i fully agree on that part, about all the mentoring and coaching in the world not mattering when you are on the spot and need to make a critical decision on something that can go horribly wrong in an instant.
it is funny but extremely long articles, even authoritative sounding ones, have this tendency to trip themselves up by their own loquacity, especially where the author is editorializing on his own pet hobby horse. Pet theories have this way of breaking down when they stand the stress of way too detailed an explanation, and what sounds short and pithy (and gets called a nameism, like a shirkyism or a lessigism for example) gets to sound grandiloquent and/or just plain silly when taken beyond a few hundred words. another place they break down is where a plausible looking analogy from a completely unrelated field is dragged in to prove a point. Probably the only place where you can find several one liners that stand up to detailed examination is science / math, with laws, axioms and lemmae which can be backed by scientific proof. That has a way of blowing up in your face, especially if you get your facts wrong (neal stephenson on gold rush geeks, say, or schneier when he steps anywhere outside crypto and makes his usual emphatic, sweeping and soundbite laden generalizations). --srs(iPad) On 01-Oct-2011, at 22:42, ss <[email protected]> wrote: > 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 >
