Proctology

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Why choose any area of medicine?
 
So a random question...why do some people choose this area of medicine?

It's part of GI now. You could ask your question about virtually every area of medicine -- there are unappealling aspects of all parts of the body, particularly when people are unhealthy, and quite a few fields where you are going to be putting scopes in people's existing or newly created orifices. And in many specialties besides GI you are going to have to do digital rectal exams, so if getting involved in that orifice is what's bothering you, your career choices are going to be somewhat limited.
 
Indeed, the Assman plates make it all worthwhile.
 
The Butt Doctor


A man went into the proctologist's office for his first exam. The doctor told him to have a seat in the examination room and that he would be with him in just a few minutes. Well, when the man sat down in the examination room, he noticed that there were three items on a stand next to the doctor's desk: a tube of K-Y jelly, a rubber glove, and a beer.

When the doctor came in, the man said, "Look Doc, this is my first exam... I know what the K-Y is for... and I know what the glove is for...but what's the BEER for?"

At this instant, the doctor became noticeably outraged and stormed over to the door. The doc flung the door open and yelled to his nurse, "Dammit, nurse!!! I said a BUTT LIGHT!!!"


:hardy::meanie:
 
"proctology" really doesn't exist anymore as a specialty. Its either Gastroenterology or Colorectal Surgery.

Either way, many choose the specialty because it reimburses fairly well (esp for GI), has a pretty good lifestyle (most Colorectal Surgeries are elective) and there is a lot of interesting research into the genetics of colorectal diseases. I know of at least one medical student who chose Surgery with a plan for a CRS fellowship because of his own problems with Ulcerative Colitis.

But Law2Doc is right...in every field, there is a bit of unpleasantness. When choosing a specialty you have to decide which grosses you out the least: poop, puke, or mucus...then you have your answer! 😀
 
(most Colorectal Surgeries are elective)

Huh? Maybe you mean elective in the sense that they don't have to be done at 1am, but a huge part of colorectal surgery is oncologic. I doubt all those patients with colon/rectum/anus carcinoma consider their surgery elective.
 
"proctology" really doesn't exist anymore as a specialty. Its either Gastroenterology or Colorectal Surgery.

Either way, many choose the specialty because it reimburses fairly well (esp for GI), has a pretty good lifestyle (most Colorectal Surgeries are elective) and there is a lot of interesting research into the genetics of colorectal diseases. I know of at least one medical student who chose Surgery with a plan for a CRS fellowship because of his own problems with Ulcerative Colitis.

But Law2Doc is right...in every field, there is a bit of unpleasantness. When choosing a specialty you have to decide which grosses you out the least: poop, puke, or mucus...then you have your answer! 😀

Yeah, I think it's more Colorectal Surgery now. Wasn't the "old" "Proctology" a surgical specialty?

Anyway, I did some shadowing in anesthesiology last week and 2 of the procedures were done by Colorectal surgeons. The fellow was a cool dude and commented on how it's getting more competitive as a specialty cause "it's a lifestyle specialty". Anyway, that's what he said.

Also, in all reality, if you think about it, these surgeons help people that are experiencing some rather uncomfortable conditions. It's a pretty important specialty to those who need their services. So, I could see it being pretty rewarding in that respect. Also, in a sterile environment, it really is just another orifice.... lol
 
Huh? Maybe you mean elective in the sense that they don't have to be done at 1am, but a huge part of colorectal surgery is oncologic. I doubt all those patients with colon/rectum/anus carcinoma consider their surgery elective.

You have made the common mistake of confusing the non-surgeon's definition of the term elective with the surgical one. An elective surgery is a planned, non-emergency surgical procedure. It may be either medically required (e.g., for colon cancer or cataract surgery), or optional (e.g., breast augmentation) surgery but is still considered elective.

It doesn't matter whether or not the patient or even the surgeon considers medical management of a surgical disease a "choice" (given the likely outcome of not treating their disease surgically), these are still considered elective surgeries and hence, the better lifestyle for CRS who do not take general surgery call.
 
Yeah, I think it's more Colorectal Surgery now. Wasn't the "old" "Proctology" a surgical specialty?

Typically, although you would have some practitioners who tended to specialize in just office procedures, or the "back 80 cm" calling themselves proctologists as the field focuses on the anus, rectum and perianal areas.

However, come to find out, there is an association for osteopathic physicians, the American Osteopathic College of Proctology, which certifies physicians under their training scheme.

According to their web site: The practice of proctology shall consist of and include the treatment of diseases and conditions originating within or affecting the anus, rectum, perianal and perirectal areas, and related or complicating conditions not including the use of major surgery.
http://www.aocpr.org/HomePage.html

Interesting really, since most other mainstream publications refer to the term "proctology" as a thing of the past. But you learn something new everyday.

Anyway, I did some shadowing in anesthesiology last week and 2 of the procedures were done by Colorectal surgeons. The fellow was a cool dude and commented on how it's getting more competitive as a specialty cause "it's a lifestyle specialty". Anyway, that's what he said.

Its true...during training in general surgery, I knew a number of residents who were drawn to it for its lifestyle or had it suggested to them as a consideration when thinking about fellowships. If you don't take general surgery call, you can really tailor your practice to elective procedures, although some of the patients can be pretty sick post-op, most do quite well.

Also, in all reality, if you think about it, these surgeons help people that are experiencing some rather uncomfortable conditions. It's a pretty important specialty to those who need their services. So, I could see it being pretty rewarding in that respect. Also, in a sterile environment, it really is just another orifice.... lol

Really, a prepped bowel is not very gross. Perianal disease has a bit more "ick" factor for most, especially when using a medieval torture device called the Lone Star retractor (see http://www.avequip.co.uk/images/lonestar.gif - warning graphic photo..although I somewhat suspect that the image of one of a dalmation rather than a human. Either that or the patient has a horribly speckled behind...but you get the idea.)

And there really is something to be said for helping people with diseases that cause a lot of morbidity and mortality, as well as social embarassment.
 
Huh? Maybe you mean elective in the sense that they don't have to be done at 1am, but a huge part of colorectal surgery is oncologic. I doubt all those patients with colon/rectum/anus carcinoma consider their surgery elective.

hell, I want to know what an elective colorectal surgery is.... like anal rejuvenation surgery? :laugh:
 
Lifestyle and pay are big attractants to this one. Sure, it may not seem all that much fun to be back there all day, but some people are less bothered by it and dive into the field (no pun) anyway. Everyone has things that bother them more than others, and in most specialties you are going to have to dabble in lots of areas of the body your didn't previously expect.

It always makes me laugh when I hear younger boys (usually early teens) laugh and joke that it must be SO cool to be an ob/gyn because, like, you stare at p**** all day! How awesome! Sure...not when you set foot in a public, urban teaching hospital and realize that very few, if any, of your patients during that long residency are playboy worthy :laugh:...not to mention that some STD's and other genital infections are the foulest smelling things you can imagine. So in summary, there is something for everybody out there.
 
hell, I want to know what an elective colorectal surgery is.... like anal rejuvenation surgery? :laugh:

Well, I'm not sure what anal rejuvenation would entail but if it exists that would certainly qualify as an elective procedure. However, as I noted above:

in the parlance of surgeons, elective surgery is a planned, non-emergency surgical procedure. It does not involve a decision about whether or not the procedure is medically necessary, recommended or purely aesthetic. It does not factor in whether or not the patient wants it done, whether or not they will die without the procedure, etc. Elective = non-emergency. There are very few emergent colo-rectal procedures save for patients with toxic megacolon or perforation with gross peritonitis (and these are most often managed by general surgeons out in the community). Operations for cancer are not emergencies.

Therefore, elective colorectal surgery could include (note that some of the below can and will be done, at times, as emergent, non-elective procedures):

sigmoid colectomy
ileal-pouch anal anastomosis
hemorroidectomy
lateral internal sphincterotomy
right hemicolectomy
ileostomy/colostomy take-down
total abdominal colectomy with ileostomy
fistulotomy
abdomino-perineal resection
low anterior resection
DeLorme procedure

Etc...sorry to be such a pain in the you-know-what about this, but this is a frequent semantic error that needs to be clarified.
 
in the parlance of surgeons, elective surgery is a planned, non-emergency surgical procedure.

You may very well be correct. Although I've done 6 months on dedicated surgical services as both a student and an intern, and this distinction has never been made. To offer something tangible, at my hospital, the OR schedule only refers to elective (using your definition) surgeries as "routine". "Elective" is reserved for cosmetic surgery or LASIK, etc. Again, I'm not saying you're wrong; I'm just suggesting that the distinction is not as universal as you might think.
 
You may very well be correct. Although I've done 6 months on dedicated surgical services as both a student and an intern, and this distinction has never been made. To offer something tangible, at my hospital, the OR schedule only refers to elective (using your definition) surgeries as "routine". "Elective" is reserved for cosmetic surgery or LASIK, etc. Again, I'm not saying you're wrong; I'm just suggesting that the distinction is not as universal as you might think.

Perhaps not. Although in my many years as a surgical resident, fellow and attending at many different hospitals, this was the way I was taught and it is the parlance that most of my colleagues use (ie, that elective means non-emergent).

As a rule, I have never seen an OR schedule noting whether a procedure is emergency, elective or routine. The list usually just says something like "ex lap" (presumably emergent), ileal pouch anal anastomosis (presumably "routine" or "elective") or bilateral augmentation mammoplasty (presumably elective or cosmetic at your hospital but could be considered reconstructive and not cosmetic). But your hospital may be different and I respect that you may have been taught differently.

Therefore, it seems that we can agree that regardless of the semantics, colorectal surgery is elective or routine most of the time and that gives way to the better lifestyle that its practitioners enjoy.
 
Etc...sorry to be such a pain in the you-know-what about this, but this is a frequent semantic error that needs to be clarified.

Well-explained - and you're right, this is definitely a common area of misunderstanding.

At our level 1 trauma center:

Elective - planned within next 24 hr
Urgent - within next 6 hr
Emergent - within next hr
 
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