My thoughts on general surgery

[seelee]

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I don't usually like to knock other specialties as it normally smacks of elitism and jealousy. Buuuuut, I overheard one of the surgical residents say something so outrageously boneheaded that I had to rush right over to the interwebz and bitch about it.

I overheard a surgery resident gripe about being on infectious disease and rounding for 3-4 hours. "They take all day to do what we do in 30 minutes" he said. Everyone around him started nodding in agreement and patting themselves on the back for their mastery of medicine and how efficient they were.

Never mind how surgical patients are the least complicated patients ever, and when they are complicated, surgery rushes to consult medicine.

 

[MeRLin443]

I don't usually like to knock other specialties as it normally smacks of elitism and jealousy. Buuuuut, I overheard one of the surgical residents say something so outrageously boneheaded that I had to rush right over to the interwebz and bitch about it.

I overheard a surgery resident gripe about being on infectious disease and rounding for 3-4 hours. "They take all day to do what we do in 30 minutes" he said. Everyone around him started nodding in agreement and patting themselves on the back for their mastery of medicine and how efficient they were.

If you don't think that medicine rounds take way too long 90% of the time, then I can find a room full of internists and internal residents who will attest to the same thing.

Never mind how surgical patients are the least complicated patients ever, and when they are complicated, surgery rushes to consult medicine.

Tell the trauma, hpb, vascular, colorectal, and transplant surgeon how easy their patients are to manage, and how they obviously are "the least complicated patients eva!!" because those surgical patients never have any comorbidities.

 

[seelee]

If you don't think that medicine rounds take way too long 90% of the time, then I can find a room full of internists and internal residents who will attest to the same thing.

Tell the trauma, hpb, vascular, colorectal, and transplant surgeon how easy their patients are to manage, and how they obviously are "the least complicated patients eva!!" because those surgical patients never have any comorbidities.

Yeah, i med rounds take a long time. I am not refuting that. They could probably be done faster (and do when teaching isn't a concern). Regardless, to assume that the difference in time between surg and imed rounds can be chalked up to "efficiency" is insanely short sighted.

If you are only looking at the surgical issues surgery patients ARE less complicated. When surgery patients do have comorbidities, medicine is almost always consulted.

I am not arguing that i med is better. I am just blowing off steam about the arrogance among surgeons.

 

[Rendar5]

Yeah, i med rounds take a long time. I am not refuting that. They could probably be done faster (and do when teaching isn't a concern). Regardless, to assume that the difference in time between surg and imed rounds can be chalked up to "efficiency" is insanely short sighted.

If you are only looking at the surgical issues surgery patients ARE less complicated. When surgery patients do have comorbidities, medicine is almost always consulted.

I am not arguing that i med is better. I am just blowing off steam about the arrogance among surgeons.

Having had to rotate in the SICU and the MICU during my residency, sick surgical patients are not less complicated than sick medical patients, medicine rarely has to be consulted on a sick surgical patient, and it should not take more than a half hour per patient to decide the antibiotic.

Medical consults on surgical patients are to ensure that care is not screwed up by someone who doesn't do something every day (like a CP work-up, COPD management), just as surgical consults on medical patients accomplish the same thing.

All I can say is thank god I'm neither, rounding kills me🙂

 

[45408]

If you are only looking at the surgical issues surgery patients ARE less complicated. When surgery patients do have comorbidities, medicine is almost always consulted.

Speaking of outrageously boneheaded...

We almost never consult medicine, and we can certainly go head-to-head with "who's got the most co-morbidities???" list with the medicine crew. That old lady with syncopal episodes from her bradycardia? She falls down the stairs and comes in as a trauma. The bad alcoholic with pancreatitis? The fluid collection just got infected, and now he needs a debridement.

Or any vascular/transplant patient, ever.

 

[mandinca]

Now granted, I'm biased b/c I want to be a general surgeon, BUT that being said, IM rounds were SUCH a drag. I totally get what the surgical resident is saying. On IM rounds, you walk slow, talk slow, cover EVERYTHING slowly, then move on. That whole "mental masturbation" thing grated on my nerves. With surgical rounds: you move fast (b/c you have to get to clinic or the OR), hit the important stuff, then move on...QUICKLY. I can dig it ;-)

 

[duckie99]

The length of rounds in any field is very attending dependent. The longest rounds of my 3rd year were on my general surgery service. Our census was about 15-20 patients (same as medicine) but no way rounds would be less than 4-5 hours. And clinic days were even worse. Always 2-3 hours behind schedule. It was brutal. Also these patients had some pretty bad issues but it honestly wasn't something that needed to take that long.

The shortest easiest rounds of my third year were on medicine, go figure. We just table rounded and it took max 2 hours with 20 patients with complicated social issues and medical problems.

When it comes to rounding in teaching hospitals you have to remember that residents and students are there to learn and it is the attending's responsibility to teach. Good attendings find a balance. I found on medicine that teaching occurs on rounds and at the bedside. Never got any teaching on surgery aside from random pimp questions. Surgery rounds were purely devoted to working and they still took over 4 hours.

Just remember that when you are all done with training and out on your own you set your own pace. I personally like to work at an efficient pace but didn't really complain too much about the length of rounds because I know as a student I don't know ****. As an attending I'll work quick but will not ever short change a patient's case like I feel some docs do for the sake of rounding quickly.

 

[SLUser11]

Never mind how surgical patients are the least complicated patients ever, and when they are complicated, surgery rushes to consult medicine.

Yeah, i med rounds take a long time. I am not refuting that. They could probably be done faster (and do when teaching isn't a concern). Regardless, to assume that the difference in time between surg and imed rounds can be chalked up to "efficiency" is insanely short sighted.

If you are only looking at the surgical issues surgery patients ARE less complicated. When surgery patients do have comorbidities, medicine is almost always consulted.

I am not arguing that i med is better. I am just blowing off steam about the arrogance among surgeons.

I can understand your frustration. Sometimes the gigantic egos in surgery are difficult to absorb.

However, your comments are, as you put it, "insanely short-sighted." You've only experienced a small fraction of how surgeons behave. As Prowler pointed out, most surgery training programs manage their patients' medical issues, and rarely consult medicine. Surgery patients can also be extremely complicated, with all the comorbidities and medical issues of a medical patient....but then you add the stress of a major surgery.

I agree that the resident you overheard was being ignorant, but you are no better with your online rant. People who routinely makes blanket statements to insult an entire specialty end up looking like "boneheads."

 

[45408]

I would like to amend my original comment though. The average patient on a general surgery service has fewer medical co-morbidities than the average patient on a medical service. That's simply by design. If a patient has bad lungs/kidneys/heart, then we try to operate as rarely as possible on these patients. We'll exhaust our medical options and/or tell them that the risk:benefit ratio simply doesn't favor this operation. If they're sick enough to be on a medical service, then they probably wouldn't do well with an operation, except for an emergency.

However, when things really hit the fan, and someone has an MI and requires an emergent CABG, and then they subsequently develop ischemic bowel because their heart wasn't perfusing for some period of time, then I think that patient is easily in the running for "the sickest patient in the hospital."

I do still think that vascular patients (at a tertiary center like ours) are probably sicker than most medical patients. They all tend to have bad hearts, lungs and kidneys, because they smoked for 100 pack years in order to develop their bad vascular disease, and they took most of their other organ systems with it.

 

[seelee]

Very well. Point conceded.

 

[mimelim]

Never mind how surgical patients are the least complicated patients ever, and when they are complicated, surgery rushes to consult medicine.

How can you possibly call someone boneheaded and make a comment like this? Even if it were true, which it isn't remotely, saying it is rather boneheaded.