the real greys anatomy

[Cmaj7th]

so I've been reading this book called the real greys anatomy, it's a biography about some general surgery residents at OHSU. not very well written but pretty interesting none the less.

anyway the part that has me bothered is a quote from one of the residents when asked about international work. he said "the reason I chose general surgery is because we're the most useful physicians- not only can we operate but we can manage sick patients medically as well."

now I've always admired general surgeons for doing alot of their own medical management but I never thought you could label any one specialty as the most useful. and honestly if I HAD to take one doc with me to a desert island I'd prefer a rural fp who likes to get down and dirty.

is this attitude typical of general surgery residents? does it have any merit or does this guy have his head up his ass?

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[Paseo Del Norte]

Not sure how this applies to EM residency?

I worked with a general surgeon who moonlighted in our ER, he was a fine doc and I enjoyed working with him and IMHO his medical management was great. I also worked ER with a thoracic surgeon who was great. Neither had anything negative to say about their FP, IM and EM counterparts. My best ER experiences as far as fast, efficient care has been with EM physicians. Take may statements for what they are worth however.

Overseas, the best docs I ever worked with were South African casualty physicians. The main reason being, they were very efficient at packaging and working with the equipment. I had a flight or two with a FP doc who specialised in African OB patients. He was a great guy and I loved him to death; however, when we flew I had to do the packaging, work and programme the infusion devices and monitors and manage the ventilator. However, these are pretty much monkey skills and he caught on pretty quickly.

 

[gutonc]

is this attitude typical of general surgery residents? does it have any merit or does this guy have his head up his ass?

Yes and no, yes and no, definitely. In that order.

And why in the name of FSM did you post this in the EM forum?

 

[deleted65604]

General surgeons are vital. They are also very hard to train and recruit. In my small community, we had two general surgeons when I moved here 2 years ago. The hospital recruited a third right out of residency and one of the old grey haired surgeons retired. The new surgeon sucked at laparoscopy, had a few bad complications, and got run out of town. The hospital recruited a second surgeon who had been practicing for a few years, who had some bad patient complications (and was a first class jerk). He got run out of town as well.

So, for a few weeks, I had the misfortune of having to transfer out basic bread and butter cases because we had no surgeon on call (our administration arranged this with another hospital). Imagine how embarassing it is for an administration to have to admit to the public that we can't take care of an appendicitis case.

General surgery is not very competitive, because it is grueling, long, and demoralizing. A lot of applicants going into the specialty are the dregs of med school (and a lot are rock-stars). Combine the poor applicant with work-hour restrictions that limit exposure to basic bread and butter gall-bladder, appendectomy, bowel surgery, etc. and you have a real problem with producing consistently good surgeons.

I would say without hesitation, that a good general surgeon is the most valuable person in a hospital. I say this because they are indispensible for patient care, they bring in a lot of revenue for the hospital, they form a core pillar for a hospital's reputation, and when you have a shattered liver/spleen laceration that is too critical to transfer and needs emergent laparotomy, you'll want them at the bedside.

If I had to pick a single specialty to staff a rural hospital with, I'd pick a general surgeon. You can always tell a surgeon how to manage a medical problem, you can't teach an internal medicine doctor how to do emergent surgery.

 

[ncguy2005]

General surgeons are vital. They are also very hard to train and recruit. In my small community, we had two general surgeons when I moved here 2 years ago. The hospital recruited a third right out of residency and one of the old grey haired surgeons retired. The new surgeon sucked at laparoscopy, had a few bad complications, and got run out of town. The hospital recruited a second surgeon who had been practicing for a few years, who had some bad patient complications (and was a first class jerk). He got run out of town as well.

So, for a few weeks, I had the misfortune of having to transfer out basic bread and butter cases because we had no surgeon on call (our administration arranged this with another hospital). Imagine how embarassing it is for an administration to have to admit to the public that we can't take care of an appendicitis case.

General surgery is not very competitive, because it is grueling, long, and demoralizing. A lot of applicants going into the specialty are the dregs of med school (and a lot are rock-stars). Combine the poor applicant with work-hour restrictions that limit exposure to basic bread and butter gall-bladder, appendectomy, bowel surgery, etc. and you have a real problem with producing consistently good surgeons.

I would say without hesitation, that a good general surgeon is the most valuable person in a hospital. I say this because they are indispensible for patient care, they bring in a lot of revenue for the hospital, they form a core pillar for a hospital's reputation, and when you have a shattered liver/spleen laceration that is too critical to transfer and needs emergent laparotomy, you'll want them at the bedside.

If I had to pick a single specialty to staff a rural hospital with, I'd pick a general surgeon. You can always tell a surgeon how to manage a medical problem, you can't teach an internal medicine doctor how to do emergent surgery.

Amen to that last part.... if there isn't a surgeon you may have to wait out on a stretcher in the rain while the paramedics look for the key to the ambulance so they can transfer you downtown... Its not fun to get rained on when you have a grade IV spleen laceration...

 

[Cmaj7th]

this has no relevance to emergency medicine at all. I just prefer the responses from ER trained physicians on this site because they seem the most laid back.

 

[dchristismi]

Yes and no, yes and no, definitely. In that order.

And why in the name of FSM did you post this in the EM forum?

I just have to say that I've never invoked the FSM like that before, but LOVE it.

RAmen.

Carry on.
D

 

[BlondeDocteur]

If I had to pick a single specialty to staff a rural hospital with, I'd pick a general surgeon. You can always tell a surgeon how to manage a medical problem, you can't teach an internal medicine doctor how to do emergent surgery.

That's a notion a lot of surgery people in international health have. There's a lot of hubris behind it, but they basically feel that anyone who went to medical school can run a clinic (I know I know I KNOW), but you can only treat the huge spectrum of surgical disease-- including surgical management of labor-- if you're a surgeon. Therefore they reason that they're the most useful doc overseas in an isolated, solo setting.