Specialisation and Professionalism
There was a time when the General surgeon was king of all he surveyed. Not long ago, I had seen "larger than life" surgeons walk through the wards of General surgery, trained to handle any issues in surgery, comfortably operating in all the body cavities and getting patients back to shape. My father was one such surgeon. In the 1990s, when I was training to be a doctor, I have seen my father operate on the bigs of gastrointestinal surgery - Surgery for portal hypertension, Whipple's operation for pancreatic cancer, colon surgeries notably APR and still care for patients with face lacerations and parotid swellings, equally well. I would mention a host of surgeons from that era, who drew my attention and taught me basics of surgery with very little pain.
But these surgeons had put in more than 2 decades of hard work before they could achieve this level of expertise. When I joined surgical training in 1997, general surgery was already in its waning phase. The tides had changed. As trainees, exposure to major gastrointestinal surgeries became rare events. Because of my early interest in gastrointestinal surgery, I stayed on to learn the finer aspects of gastrointestinal surgery and other specialties, notably Urology and Thoracic surgery. Each one was a master and from each one I had learnt the technique of access, exposure and tissue handling. What was most remarkable about each one of these surgeons was their decison making. At each point of the timeline of care, these surgeons decided what to do and did them well. They were not magicians, but simply meticulous people. In 2000, when I stepped out of Medical College, Trivandrum, with a Masters degree in my hand, I made a call to my father. The words, he spoke have stayed in my memory all these years. "My son, just because you have an MS does not mean that you are a master in surgery. it just means that you are a good student of surgery". Now, I find that more true, as I see more of young surgeons walking out of medical schools - acting like masters, forgetting the true standing.
I practised Surgery for 7 years before deciding to specialise. In the mean time, I had the joy of overseeing the development of a comprehensive diabetic foot care center and a flourishing hernia clinic. I had learnt laparoscopic surgery and diagnostic and therapeutic endoscopy. It was during those years the gaps in my knowledge became clear. I had only learnt a little about some diseases and as the preface of Hutchison's clinical methods points out "we all have gaps in our knowledge". But I had so much to learn about the effects of the disease on the patients and also so much about the patient themselves.
Then I specialised in Gastrointestinal surgery. I had 3 joyful years of filling the gaps in my knowledge and polishing the skills I had. Are they enough? No, never. Medical knowledge is like an exploding supernova, a rapid increase for which the brain has no space.
Specialisation is needed. But what is needed more is professionalism. Professionalism is a character or ability or skill to do a job from start to finish. It is possible for any person with 2 years of work in surgery to operate on any organ with sufficient skill, but it is rare to find a person in that time frame to take the battle to the logical finish.
What differentiated those surgeons of yore was not the additional degrees they had, but the commitment and professionalism in seeing the patient through the difficult phase of their life. I have seen them take bedside duties and attend calls even when they were senior, to make sure everything is alright. These were rewarded and sometimes remained unrewarded.
Specialisation alone will not make a difference. Two letter words behind the name does not make a specialist. It is the professionalism that makes the difference. My operating skills have improved, but specilisation has laid a foundation of professionalism in my work. Now, it is possible to have the over all picture and better decision making is possible.
It is important for a patient to know their doctors well and the qualifications well. It is quite common to see many degrees in the practice of medicine. It is difficult for patients to sort the good and useful one from the useless ones. But professionalism is easily identifiable. One of the salient features of a surgeon is availability. "Give me a guy who will get from the bed at night" was a favourite remark of one of my assistant professors. We can make a difference for the patient when we make ourselves available. It is bad practice to give instructions over phone for a patient whom we have not seen.
Another great surgical character is follow up. One of my teachers used to come for night time rounds around 9 pm to see his surgical patients. He would talk to the patient and find out how he is doing and also whether the operating surgeon had given a visit to see the patient in the evening. If the surgeon had not seen the patient in the immediate post operative period, he was reprimanded and would not operate with the master surgeon the next time. It was deeply ingrained into the training that we never thought of it a s a burden when we started practice. It is so surprising that surgeons operate in Tamilnadu at remote hospitals and never visit the patient during the post operative period. It is clearly not professionalism.
So what do you do? A difficult question. Look for professionalism in your surgeon. If you get a specialist, who is also a professional, then you are very lucky indeed.
But these surgeons had put in more than 2 decades of hard work before they could achieve this level of expertise. When I joined surgical training in 1997, general surgery was already in its waning phase. The tides had changed. As trainees, exposure to major gastrointestinal surgeries became rare events. Because of my early interest in gastrointestinal surgery, I stayed on to learn the finer aspects of gastrointestinal surgery and other specialties, notably Urology and Thoracic surgery. Each one was a master and from each one I had learnt the technique of access, exposure and tissue handling. What was most remarkable about each one of these surgeons was their decison making. At each point of the timeline of care, these surgeons decided what to do and did them well. They were not magicians, but simply meticulous people. In 2000, when I stepped out of Medical College, Trivandrum, with a Masters degree in my hand, I made a call to my father. The words, he spoke have stayed in my memory all these years. "My son, just because you have an MS does not mean that you are a master in surgery. it just means that you are a good student of surgery". Now, I find that more true, as I see more of young surgeons walking out of medical schools - acting like masters, forgetting the true standing.
I practised Surgery for 7 years before deciding to specialise. In the mean time, I had the joy of overseeing the development of a comprehensive diabetic foot care center and a flourishing hernia clinic. I had learnt laparoscopic surgery and diagnostic and therapeutic endoscopy. It was during those years the gaps in my knowledge became clear. I had only learnt a little about some diseases and as the preface of Hutchison's clinical methods points out "we all have gaps in our knowledge". But I had so much to learn about the effects of the disease on the patients and also so much about the patient themselves.
Then I specialised in Gastrointestinal surgery. I had 3 joyful years of filling the gaps in my knowledge and polishing the skills I had. Are they enough? No, never. Medical knowledge is like an exploding supernova, a rapid increase for which the brain has no space.
Specialisation is needed. But what is needed more is professionalism. Professionalism is a character or ability or skill to do a job from start to finish. It is possible for any person with 2 years of work in surgery to operate on any organ with sufficient skill, but it is rare to find a person in that time frame to take the battle to the logical finish.
What differentiated those surgeons of yore was not the additional degrees they had, but the commitment and professionalism in seeing the patient through the difficult phase of their life. I have seen them take bedside duties and attend calls even when they were senior, to make sure everything is alright. These were rewarded and sometimes remained unrewarded.
Specialisation alone will not make a difference. Two letter words behind the name does not make a specialist. It is the professionalism that makes the difference. My operating skills have improved, but specilisation has laid a foundation of professionalism in my work. Now, it is possible to have the over all picture and better decision making is possible.
It is important for a patient to know their doctors well and the qualifications well. It is quite common to see many degrees in the practice of medicine. It is difficult for patients to sort the good and useful one from the useless ones. But professionalism is easily identifiable. One of the salient features of a surgeon is availability. "Give me a guy who will get from the bed at night" was a favourite remark of one of my assistant professors. We can make a difference for the patient when we make ourselves available. It is bad practice to give instructions over phone for a patient whom we have not seen.
Another great surgical character is follow up. One of my teachers used to come for night time rounds around 9 pm to see his surgical patients. He would talk to the patient and find out how he is doing and also whether the operating surgeon had given a visit to see the patient in the evening. If the surgeon had not seen the patient in the immediate post operative period, he was reprimanded and would not operate with the master surgeon the next time. It was deeply ingrained into the training that we never thought of it a s a burden when we started practice. It is so surprising that surgeons operate in Tamilnadu at remote hospitals and never visit the patient during the post operative period. It is clearly not professionalism.
So what do you do? A difficult question. Look for professionalism in your surgeon. If you get a specialist, who is also a professional, then you are very lucky indeed.
Comments
Post a Comment