Why are surgeons held with higher esteem than are physicians?

[bannie22]

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Huh? Why would you think that surgeons are held in higher regard?

its all abt teh chicks

 

[VA Hopeful Dr]

cure that appendicitis with cefazolin?

What?

 

[dpmd]

meanwhile the people who actually trained to do it, like 95 + % of them completely ignore it. so clearly you're overstating its efficacy

if OMM was so great allo medicine would pick it up in a heartbeat

If there was good reimbursement for it I think everyone would want to do it.

 

[dpmd]

What?

I think he means cefoxitin. Around 70% success in highly selected patients. Not like it is going to put surgeons out of work.

 

[VA Hopeful Dr]

I think he means cefoxitin. Around 70% success in highly selected patients. Not like it is going to put surgeons out of work.

I saw those studies as well - longer recovery, higher chance of recurrence (duh).

No thanks, I'll stick with surgery.

 

[dpmd]

I saw those studies as well - longer recovery, higher chance of recurrence (duh).

No thanks, I'll stick with surgery.

I don't think it is quackery or anything and I am willing to do it for someone who is interested in it (have had good success in those I tried it on but no long term follow up on most of them). But even if the indications get dialed in to where success rates are higher I don't see surgeons getting edged out. More likely it will become like hospitalized diverticulitis where almost everyone gets a surgery consult though most don't require surgery.

 

[VA Hopeful Dr]

I don't think it is quackery or anything and I am willing to do it for someone who is interested in it (have had good success in those I tried it on but no long term follow up on most of them). But even if the indications get dialed in to where success rates are higher I don't see surgeons getting edged out. More likely it will become like hospitalized diverticulitis where almost everyone gets a surgery consult though most don't require surgery.

Agreed, I don't think trying antibiotics first is malpractice or anything like that.

But, I would not choose that route for myself, my kids, or recommend it to my patients. Even if recovery time/pain/complications were the same, if you leave the appendix in you're just asking for it to cause trouble again in the future (I know that you know all of this, just spelling it out in case any of the students are actually still following the thread).

 

[Vain Brother]

prettty dumb conversation, congrats to all involved

 

[Kahreek]

I think he means cefoxitin. Around 70% success in highly selected patients. Not like it is going to put surgeons out of work.

Cefazolin - Wikipedia

Agreed, I don't think trying antibiotics first is malpractice or anything like that.

But, I would not choose that route for myself, my kids, or recommend it to my patients. Even if recovery time/pain/complications were the same, if you leave the appendix in you're just asking for it to cause trouble again in the future (I know that you know all of this, just spelling it out in case any of the students are actually still following the thread).

there can be recurrence after surgery. 😀
(it is called "stumpitis" though)
I would chose the antibiotics, but in no way i am anti surgery, because when **** hits the fan, who you gonna call? A surgeon.

 

[Kahreek]

prettty dumb conversation, congrats to all involved

So you dont like medical science.?

 

[dpmd]

Cefazolin - Wikipedia

Not the appropriate spectrum of coverage.

 

[VA Hopeful Dr]

Not the appropriate spectrum of coverage.

Not even close

 

[W19]

Agreed, I don't think trying antibiotics first is malpractice or anything like that.

But, I would not choose that route for myself, my kids, or recommend it to my patients. Even if recovery time/pain/complications were the same, if you leave the appendix in you're just asking for it to cause trouble again in the future (I know that you know all of this, just spelling it out in case any of the students are actually still following the thread).

Yeah, I pointed that out to a surgeon once and he told me when that appendix get perforated and someone dies, it will be hard to convince a jury why you chose conservative treatment when almost all surgeons choose surgery. Physicians are practicing medicine with lawyers breathing down their neck.

 

[VA Hopeful Dr]

Yeah, I pointed out that to a surgeon once and he told when that appendix get perforated and someone dies, it will be hard to convince a jury why you chose conservative treatment when almost all surgeons choose surgery. Physicians are practicing medicine with lawyers breathing down their neck.

Hence why all of the initial work for this came out of Europe. Antibiotic therapy is significantly cheaper in uncomplicated patients than surgery.

 

[sloop]

That's one of the reasons why I love surgery - I feel like I can make immediate, tangible changes in a patient's life.

It's very tough to "treat" or "cure" chronic conditions like HTN, DM, etc. But in many cases, for many disease processes, surgery offers the patient a chance at a cure - or, in other cases, the relief of suffering.

I know people who say this, but my experience was that for many or even most types of surgery, this is not the case at all. Patients may get relief and this is likely better than not getting the surgery, but it comes at the cost of high risks of complications both immediately and over the long-term. A lot of surgical patients (particularly vascular, many types of oncological surgery, certain transplants, trachs, pegs, ostomies, etc.) have problems whose course won't fundamentally be altered by the intervention or for which the surgery carries significant treatment burden. Again, might be better than the alternative but I definitely think that the idea of surgery as an instant curative therapy is very simplistic and at best only true for certain types of surgery and surgical practice.

 

[ridethecliche]

Not the appropriate spectrum of coverage.

Not even close

This just reminded me that I need to study antimicrobials like WOAH!

 

[zaztong]

From Trilla A et al, Phenotypic differences between male physicians, surgeons, and film stars: comparative study. BMJ 2006; 333:1291-3:

Objectives
To test the hypothesis that, on average, male surgeons are taller and better looking than male physicians, and to compare both sets of doctors with film stars who play doctors on screen.

Design
Comparative study.

Setting
Typical university hospital in Spain, located in Barcelona and not in a sleepy backwater.

Participants
Random sample of 12 surgeons and 12 physicians plus 4 external controls (film stars who play doctors), matched by age (50s) and sex (all male).

Interventions
An independent committee (all female) evaluated the "good looking score" (range 1-7).

Main outcome measures
Height (cm) and points on the good looking score.

Results
Surgeons were significantly taller than physicians (mean height 179.4 v 172.6 cm; P=0.01). Controls had significantly higher good looking scores than surgeons (mean score 5.96 v 4.39; difference between means 1.57, 95% confidence interval 0.69 to 2.45; P=0.013) and physicians (5.96 v 3.65; 2.31, 1.58 to 3.04; P=0.003). Surgeons had significantly higher good looking scores than physicians (4.39 v 3.65; 0.74; 0.25 to 1.23; P=0.010).

Conclusions
Male surgeons are taller and better looking than physicians, but film stars who play doctors on screen are better looking than both these groups of doctors. Whether these phenotypic differences are genetic or environmental is unclear.

(For any people here unfamiliar with the BMJ, every Christmas issue they conduct scientific, tongue-in-cheek studies like the one above.)

If you actually read the study:

"There are several potential explanations for the phenotypic changes between surgeons and physicians. Firstly, surgeons spend a lot of time in operating rooms, which are cleaner, cooler, and have a higher oxygen content than the average medical ward, where physicians spend most of their time. Furthermore, surgeons protect (but not always properly) their faces with surgical masks, a barrier to facial microtrauma, and perhaps an effective anti-ageing device (which deserves further testing). They often wear clog-type shoes, a confounding factor that adds 2-3 cm to their perceived height. The incidental finding that fewer surgeons are bald might be related to these environmental conditions and to the use of surgical caps."

"Firstly, we did not independently assess the height of the study subjects. However, we trust in their honesty and believe that any potential bias would always point in the same direction, as people tend to overestimate rather than underestimate their height. Secondly, we did not check if the submitted photographs had been improved using the latest technology. The members of the evaluating committee know all the study subjects well, and would easily have spotted any gross attempt at cheating (such as submitting photographs taken when the subject was younger or photographs of another person). Thirdly, the evaluation process of the good looking score is subjective, but we have no reliable alternative. The best known alternative published in the literature (asking a mirror, “Mirror, mirror on the wall, who is the fairest of them all?”) works only for queens, a notable shortcoming of this test.4 Although it is widely known that the mirror always spoke the truth, at present we do not have access to this device (not currently supplied by the Spanish national health system)."

Sounds like this study lacks rigor.

 

[Kahreek]

Not even close

Cefazolin covers most colon flora that is pathogenic in those cases namely some of the nastier gram+. Cefuroxime is second generation, it is more effective agaisnt e.coli and other gram -, it also crosses the BBB. It is a broader antibiotic, but it is weaker overall and agaisnt gram + . To say it is superior in digistive tract infections is just plain false.
If you have a serious billiary tract infection or soft tissue digestive infection and you can only choose one drug you better bet your life in cefazolin over cefuroxime. I would.

 

[dpmd]

Cefazolin covers most colon flora that is pathogenic in those cases namely some of the nastier gram+. Cefuroxime is second generation, it is more effective agaisnt e.coli and other gram -, it also crosses the BBB. It is a broader antibiotic, but it is weaker overall and agaisnt gram + . To say it is superior in digistive tract infections is just plain false.
If you have a serious billiary tract infection or soft tissue digestive infection and you can only choose one drug you better bet your life in cefazolin over cefuroxime. I would.

You are all over the place here. Let me identify the problems I see in your post.
A. No one brought up cefuroxime. Cefoxitin is a different med.
B. No one is talking about biliary tract disease
C. Cefazolin lacks anaerobic coverage so you can automatically rule it out as covering most colon flora
D. The most likely organisms involved with appendicitis are bacteroides and ecoli, not gram positives (though they can be found as well as can pseudomonas)

 

[VA Hopeful Dr]

You are all over the place here. Let me identify the problems I see in your post.
A. No one brought up cefuroxime. Cefoxitin is a different med.
B. No one is talking about biliary tract disease
C. Cefazolin lacks anaerobic coverage so you can automatically rule it out as covering most colon flora
D. The most likely organisms involved with appendicitis are bacteroides and ecoli, not gram positives (though they can be found as well as can pseudomonas)

Interestingly (cause I just looked this up), apparently it's recommended to give a single dose of antibiotics prior to surgery. Best evidence is either Unasyn, cefoxitin, or cefazolin PLUS metronidazole.

So in response to our student friend, if I had to choose a single drug I in fact that would go with cefoxitin.

 

[dpmd]

Interestingly (cause I just looked this up), apparently it's recommended to give a single dose of antibiotics prior to surgery. Best evidence is either Unasyn, cefoxitin, or cefazolin PLUS metronidazole.

So in response to our student friend, if I had to choose a single drug I in fact that would go with cefoxitin.

Unasyn can have some ecoli resistance issues which isn't so much an issue if you are getting rid of the source, but probably not great for nonoperative management. Ancef plus flagyl is inferior in my mind because it is two meds (and if you are managing nonoperatively it means more nursing work).

 

[anbuitachi]

Mainly cause of TV. And their egos

 

[VA Hopeful Dr]

Unasyn can have some ecoli resistance issues which isn't so much an issue if you are getting rid of the source, but probably not great for nonoperative management. Ancef plus flagyl is inferior in my mind because it is two meds (and if you are managing nonoperatively it means more nursing work).

Agree completely, I was purely quoting SCIP for pre-op antibiotics.

 

[Kahreek]

Agree completely, I was purely quoting SCIP for pre-op antibiotics.

Interestingly (cause I just looked this up), apparently it's recommended to give a single dose of antibiotics prior to surgery. Best evidence is either Unasyn, cefoxitin, or cefazolin PLUS metronidazole.

So in response to our student friend, if I had to choose a single drug I in fact that would go with cefoxitin.

Ahh, this discussion was worthwhile. At least now you considering abx only therapy. 🙂

 

[VA Hopeful Dr]

Ahh, this discussion was worthwhile. At least now you considering abx only therapy. 🙂

Nope, I'd still pick surgery 100% of the time.

 

[Kahreek]

Nope, I'd still pick surgery 100% of the time.

🙂

 

[814965]

prettty dumb conversation, congrats to all involved

I don't think they realize it started in 2008...