my own if you went POOF! and were wiped off the face of the Earth.

I don't NEED you to take out my choledocholiths, though I suppose some surgeons would PREFER it. I've done plenty of choledochotomies and explorations to fish out stones. Hell, these are even done laparoscopically on Tuesdays!

I don't NEED you to drain my pseudocysts, thank you very much. I can handle those on my own if I didn't PREFER you to do it.

Perhaps you should read and understand before you write.

 

[SLUser11]

What hospital do you work at sunshine?? I have a lot of friends who are surgical residents in NYC. You are quite hostile and bitter. I don't want to be a surgeon, sorry to disappoint you. I will also be doing an advanced procedure year (PGY7)....is that enough training for you? Or is it still "unethical" for me to do "invasive procedures?" And you don't need me to stent your bile leaks after cholecystectomies or take out CBD stones (try to get those out in the operating room) or drain pseudocysts so you don't have to take the patient to the OR? Please, think before you write....you are displaying your ignorance.

You join SDN and enter the Surgery forums specifically to brag and pick fights, and you're surprised that you're not welcomed warmly.

It's ridiculous to think that surgeons would want to do GI if it didn't involve IM (as your original question asked). The things you get excited about, like polyp removal, managing GI bleeds, etc, I personally find to be really boring and monotonous. In my program, we do a lot of endoscopy, and it gets really old (and easy, btw).

Still, if you love it, more power to you. If I have a CBD stone that's not amenable to laparoscopic extraction, I will need a GI doc to perform the ERCP. If the GI doc finds colon cancer, diverticulitis, refractory GI bleeds, etc, he will need the surgeon to operate.

We all work together, and play a different role in medicine.....unfortunately, yours seems to be the role of the D-bag.......

 

[Leforte]

Man - is it getting hot in here?

All fields rely on each other at times to bail them out, though I do think that GS handles most of their own crap, and that GI will defer to surgery. Personally, I don't think I know of too many GS attendings who want to take care of esophageal bleeds, colon polyps, etc - and are glad that GI does these. At the same time, I can't tell you how many patients have been referred to my ENT clinic from GI for globus sensation from reflux and I am asked to manage their GERD ( I was like WTF?!?! ). Evidently GI wants the $$$ from procedures and is looking to pass off GI medical management. It is an internal medicine subspecialty right?

As an aside, in ENT we are now doing trans-nasal esophagoscopy in the office, and can biopsy any suspicious lesion from the esophagus to the descending duodenum. The patient is fully awake, non-sedated and can drive home. Does this mean I can claim to be as qualified as a Gastroenterologist?

Moreover, If GI does a NOTES procedure and gets a leak, who is going to take care of the patient with peritonitis? I assure you it will not be the GI fellow with his endoscope. Furthermore, I doubt you will be able to be credentialed once you finish your training in these complex procedures unless there is surgery back-up. I have never heard of a surgeon needing GI back-up in order to be credentialed. Something to think about before talking smack in a surgery forum.

 

[doc02]

If GI does a NOTES procedure and gets a leak, who is going to take care of the patient with peritonitis? I assure you it will not be the GI fellow with his endoscope.

I assure you it will be, lol.

 

[rapid]

Ok, Ok, you can all settle down now. You clearly have fragile egos and I will try not to stir things up anymore. One last thing....all those things you can do surgically (CBD stones, psuedocysts, bile leak repair, big polyps)....sure you can do them surgically, but we can do them less invasively, with less morbidity...and that is the direction that medicine/surgery is heading and that is why you guys are being so hostile. It is called insecurity.

 

[Winged Scapula]

Let's remain civil folks and cut out the name calling. Anymore and I'll close this thread because it seems to have served its original purpose.

 

[doc02]

all those things you can do surgically...we can do them less invasively, with less morbidity

This isn't totally true. For example, rather than examining the rectum with a proctoscope, you have opted to insert your entire head for direct vision.

 

[Castro Viejo]

This isn't totally true. For example, rather than examining the rectum with a proctoscope, you have opted to insert your entire head for direct vision.

 

[H_Caulfield]

Rapid, it's okay. It's natural, when you realize that you've made a wrong decision in life, to backstep and try to force-feed your rationalizations regarding how there's not much of a difference between what you're doing and what you should have done to others. I know that you're probably just looking for someone to agree with you, so that you won't have to go on forever wishing you'd chosen surgery. I feel and kinda pity you.

By the way... are we really subjecting a real-life surgeon to this petty, highschool-esque message-board war? Stop it.

 

[dpms]

By the way... are we really subjecting a real-life surgeon to this petty, highschool-esque message-board war? Stop it.

I agree. As a med student I have gotten a ton of information of these boards, which will undoubtedly be beneficial. I would hate to see questions stopped being answered because of this crap...If someone is taking the time to answer your question, don't repay them by acting like a jerk (even if you don't agree). Also, if you are trolling, well, even Misterioso seems to stay on the surgery forum...(don't quite know if that is good or bad.)

 

[Winged Scapula]

As much as we'd love to, we (surgery) cannot lay claim to Misterioso as our own. He is well known on the Anesthesia boards where he raised some fuss last year.

Don't worry...threads like this come and go and those of us that have been around long enough, aren't going anywhere even if we do find these sort of threads tiresome. 😉

 

[SLUser11]

This isn't totally true. For example, rather than examining the rectum with a proctoscope, you have opted to insert your entire head for direct vision.

Zing.

 

[Blade28]

Another day, another surgery vs. IM thread.

👎

 

[doc02]

As much as we'd love to, we (surgery) cannot lay claim to Misterioso as our own.

Don't worry, you've got me instead. And I'm way worse than him. MWAH HA HA HA HA!! *chains K. Cocks to the stove*

 

[H_Caulfield]

Don't worry, you've got me instead. And I'm way worse than him. MWAH HA HA HA HA!! *chains K. Cocks to the stove*

Hey, doc02, to pull off the whole one-sentence-whitty-comment-interspersed-between-real-conversation thing you have to be SMART. Ooh, yea, sorry about that; it looks like you'll have to stop doing it. You know how you can get really embarrassed for someone when they're evidently trying SO hard to pull something off but are clearly just failing? Well you're making me blush and sweat a little; please stop.

Scrolling upward on this thread I see nothing but offensive and inflammatory comments from you. Someone ought to delete this whole thing.

 

[doc02]

you're making me blush and sweat a little

*cough*whatahomo*cough*

 

[Dr. V]

...sure you can do them surgically, but we can do them less invasively, with less morbidity...and that is the direction that medicine/surgery is heading

I don't know about that. We just recently reviewed a few studies in M&M that revealed that CBD exploration and ERCP were about the same in morbidity and actually CBD was a touch better. 😱😱

Whoops, doesn't seem on the surface but after further review EBM says it is so.

 

[doc02]

Hey, doc02, to pull off the whole one-sentence-whitty-comment-interspersed-between-real-conversation thing you have to be SMART. Ooh, yea, sorry about that; it looks like you'll have to stop doing it. You know how you can get really embarrassed for someone when they're evidently trying SO hard to pull something off but are clearly just failing? Well you're making me blush and sweat a little; please stop.

Scrolling upward on this thread I see nothing but offensive and inflammatory comments from you. Someone ought to delete this whole thing.

Sorry, I was just notified that it's OK to make insults as long as they are long and painfully drawn-out, rather than direct and to-the-point, so I'll rephrase my earlier post:

Dear H_Caulfield, I can tell by your handle and the fact that you sport Dr. House as your avatar that you go through life all emo and cutting your wrists and massaging your furrowed brow. Either that, or you're just unimaginative. Either way, I wouldn't stoop so low as to ask you for your literary opinion of my posts. I don't particularly care about your whining embarrassment for me and you should probably go home and tell your mom that a man made you blush and sweat and giggle nervously today and see her reaction. It won't be pride.

 

[Winged Scapula]

Sorry, I was just notified that it's OK to make insults as long as they are long and painfully drawn-out, rather than direct and to-the-point:

You may want to reread your PM warning because me thinks you misinterpreted it. Long and drawn out insults are even worse because I actually have to read them before giving the warning.

Since this thread has served its purpose (and more) I'll close it. Please refrain from posting a plea to reopen this thread.