- Joined
- Apr 14, 2006
- Messages
- 26
- Reaction score
- 0
Bobby,
Have you even thought about what you suggested? No, the Le article is not prospective, randomized, double-blind, and the response rate/quality is certainly questionable. You try to insult me for suggesting some background reading (which based on the way you were talking, seemed well-justified) instead of taking a step back, having a little breather, and reminding yourself of the original issues at the root of this debate. To summarize, OMFS is an emerging specialty; there are many, many driven individuals who are willing to sacrafice the entirety of their adult lives to surgical training. Over time, boredom sets in and the need for professional progression and expansion ensues: what you call "arrogance" and desire to "prove something" is what, I would argue, is how the enthusiasm and excitement of an emerging specialty manifests itself. These guys are driven to do trachs. So what. Fifteen years ago, when resedencies were two-three years, their predecessors didn't even have those opportunities. They've got a right to be excited, and as I see it, they've got a right to show that they can manage those cases to the previously established standard of care (set forth by many generations of territorial knife-jockeys like yourself). Seriously. Take a step back and look at what we do: we're surgeons. We're the monkeys of the medical community; all of us - whether it's ENT, plastics, or OMFS. You say cut, we think for a bit and weigh the options, and then we cut. It would be at least halfway comprehensible if some endocrinology fellow got on here and started calling us a bunch of flint-stone wielding cavemen, but to hear it from someone who's allegedly within that circle of surgery just doesn't make sense.
No matter what kind of surgeon you are, or aspire to be, you're still a surgeon and for the most part, that's still a very, very primitive way to cure disease. Don't get me wrong, I love what I'm getting into, but I also like to believe that I'm a little more grounded than you. The next time you swing a scalp flap, pec flap, and RFFF to close up some gnarly ablative cancer defect, take a step back and look at that final product and tell me there's not a thousand people around the country doing the same thing. That little pearl of medical knowledge you guard so dear is really common knowledge; anyone can be trained to do it, even a "dentist." ENT and plastics are more established specialties; no question. The history, tradition, and literature is much deeper than OMFS. To carry out a RCT on the subject you suggest is pointless, unless your point indeed is to "prove" who handles procedure X better. As a whole, a greater percentage of ENTs are "better" with the acute airway; as a whole, a greater percentage of plastics are "better" managing the SMAS, and yes, as a whole, it's reasonable to assume that a greater percentage of OMFS is probably "better" with orthognathics and mandibular trauma. Those are all reasonable hypotheses. The thing this multi-center RCT (aka. professional jihad) of yours won't tell you about are the outliers, the "trend-setters" who are paving the way for progression within their field. As an example, the chairman where I'm going is probably as (or more) competent in thyroid surgery than many ENTs (mainly the one's who've been rendered to the mundanes of otology). Somewhere out there, I imagine there's a plastic surgeon, a good one, who's learned to incorporate orthognathics into his rhinoplasty cases. Likewise, there's probably a handful of ENTs who manage cleft lip/palate as well, or better than any OMFS, despite not having the word "oral" anywhere in their professional title. The Le study is not perfect and most literature is garbage, but it's a good starting point. You, of all people, should appreciate how difficult it is to conduct a multicenter RCT. Any review board is going to laugh at you for trying to start a study like that de novo; and for what reason... to satiate your fragile professional ego. Bottom line, we're all doing the same procedures and we all have the same access to the literature. Nothing within the realm of surgery is that difficult; it just takes some experience, and we're all more than capable of performing each other's jobs. Just focus on what you do; enjoy your time doing it, and more importantly, enjoy you're time when you're not doing it. Getting all caught up in this garbage is a waste of everyone's time. If feel bad for all you white-coats who walk big and talk big like your some sort of gift to the common-man. Truth is, the moment one of us surgeons retires (or expires), there's a line of residents waiting to fill the void and nobody will miss us when we're gone.
What makes you so special (as an individual or a discipline)?
Keep it real! Booyakasha!
And PS... you seem quick to jump on reseach biases, but you've continued to evade informing us of your own personal biases: again, what specialty do you belong to and where do you train? It is a fair and reasonable quesiton.
Have you even thought about what you suggested? No, the Le article is not prospective, randomized, double-blind, and the response rate/quality is certainly questionable. You try to insult me for suggesting some background reading (which based on the way you were talking, seemed well-justified) instead of taking a step back, having a little breather, and reminding yourself of the original issues at the root of this debate. To summarize, OMFS is an emerging specialty; there are many, many driven individuals who are willing to sacrafice the entirety of their adult lives to surgical training. Over time, boredom sets in and the need for professional progression and expansion ensues: what you call "arrogance" and desire to "prove something" is what, I would argue, is how the enthusiasm and excitement of an emerging specialty manifests itself. These guys are driven to do trachs. So what. Fifteen years ago, when resedencies were two-three years, their predecessors didn't even have those opportunities. They've got a right to be excited, and as I see it, they've got a right to show that they can manage those cases to the previously established standard of care (set forth by many generations of territorial knife-jockeys like yourself). Seriously. Take a step back and look at what we do: we're surgeons. We're the monkeys of the medical community; all of us - whether it's ENT, plastics, or OMFS. You say cut, we think for a bit and weigh the options, and then we cut. It would be at least halfway comprehensible if some endocrinology fellow got on here and started calling us a bunch of flint-stone wielding cavemen, but to hear it from someone who's allegedly within that circle of surgery just doesn't make sense.
No matter what kind of surgeon you are, or aspire to be, you're still a surgeon and for the most part, that's still a very, very primitive way to cure disease. Don't get me wrong, I love what I'm getting into, but I also like to believe that I'm a little more grounded than you. The next time you swing a scalp flap, pec flap, and RFFF to close up some gnarly ablative cancer defect, take a step back and look at that final product and tell me there's not a thousand people around the country doing the same thing. That little pearl of medical knowledge you guard so dear is really common knowledge; anyone can be trained to do it, even a "dentist." ENT and plastics are more established specialties; no question. The history, tradition, and literature is much deeper than OMFS. To carry out a RCT on the subject you suggest is pointless, unless your point indeed is to "prove" who handles procedure X better. As a whole, a greater percentage of ENTs are "better" with the acute airway; as a whole, a greater percentage of plastics are "better" managing the SMAS, and yes, as a whole, it's reasonable to assume that a greater percentage of OMFS is probably "better" with orthognathics and mandibular trauma. Those are all reasonable hypotheses. The thing this multi-center RCT (aka. professional jihad) of yours won't tell you about are the outliers, the "trend-setters" who are paving the way for progression within their field. As an example, the chairman where I'm going is probably as (or more) competent in thyroid surgery than many ENTs (mainly the one's who've been rendered to the mundanes of otology). Somewhere out there, I imagine there's a plastic surgeon, a good one, who's learned to incorporate orthognathics into his rhinoplasty cases. Likewise, there's probably a handful of ENTs who manage cleft lip/palate as well, or better than any OMFS, despite not having the word "oral" anywhere in their professional title. The Le study is not perfect and most literature is garbage, but it's a good starting point. You, of all people, should appreciate how difficult it is to conduct a multicenter RCT. Any review board is going to laugh at you for trying to start a study like that de novo; and for what reason... to satiate your fragile professional ego. Bottom line, we're all doing the same procedures and we all have the same access to the literature. Nothing within the realm of surgery is that difficult; it just takes some experience, and we're all more than capable of performing each other's jobs. Just focus on what you do; enjoy your time doing it, and more importantly, enjoy you're time when you're not doing it. Getting all caught up in this garbage is a waste of everyone's time. If feel bad for all you white-coats who walk big and talk big like your some sort of gift to the common-man. Truth is, the moment one of us surgeons retires (or expires), there's a line of residents waiting to fill the void and nobody will miss us when we're gone.
What makes you so special (as an individual or a discipline)?
Keep it real! Booyakasha!
And PS... you seem quick to jump on reseach biases, but you've continued to evade informing us of your own personal biases: again, what specialty do you belong to and where do you train? It is a fair and reasonable quesiton.