Surgeons are great folks. I was talking to some of the surgeons today about a patient, and they didn't know the patient's name. It was such a classic surgeon moment.
The thing I love about surgeons is that they are so very different from me. However you want to cut it up, my ability to do my job is entirely dependent on my ability to get reliable information from the patient. I need to establish rapport. I need to ask the right questions. I need to review systems. I need to advocate. I know my patients quite well.
Surgeons however, some of them at least, go out of their way not to know their patients. Of course they know the medical issues. They know the past history and the physical findings and the lab results. Sure. But I'm the one wasting my time talking to Mr H about his service in WW2.
I think that the reason for this is that it takes a certain level of detachment to be able to cut someone open and play with their innards. Surgeons have to distance themselves quite far from the people they cut on. It would be too much to see Mrs M, mother of 3, grandmother to 10, baker of the best pies of all the ladies in the local Legion auxiliary, as a scared and fragile human being. It is much more sane to view her as 20cm of necrotic colon.
I remember one of the surgery residents I worked with as a medical student. We took out half of this lady's colon because of obstructing mass. When we opened her up, we found diffuse metastasis all over the abdomen. We did a colostomy and that was that. I asked him several days later if she had a shot at survival. "I'm sure she'll do fine. We did our part."
Despite what you may think about surgeons, it seems to me to be quite an optimistic specialty. While I talk about CHF and renal failure and lethal arrhythmias, they cut to cure. And although I may disagree a lot of times, it's nice to have someone who thinks he can actually do something to make a difference.
It takes a certain detatchment to get though rounds in time to make it to the O.R., or you will have a senior resident or attending bitching at you. I love to hear the WW2 stories and any other story. In the past year I have had a fighter pilot, two WW2 war brides, a lady who didn't want to be in the hospital because she was working on a painting that she was really exited about, and a marine who wanted to get his Crohn's disease under control so he could go back to his buddies in Iraq. Dressing changes and central lines are a great time to get to know your patients. Rounds and clinic are too busy. It's worth it, too. I have had enough interaction with patients that I sometimes see people I have taken care of out in the world, and it's nice when they smile and say hello. I think of that when I start to feel like someone is only another note to write, and I'm not invested enough in who they are.
ReplyDeleteI think one of the nice things about IM residency is that you start out with your own clinic. I'm sure an attending is always there, but there's much more continuity for you guys. I got to clinic with the doctors I work with, and I switch rotations every month. There isn't a group of patients that are "mine." I won't have that until I'm an attending.
Most of the time, I do feel that surgery is an optimistic specialty. You can fix people up and they go home to be better off. There are still a lot of times when you know there will be no happy ending. Sometimes it's easier to look at lab values, and apply your skills where needed.
One of my attendings says you have to always delve a little deeper, and know the patients as people. Otherwise, you're nothing better than an technician.