On Friday 30 Sep 2011 3:42:33 pm Anish Mohammed wrote: > > Have you tried it, or seen it being tried? With what results? > As usual I did not receive the first email from Udhay but saw some replies and this one had my name so.
The article is too long. Too much boring surgical detail for a concept that could have been conveyed from one surgeon to another in a few words. I thought conferences, "How I do it" videos and live demonstrations, and colleagues that one sometimes asks for help do exactly the same job. Working as part of a surgical team, or as a junior colleague for many years serves a similar purpose, as opposed to breaking off into individual practice soon after certification. Also what is missing form this "Surgeon to layman" article is a fact that is dramatically summed up by one of my friends, a neurosurgeon: It took me five years to learn how to operate It took me ten years to learn when to operate But it took me twenty years to learn when not to operate. The "operation" part of surgery is overdramatized, although that is the part that often saves lives. The pre operative assessment, the selection and skill of anaesthesia, surgical judgement at the table during surgery and the post operative care and decisons play a huge role in surgery but are not as romantic as the act of operation itself. All these things are routine humdrum work with constant peer review and cross consultation. Perhaps the author's own practice does not allow him to interact with his peers constantly for feedback and advice in complex situations. That is normal in teaching hospitals and in hospitals where multiple surgeons mix, chat in the theater lounge and operate in the theater complex. As regards the operative procedure itself the author shows how it is possible for bystanders, onlookers, advisers, coaches or mentors to give general advice on surgery, but when it comes to the crunch - when you are faced with the situation of having to cut a small structure without knowing if it is going to free the gall bladder or end in a huge torrent of life threatening bleeding the surgeon is alone - more lonely than anyone else can be. The coach can only give general guidelines. There is no alternative to experience there. Coaching can guide you on how to handle that, but will not stop it. Experience makes you safer only if you are an inexperienced surgeon. If you are an experienced surgeon you will find out that complications and the unexpected will come and kick you in the backside no matter what. The surgeon who has not had complications and even deaths is not operating. If you find a doctor guaranteeing you with a 100% result, watch out. As I watch out for people who are asking for 100%. which is not on offer. Finally, being a surgical patient is as much about psychology as anything else. The best and most competent surgeon who tells you "Well I have done this 1,230 times and my complication rate is 3% which is about average" may not inspire confidence in a patient who just hears the surgeon say "Don't worry. I will fix you" shiv
