“Surgeons are not technicians. Surgeons are doctors who also know how to operate.”


Wise words from a world respected cardiac surgeon and intensivist. At least I like them.

Today I witnessed practitioners (they certainly didn’t earn the title doctor today) acting in a manner (I would not call it practicing medicine or helping people) that made me physically ill. It was worse than homeopathy, worse than witchcraft. It was blatant and unabashed nonfeasance.  Forget sued. People should be in jail.

I am currently delegated to “The Emergency Department.” I realize not everyone has my history or insight, but what I witnessed today made me physically ill and I powerlessly watched.

Here is what I saw.

Medics (aka non surgeon doctors) who would not perform simple manual skills on patients because they were considered “surgical skills” and deferred to consulting a surgeon. These included suture removal and incision and drainage of a grossly purulent abscess. When I offered to do it for them, I was told by my supervisor I am not a fully qualified specialist surgeon and therefore I cannot.

Surgery came down and declared this patient had too many medical issues to admit to surgery and therefore he would not provide further care to the patient. To say the treatment plan was conservative would be a gross understatement. It was outright neglectful.

When I raised my concerns I was then fed a line on how doctors are afraid of being sued and lack expertise in a range of common medical procedures and in the interest of the patient perform the absolute least amount of treatment and escalate accordingly. (In other words, not do shit, because I have no other conclusion that they really have no idea or experience what they are doing.)

So now that my rant is over, I am here to pontificate on the absolute asinine idea that non-surgeons cannot do manual procedures and surgeons cannot take on patients with medical complications.

In modern medicine, there cannot be a line between surgery and medicine. All of these people go to medical school. All of these people need to be signed off in medical on being capable to perform certain procedures. I know, because I went to the same school and was signed off.

Interventional radiology, Interventional cardiology, Neurology, these are all medical disciplines with surgical procedures. Anesthesiology and Intensive medicine have surgical skills. Even Internal medicine has surgical skills.

Conversely, surgeons qualify people for surgery. Surgeons write post operation orders. Both of these actions require medical knowledge. No small amount of it at that. If it didn’t they would still be barbers.

What is driving this idea a person can do one and not the other? The answer to that is simple.

Laziness. It is much easier to go to work every day and do a handful of things than it is to maintain knowledge and proficiency over many things. It is much easier to decide that particular thing you don’t want to do is not your job.

But patients don’t see it that way. Doctors who actually care about people don’t see it that way. People with even a modicum of integrity don’t see it that way. The job description of medicine and by extension all of healthcare is to help. (full stop)

Making excuses to do nothing is not helping anyone but yourself.

If I had a dollar for every time I heard a premed or medical student say they want to be a doctor to help people, I could work for free because I would be independently wealthy enough to do it.

Perhaps it is time to qualify that with some truth.

“I only want to help people if it is convenient, doesn’t require responsibility, takes very little effort, and pays well for doing absolutely the minimum possible.” That is what modern medicine really is. It doesn’t matter if you are in Poland or the USA. Just ask a dermatologist. It is all about minimal effort.

There are a handful of people I have met who are not like this. But are by far a very small minority.

When did this idea of doing nothing start? Where? How did it catch on?

Whether it is convenient or not, the foreseeable future of medicine is a combination of medical knowledge and surgical skill. More so everyday. To their extreme credit, specialized emergency doctors I know get this. They take it as a challenge to be met.

I must recognize and admit, my thoughts that EM should not be a specialty was biased because of the ability of a small number of outstanding non-EM providers I saw doing an admirable job in the ED and on ambulances.

For the rest of the quacks who make their patients suffer for their convenience, please do everyone a favor and go find some job with no responsibility or effort like working the grill at McDonalds.

If any lawyers need an expert witness to sue one of these charlatans, I am available for only the cost of transporting me to your court. (sorry, I am not wealthy enough to take a loss)

Touch your fucking patients. Help your Fucking patients. Earn the title and respect of being called “doctor.” At the very least, earn your pay cheque!

Your job is to help. Not talk about what you don’t or can’t do.

I am supervised by people who can’t do shit! Otherwise I am supervised by people who won’t do shit. I hold out hope for the former.

If you don’t know how. Ask, and I will teach you myself.


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