Continuing rants of a 'desi' surgeon
Hello friends,
back with more rants from a 'desi'surgeon
Speciality units in General Surgery Department
I wanted to share my views on the concept of speciality units in general surgery departments in 'desi'land.
The concept of speciality units is not new.
Many teachers in surgery have tried to introduce it in different medical colleges, only to be turned down by the head of the department or booed down by their exalted colleagues.
The concept goes like this-
Generally, there are six units in each Surgery Department(one for each day of the week- if you had not guessed that before!)
The units do similar General surgical work, that is everything that comes under the ambit of General Surgery.
The idea is to assign an organ based speciality to each unit;
like Breast and endocrine/ Thyroid and neck/Hepatobiliary pancreatic/Upper GI/ Lower GI/ units.
There should be separate speciality clinics as well.
There should be separate speciality clinics as well.
Perceived advantage being that surgeons can work in a focused way in a particular speciality.
Organ based speciality is an accepted way of patient care and teaching worldwide.
Working on one particular organ system helps the surgeon in honing his skills over time, generating database for research and education, and more importantly gives recognition to the surgeon as a leader in that speciality.
Greatest opposition to this seemingly attractive concept comes from the surgeons themselves.
Some excuses put forward by them are
1. I shall forget how to operate on the breast if I do colorectal only- that's an example but you get the idea, right?
2. I have a reputation of being a great general surgeon. I can operate on anything under the sun. If I start doing only one organ system - I shall lose my reputation and my practice.
3. My job in desiland is transferable. I can be shunted out to any nondescript place a month later. What will happen to the skills I acquired by working in one particular organ system?
4. I think of the greater good , always! What if an innocent surgeon gets transferred into my department. That poor soul will be lost trying to focus in a particular speciality.
5.Everybody wants Hepato biliary( or so it seems) - I may not get the speciality of my choice.
6. What will happen to my trainees. Will they learn surgery of only one organ during their tenure?
If the trainees rotate between units- how will they build up rapport with their teachers?
7.Dr X gets Upper GI and gets all credit and recognition and I am stuck with thyroid. It is so unfair.
Why ,he doesnt even have a big flat!- (I think this should be reason number 1 for all those against speciality units)
The answers to these rants lie within us -the surgeons-
1. No one who is experienced enough ever forgets to do an operation.
Its like riding a bicycle- you can never unlearn it.
Of course- one may need more time to perform a procedure after some time, but the knowledge never completely disappears.
2. Being a master in colorectal surgery( for example) wont be detrimental to private practice- one can still continue to be a general surgeon with a speciality interest in colorectal surgery.
3. Once transferred out- one has the option of going back to general surgery or trying to introduce this concept in the new place. It's a lot of work I agree- and I would like to return home early doing my 3 days in North North desi land. why bother about speciality!
4. The new surgeon in the department can always start afresh in a speciality of his choice.
5. Of course- its a democracy( we have too much democracy in desiland! its injurious to health) the allotment of speciality should be on the basis of seniority.
6. The trainees rotate between different specialities. They get access to focused work and learn more over a period of time.
As for rapport building with trainees, if it can happen elsewhere in the world, why not in desiland.
7 Cant suggest anything to tackle this issue of EGO
The problem lies in our mindset. We are so accustomed to telling and hearing 'NO' to everything that we cant accept any proposal that is for our general good.
General Surgery is already a threatened subject under the onslaught of superspecialities.
If the surgeons dont work together it will be more difficult in the coming days.
The patient's viewpoint
The patient gets better treatment in a dedicated unit.
If he has a gall bladder - he will be managed in a gall bladder unit- an unit that has the knowledge and experience gathered through focused work on gall bladder diseases.
The patient has more chances of being managed in a systematic manner adherent to acceptable guidelines- which produce better outcomes.
The Institution's viewpoint
Having speciality units is a boon for the Institute.
It can project itself as a center of excellence on a particular speciality.
The Institute can get funds for research on a particular topic more easily.
The Institute will ultimately be popular among the general public for providing quality care with better outcome.
Of course, all this is a bit Utopian- but my dream is to see my 'desi' college right at the top of the list of best hospital for teaching and care in 'desi'land
Organ based speciality is an accepted way of patient care and teaching worldwide.
Working on one particular organ system helps the surgeon in honing his skills over time, generating database for research and education, and more importantly gives recognition to the surgeon as a leader in that speciality.
Greatest opposition to this seemingly attractive concept comes from the surgeons themselves.
Some excuses put forward by them are
1. I shall forget how to operate on the breast if I do colorectal only- that's an example but you get the idea, right?
2. I have a reputation of being a great general surgeon. I can operate on anything under the sun. If I start doing only one organ system - I shall lose my reputation and my practice.
3. My job in desiland is transferable. I can be shunted out to any nondescript place a month later. What will happen to the skills I acquired by working in one particular organ system?
4. I think of the greater good , always! What if an innocent surgeon gets transferred into my department. That poor soul will be lost trying to focus in a particular speciality.
5.Everybody wants Hepato biliary( or so it seems) - I may not get the speciality of my choice.
6. What will happen to my trainees. Will they learn surgery of only one organ during their tenure?
If the trainees rotate between units- how will they build up rapport with their teachers?
7.Dr X gets Upper GI and gets all credit and recognition and I am stuck with thyroid. It is so unfair.
Why ,he doesnt even have a big flat!- (I think this should be reason number 1 for all those against speciality units)
The answers to these rants lie within us -the surgeons-
1. No one who is experienced enough ever forgets to do an operation.
Its like riding a bicycle- you can never unlearn it.
Of course- one may need more time to perform a procedure after some time, but the knowledge never completely disappears.
2. Being a master in colorectal surgery( for example) wont be detrimental to private practice- one can still continue to be a general surgeon with a speciality interest in colorectal surgery.
3. Once transferred out- one has the option of going back to general surgery or trying to introduce this concept in the new place. It's a lot of work I agree- and I would like to return home early doing my 3 days in North North desi land. why bother about speciality!
4. The new surgeon in the department can always start afresh in a speciality of his choice.
5. Of course- its a democracy( we have too much democracy in desiland! its injurious to health) the allotment of speciality should be on the basis of seniority.
6. The trainees rotate between different specialities. They get access to focused work and learn more over a period of time.
As for rapport building with trainees, if it can happen elsewhere in the world, why not in desiland.
7 Cant suggest anything to tackle this issue of EGO
The problem lies in our mindset. We are so accustomed to telling and hearing 'NO' to everything that we cant accept any proposal that is for our general good.
General Surgery is already a threatened subject under the onslaught of superspecialities.
If the surgeons dont work together it will be more difficult in the coming days.
The patient's viewpoint
The patient gets better treatment in a dedicated unit.
If he has a gall bladder - he will be managed in a gall bladder unit- an unit that has the knowledge and experience gathered through focused work on gall bladder diseases.
The patient has more chances of being managed in a systematic manner adherent to acceptable guidelines- which produce better outcomes.
The Institution's viewpoint
Having speciality units is a boon for the Institute.
It can project itself as a center of excellence on a particular speciality.
The Institute can get funds for research on a particular topic more easily.
The Institute will ultimately be popular among the general public for providing quality care with better outcome.
Of course, all this is a bit Utopian- but my dream is to see my 'desi' college right at the top of the list of best hospital for teaching and care in 'desi'land
