Surgical specialties and attending life

[bertino]

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So i wanted to ask .....
1- to what degree do surgical specialties come with stress ? Will it affect my mental health ? I can endure the hours for five years but i have no clue how is it to have patients with complications when you are attending . Aiming for small private practice. I like surgery but what if my life is ruined ... lol
2- senior attendings , have you felt at a later stage on life the desire to cut down on operating time ?

 

[DrOwnage]

Medicine is not a specialty for someone without mental fortitude. No matter what specialty you will face mental hardship. If you want less you could always go into pathology.

 

[Iamnew2]

Medicine is not a specialty for someone without mental fortitude. No matter what specialty you will face mental hardship. If you want less you could always go into pathology.

isn't that the truth!

 

[LucidSplash]

So i wanted to ask .....
1- to what degree do surgical specialties come with stress ? Will it affect my mental health ? I can endure the hours for five years but i have no clue how is it to have patients with complications when you are attending . Aiming for small private practice. I like surgery but what if my life is ruined ... lol
2- senior attendings , have you felt at a later stage on life the desire to cut down on operating time ?

I’m a junior attending who only wants more OR time so can’t reply to #2.
But as far as #1, no one can really answer this for you. Everyone’s threshold is different, including mental health. In my first 18 months in practice my experience is that my anxiety about surgical decisions is much higher than as a trainee because now it is actually MY decision. I love what I do but it is not for the faint of heart. But my particular surgical specialty is one of high acuity patients with lots of complication risk. There are other surgical specialties with lower acuity that are probably less stressful in this way, but there will still be that element.

 

[Iamnew2]

I’m a junior attending who only wants more OR time so can’t reply to #2.
But as far as #1, no one can really answer this for you. Everyone’s threshold is different, including mental health. In my first 18 months in practice my experience is that my anxiety about surgical decisions is much higher than as a trainee because now it is actually MY decision. I love what I do but it is not for the faint of heart. But my particular surgical specialty is one of high acuity patients with lots of complication risk. There are other surgical specialties with lower acuity that are probably less stressful in this way, but there will still be that element.

I am not in surgery but do agree from a procedural standpoint that after residency/fellowship the anxiety is higher because you are the ultimate decision maker and the buck stops with you.

 

[bertino]

I’m a junior attending who only wants more OR time so can’t reply to #2.
But as far as #1, no one can really answer this for you. Everyone’s threshold is different, including mental health. In my first 18 months in practice my experience is that my anxiety about surgical decisions is much higher than as a trainee because now it is actually MY decision. I love what I do but it is not for the faint of heart. But my particular surgical specialty is one of high acuity patients with lots of complication risk. There are other surgical specialties with lower acuity that are probably less stressful in this way, but there will still be that element.

You are right. It varies from person to person. But i was just hoping to get an idea. I can see the stress can be slightly higher at attending level. I think without stress there can not be a strive for progress. So it might be a good thing

I’m a junior attending who only wants more OR time so can’t reply to #2.
But as far as #1, no one can really answer this for you. Everyone’s threshold is different, including mental health. In my first 18 months in practice my experience is that my anxiety about surgical decisions is much higher than as a trainee because now it is actually MY decision. I love what I do but it is not for the faint of heart. But my particular surgical specialty is one of high acuity patients with lots of complication risk. There are other surgical specialties with lower acuity that are probably less stressful in this way, but there will still be that element.

now if a patient comes in with respiratory distress or status asthmaticus, or poisoning , is that much less stressful than , lets say, post operative patient in shock or sepsis ?

 

[Dr.LeoSpaceman]

now if a patient comes in with respiratory distress or status asthmaticus, or poisoning , is that much less stressful than , lets say, post operative patient in shock or sepsis ?

I'd say yes, but others' mileage may vary. There's the pressure and stress to "figure it out" and "save" the person in both situations. Surgical subspecialties can compund that by having it be a situation where you "caused" the problem (whether avoidable or not). The pressure to figure things out, and the potential guilt associated with feeling like you hurt your patient, can weigh pretty heavily.

All that being said, if people don't feel some level of anxiety/concern, they probably shouldn't be doing it. The key is getting to a place where it's manageable and doesn't interfere with your life (both in and out of the hospital).

 

[bertino]

I'd say yes, but others' mileage may vary. There's the pressure and stress to "figure it out" and "save" the person in both situations. Surgical subspecialties can compund that by having it be a situation where you "caused" the problem (whether avoidable or not). The pressure to figure things out, and the potential guilt associated with feeling like you hurt your patient, can weigh pretty heavily.

All that being said, if people don't feel some level of anxiety/concern, they probably shouldn't be doing it. The key is getting to a place where it's manageable and doesn't interfere with your life (both in and out of the hospital).

you are right. surgical intervention has the added pressure of iatrogenic complication. and i agree the stress arises from our desire to be excellent and it is necessary for improvement . part of me just wants to make a decision and chose surgery. and hope all goes well

 

[gudog]

So i wanted to ask .....
1- to what degree do surgical specialties come with stress ? Will it affect my mental health ? I can endure the hours for five years but i have no clue how is it to have patients with complications when you are attending . Aiming for small private practice. I like surgery but what if my life is ruined ... lol
2- senior attendings , have you felt at a later stage on life the desire to cut down on operating time ?

1 - stress is unavoidable with any surgical specialty - some handle it well, some not so much
2 - not cutting down on time doing procedures, but (in my case anyway - 30 years in) have lost some interest in doing multi-hour cases - leave those to the youngsters - I will never forget an attending in training who said he disliked any procedure that lasted over one hour or one you couldn't do sitting down

 

[anonperson]

So i wanted to ask .....
1- to what degree do surgical specialties come with stress ? Will it affect my mental health ? I can endure the hours for five years but i have no clue how is it to have patients with complications when you are attending . Aiming for small private practice. I like surgery but what if my life is ruined ... lol
2- senior attendings , have you felt at a later stage on life the desire to cut down on operating time ?

I am in a procedural speciality (Obgyn with fellowship training) so I operate a decent bit.

There are 2 main issues with a procedural specialty in my mind:

1. Knowing when to operate and when not to operate. This is the mental/knowledge aspect of your specialty. This is very important and your decision making process is very important to avoid unnecessary harm to patients.

2. The technical side of things. Can you technically do the surgery/procedure? This is related to knowledge of anatomy, practice etc. Sure, you can make the right call to operate but if you tag a ureter or perforate the bowel during a hysterectomy, then there is an issue.

Complications come with the territory. Anytime you cut a patient, prescribe something, etc there will be complications. You cannot avoid this. What you can do is minimize risk: be appropriately cautious, improve your technical skills and knowledge base.

I have had a few complications in the past 3 years. Nothing too crazy. One I am still dealing with the after effects (legally) but I know I made the right call etc.

Complications bother me but I understand they come with the territory.