lifestyle of a vascular surgeon

[beaverfetus]

Castro:

Would you comment on your patients? Do you find satisfaction in offering some amount of longitudinal care to your patients as their vascular disease progresses? Are your patients generally appreciative of your care? Do you feel like you make a long term impact on the survival and function of your patients despite the progressive nature of vascular disease?

Is it true your patients are the sickest in the hospital barring liver tx recipients? How often is there a really critical situation in the OR e.g. patient crashing, stroking, dying on the table?


Take a crack at any you feel like answering,
Thanks in advance

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[LadyWolverine]

Some interesting comments on here about patients. It seems like transplant / cardio / vascular patients are considered to be the worst - they are either alcoholics or obese diabetics, neither of which lends itself greatly to compliance with the doctors orders. Do you think these are really the fields with the worst patients, i.e., do you think endocrine/minimally invasive or ortho/neuro/ENT patients are better to work with? How much would you consider the patient population as a factor in you decision of residency/fellowship?

I think about this a lot. A LOT. I get very...passionate?...about people who make poor lifestyle/health choices and then want their doctor and their insurer/Uncle Sam to spare no expense in fixing them. All the while, the non-smoking, health-conscious, responsible consumer gets screwed with higher insurance premiums and more taxes. (Please spare me the bleeding heart lecture about lacking empathy/addiction/tobacco advertising/add your favorite blame-game excuse here).

How would I justify such a career to myself? Would I find it personally satisfying? Professionally satisfying?

 

[Blue Rover]

Castro hasn't had a chance to respond to this yet, so I'll give it a shot.

Yes, I find satisfaction in offering longitudinal care to vascular patients as their vascular disease progresses. I prefer to see them in the outpatient setting, but it is true that they often are re-admitted with acute complaints. When they do, we are the best ones to help them out

Yes, I find that vascular patients are appreciative of our care. We often intervene on patients that are actively symptomatic, especially those with lower extremity ischemia. If we can alleviate their pain or improve their lifestyle, they tend to be grateful. The ungrateful patient is memorable, but thankfully rare.

Yes, I think that we make a meaningful impact on the survival and function of vascular patients despite the progressive nature of vascular disease. Long term is relative. As Keynes put it, "In the long run we are all dead." All survival curves will eventually reach 0%, no matter what interventions are performed. All we can do is slow that down, and there is good evidence that many vascular surgery interventions do exactly that. In the meantime, these patients have extended use of their extremities, or extra years to see their children and grandchildren. I honestly think we do good work.

I no longer think that vascular patients are the sickest in the hospital. Liver transplant patients and abdominal surgical oncology patients are clearly much sicker. Vascular patients have 3 other problems beside their vascular disease: cardiac, renal, and sometimes pulmonary. The solutions are straightforward: b-blockade, fluid and electrolyte management, and oxygen. I admit, this is a little glib, but rarely is there a concomitant GI issue, which can easily double the management workload. We don't need to keep track of drains with variously colored (and odored) bodily fluids, and I have never seen a purely vascular patient turn bright yellow and die bleeding from every orifice.

Really critical situations in the OR (e.g., patient crashing, dying on the table) occur all the time. However, these critical situations usually involve massive hemorrhage, and the vascular surgeon is uniquely qualified to manage that problem. Often we are called to help other surgeons with massive bleeding, and we can turn a very exciting and out-of-control situation into a very boring and easily managed situation with the proper application of pressure and 6-0 sutures.

Vascular surgery is not for thrill seekers. If you get an adrenaline rush, you need to calm down; otherwise you'll break the stitch.

Vascular surgery is also for those that appreciate long-term patient relationships and fine, technical detail. It's a good field, and I encourage students and residents to look into it.

Castro:

Would you comment on your patients? Do you find satisfaction in offering some amount of longitudinal care to your patients as their vascular disease progresses? Are your patients generally appreciative of your care? Do you feel like you make a long term impact on the survival and function of your patients despite the progressive nature of vascular disease?

Is it true your patients are the sickest in the hospital barring liver tx recipients? How often is there a really critical situation in the OR e.g. patient crashing, stroking, dying on the table?


Take a crack at any you feel like answering,
Thanks in advance

 

[Castro Viejo]

Would you comment on your patients? Do you find satisfaction in offering some amount of longitudinal care to your patients as their vascular disease progresses? Are your patients generally appreciative of your care? Do you feel like you make a long term impact on the survival and function of your patients despite the progressive nature of vascular disease?

There's a baseline level of frustration that you have to deal with in vascular surgery, and it sort of becomes background noise after a while. You come to expect that some of your patients will turn over a new leaf because of what you've told them about losing a limb or the need for a big whack to fix an aneurysm, and that other patients will continue doing the absolute wrong thing (e.g., smoking) as if to test your limits.

Vascular patients also have their own baseline level of frustration over their addiction to poor lifestyle choices, and I think that sometimes comes out during an office visit. As you build a relationship with your patients, though, the majority of them do seem rather appreciative of whatever you can do. They'll even understand, sometimes, the need for an amputation and often say they saw it coming for years -- as if acknowledging the fact that they brought it on themselves.

Do vascular surgeons make an impact in patient survival? Of course, if you believe the literature.

Is it true your patients are the sickest in the hospital barring liver tx recipients? How often is there a really critical situation in the OR e.g. patient crashing, stroking, dying on the table?

With an ever expanding number of patients eligible for endovascular interventions to fix what previously were issues that were the realm of the operating room, fewer vascular patients take up space in the SICU and they typically aren't as sick as they were 20 years ago. Still, patients undergoing open aneurysm repairs, complex mesenteric reconstructions, and even uber long infrainguinal revascularizations can be very sick.

Still not as sick as cardiac and other transplant patients... And not as sick as the multiply injured trauma patient...

Critical situations in the operating room don't happen electively. Many vascular issues remain elective cases that can undergo proper preoperative planning to avoid "critical situations." Patients really shouldn't be coding, whether they're vascular patients or transplant patients. Trauma patients and ruptured aneurysms are probably the patients that are most prone to crapping out on the table though.