who is surgery for?

[docmemi]

so i hear surgery isnt for everyone.
what type of person is surgery for in your opinion?
also, i heard the surgery rotation is hard core. whats so hard core about it?
another thing i heard is that surgeons need to be strong and powerful and active. in other words, no lazy people or wussies. do you agree?

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[fourthyear]

yep, agree with all that. Lazy people won't enjoy a surgery residency. Laid back is okay to a certain extent, in that calmness and control is often a better way to handle a stressful situation than getting all strung out (but there are plenty of high strung personalities in surgery too), but being a hard worker who never tires (or at least never admits to being tired) is mandatory to do well in surgery residency.

Why is it so "hard core"? We are the only residency that takes call every month all 5 years vs. medicine/peds/etc where there are a ceratin amount of "outpatient" months where there is only clinic and no call. We are the only residency that covers floorwork, consults, outpatient clinics, and ICU patients all at once with the same team of residents covering all that. And, oh, yeah, there's the OR too, which is where you'll want to spend as much time as you can.

So how can you spend a good part of your day in the OR and still cover consults, clinics, patients on the floors and/or ICU's? - get in early and run your ass off all day. With the 80 hour week there's even more cross-coverage than before, so that, while it's nice to leave early post-call, someone else will need to leave post-call tommorrow and you'll have to likely cover for the work they would normally do while they are gone.

Forgot to mention that, although as you can tell we still do work pretty hard, most attendings and even senior residents know a system where they worked harder (pre-80 hours) so you'll always hear about how easy you have it now -yep, no room for whiners here.

But, we have fun, we like doing surgery, we like learning all that we learn by working hard and taking care of so many patients. So if you're a high energy person who likes to constantly be challenged, surgery may be just right for you.

 

[docmemi]

yep, agree with all that. Lazy people won't enjoy a surgery residency. Laid back is okay to a certain extent, in that calmness and control is often a better way to handle a stressful situation than getting all strung out (but there are plenty of high strung personalities in surgery too), but being a hard worker who never tires (or at least never admits to being tired) is mandatory to do well in surgery residency.

Why is it so "hard core"? We are the only residency that takes call every month all 5 years vs. medicine/peds/etc where there are a ceratin amount of "outpatient" months where there is only clinic and no call. We are the only residency that covers floorwork, consults, outpatient clinics, and ICU patients all at once with the same team of residents covering all that. And, oh, yeah, there's the OR too, which is where you'll want to spend as much time as you can.

So how can you spend a good part of your day in the OR and still cover consults, clinics, patients on the floors and/or ICU's? - get in early and run your ass off all day. With the 80 hour week there's even more cross-coverage than before, so that, while it's nice to leave early post-call, someone else will need to leave post-call tommorrow and you'll have to likely cover for the work they would normally do while they are gone.

Forgot to mention that, although as you can tell we still do work pretty hard, most attendings and even senior residents know a system where they worked harder (pre-80 hours) so you'll always hear about how easy you have it now -yep, no room for whiners here.

But, we have fun, we like doing surgery, we like learning all that we learn by working hard and taking care of so many patients. So if you're a high energy person who likes to constantly be challenged, surgery may be just right for you.

hey fourthyear, thanks for the info. that was really really helpful. i really love surgery. i cannot imagine doing internel med, etc.

heres a question. an ignorant person, call me one, would think that surgeons ONLY OPERATE. now i hear you and other residents telling me about all this other work...floorwork, ICU, etc. what is this other work? are these pre-op and recovering patients? whats the role of the surgeon? are you just checking that they are not bleeding or something post surgery or that the surgery was successful? are you giving meds? im not familiar with this area of surgery. it would be awesome if you could share.
THANKS!

 

[avgjoe]

hey fourthyear, thanks for the info. that was really really helpful. i really love surgery. i cannot imagine doing internel med, etc.

heres a question. an ignorant person, call me one, would think that surgeons ONLY OPERATE. now i hear you and other residents telling me about all this other work...floorwork, ICU, etc. what is this other work? are these pre-op and recovering patients? whats the role of the surgeon? are you just checking that they are not bleeding or something post surgery or that the surgery was successful? are you giving meds? im not familiar with this area of surgery. it would be awesome if you could share.
THANKS!

So i was one of those ignorant people before my surgery clerkship. I was really impressed and excited at how much surgeons really do other than the OR. Yes, it's pre-op and post-op patients, but remember that after major surgeries the patient might stay in the hospital for quite a long time (depending on complications etc). During that whole period you are managing them completely, whether they're in the ICU (surgery is one of the fields where you can yourself take care of yr icu patient rather than others where the icu team does so), the stepdown or the floor. managing them completely means yes, giving meds, making sure they are tolerating them well, their comorbidities - diabetes, htn, etc are okay, as well as any new things that might pop up. of course checking that tehy're not bleeding, taking care of the wound/dressing etc is also important.

 

[fourthyear]

Yes, lots of pre and post op care and we do manage most standard medical problems, except we'll call cardiology for acute cardiac events, sometimes work in consult with GI for things that may be managed medically or surgically (like crohn's disease for example). But most medical things we handle - diabetes, hypertenion - we can run an insulin drip or drip of pressors or anti-hypertensives just as well as the medical folks in most cases. As above, we manage most all our critical care patients as far as ventilator management and other ICU issues.

Other daily medical management issues in surgery patients include monitoring labs/electrolytes and replacing as needed, monitoring fluid status and replacing fluids appropriately, giving blood products when neccessary. Monitoring nutritional status -advancing diet, deciding on enteral feeds (tube feeds for those who can't eat orally), TPN management (IV nutritional support). Infection is a big thing in surgical patients - knowing when to draw cultures, how to manage antibiotic regimins and monitor for response. Occasionally in a tough case ID may be involved, but most managment of infections and antibiotic regimins we do ourselves. Managing pain meds of course we do too.

There are actually often lots of patients we take care of that we don't do surgery on either. Lots of abdominal pain admissions that may not be surgical but the ER thought was more of a possible surgical cause than a non-surgical one, so we admit and watch them to either eventually do surgery or confirm they don't need surgery and send them home. Trauma is more and more frequently being treated non-operatively, so that you'll have many truama patients admitted that you care for that never get surgery, or sometimes get surgery by other services like neurosurg or ortho, but we keep them on the general surgery service to just kind of make sure nothing else is going on and to manage their overall condition. Contrary to what you see on TV, surgeons go to all the trauma activations and do all the managment of these patients except for the minimal involvement the ER docs have in the first few minutes where we work together with them to assess and stabalize the patient.

Consults on medical patient in the hospital or in the ER are often called to us to evaluate for a possible surgical condition so we'll follow those too, even if we decide surgery may not be the appropritate thing to treat them. Procedure consults - draining abscesses and placing central lines are frequent ones. Medical doctors can do these things, but they either don't want to or don't feel as comfortable with the tough ones, so we get called to do these procedures.

Don't forget clinic where we see all the pre and post-ops, including many "pre-ops" that don't really need surgery at all but were referred to us b/c someone else thought they might need it, so we do the workup and expalin the situation to the patient. Often people come to clinic with an incomplete workup so it takes several visits before they are all set up for surgery even when they do need surgery.

So you see there's lots to do outside the OR on a surgery service.

 

[Bo Hurley]

so i hear surgery isnt for everyone.
what type of person is surgery for in your opinion?

If you can pass medical school (notice I said pass, excelling is not required unless you want to match into a subspecialty), pass the USMLE, and be willing to deal with a lot of B.S. and come back every day to take more B.S. and pretend you're loving it then you can become a general surgeon. In between all the B.S. during those 5 years of residency hopefully they'll teach you how to operate and take care of patients so you don't become a malpractice risk.

By the way, the novelty of feeling important as a hot shot surgeon wears off the second you're served with your first frivolous lawsuit because Mrs. Jones who weighs 300lbs and has more comorbidities than she has helpings at the all-you-can-eat buffet doesn't think she feels 110% better after the operation. Welcome.

 

[Leukocyte]

I truly believe that people who go into (AND COMPLETE) General Sx Residencies are "different". To me, they are more like machines:

- Can work continuously for hours, without ever complaining about being tierd, sleepy, hungry.....

- Can take abuse from seniors and attendings, and never complain.

- Do not mind working in a "hostile" enviroment-Have a tough skin.

- Be under great pressure and stress, and never break.

- Are FAST FAST FAST.

- Live to work, and not work to live.

- Do not procrasinate....always on top of things.

General Sx res. is not just about the OR. The OR is the "fun" part of the res. It is the floor, ICU, and the other BS that can get to you.

 

[Winged Scapula]

Who said anything about not complaining? Of course, YOU as a medical student are not allowed to do so, just as anyone junior in the food chain is not allowed to complain (especially to us "before the 80 hour work week" old timers). We DO complain, you just have to understand the hierarchy.

Being FAST and efficient is important; I think that's why we get so many inappropriate ER consults - they know we'll be down in less than 30 minutes (our "rule" here). In opposition to the Psych resident who took 4 hours to see my patient with active S.I. and even then I had to re-page her and then call the attending wheh I was told she was busy with "2 admits" - same thing she told me 4+ hours earlier! Sorry....I'll get off my soapbox now.

 

[Brass_Monkey]

- Can work continuously for hours, without ever complaining about being tierd, sleepy, hungry.....


- Live to work, and not work to live.

Jeez, what a pathetic existence! There's more to life than working; if you don't think so, I feel truly sorry for you.

 

[DoctorDoom]

Boy, some bitter folks around here.

docmemi, it's simple. Above all else you have got to want to be a surgeon. That's whom surgery is for; people who want to be surgeons. You have got to really enjoy treating surgical diseases and helping your patients. It's a tough profession, so that is true more so for surgery than for some other professions.

It is a lot of work, but mostly it's about being focused and efficient, because you have to decide whether it's better to leave the patient alone, often while they are suffering, or if it is better to paralyze them and cut them open. You have to like being task oriented and like the manual work. You have to really enjoy problem solving and be able to do it with incomplete information. You have to be able to act decisively and be able to live with the consequences of your decisions. You have to be a bit stubborn, and enjoy challenges. You need to enjoy putting thoughts into action and thinking clearly under stress.

Most of this requires that you be on your feet and be fit most of the day. Surgery rotation is hardcore because most students aren't used to the pace. And sleep deprived residents tend to be defensive and paranoid, and are not good teachers or leaders, making them the least suitable managers of students.

Not to mention the fact that some students are smug little pissantes who are just annoying. Not all residents handle them well for the aforementioned reasons.

As for the malignancy of attendings and fellow residents, it's all individual driven. You have to be pretty secure and confident to not let the self-important asses get to you, and to give it back in the appropriate ways. Respect the hierarchy, unless a situation arises where ethics and dignity mandate that you do not.

And you should also be able to remember you are a human being and surgery is a job. It is not the entirety of your existence in your brief time on this planet. That will help you avoid personal and professional pitfalls.

Some lazy wusses become general surgeons. They shirk and browbeat those lower in the hierarchy, and wear the worst stereotypes of surgeons as a cloak. They are no better than those outside of the specialty who use that stereotype to cover their own inadequacies.

 

[sunshine2004]

I truly believe that people who go into (AND COMPLETE) General Sx Residencies are "different". To me, they are more like machines:

- Can work continuously for hours, without ever complaining about being tierd, sleepy, hungry.....

- Can take abuse from seniors and attendings, and never complain.

- Do not mind working in a "hostile" enviroment-Have a tough skin.

- Be under great pressure and stress, and never break.

- Are FAST FAST FAST.

- Live to work, and not work to live.

- Do not procrasinate....always on top of things.

General Sx res. is not just about the OR. The OR is the "fun" part of the res. It is the floor, ICU, and the other BS that can get to you.

What if you only have HALF of these traits and still want to be a surgeon? Can you develope the other half or will you just be too miserable and fail out???

 

[kinetic]

Considering that list basically breaks down into:

1) Likes to work a lot.

2) Can take a lot of abuse.

Which half of it are you? Because generally, if you're low on #1, you'll get more of #2. But if you're OK with #2, you can give them the finger.

 

[Skialta]

"if you're low on #1, you'll get more of #2. But if you're OK with #2, you can give them the finger"


Classic

 

[kungfufishing]

"if you're low on #1, you'll get more of #2. But if you're OK with #2, you can give them the finger"


Classic

y'know, it really just sounds like an awful lot of "#2" to me....

(in all seriousness I have a lot of respect for surgeons)

 

[Gerota]

everything depends on the surgery program and i also believe there is some aspect to regional differences. I went to med school in nyc and they surgery culture was brutal and very formal. I am at ucla now and things are much more laid back and a friendlier environment.

The surgery residents: personalities are all very varied, laid back to uptight intense folks. but the one common thread is everyone is ready to work hard when things need to be done....though some complain more than others.

to the original poster- if you want to see what life is like on a surgical service at ucla let me know and give me your email.

 

[doc05]

What if you only have HALF of these traits and still want to be a surgeon? Can you develope the other half or will you just be too miserable and fail out???

I would never picture someone named "sunshine" as a surgeon.