Surgery 2.0


Ok, so I stole the name from EMS 2.0…(Credit to whomever thought of it.)

In my journey through medicine, I continue to pursue my interest in trauma and emergency surgery. For the last 4 weeks I have been delegated to the cardiac surgery department. I have to say this is probably the best department I have been to in my whole time in Poland. Not just because they actually let me practice surgical skills, but because the people there are absolutely super human beings. (Perhaps a few think they are God, but we won’t quibble…) Really though, I found them to be strikingly humble for cardiac surgeons. During my time there though, I have noticed something about surgery.

Surgeons attempt to perfect the operations they do and have done yesterday, this is in contra to medicine where there is a constant effort to break new ground. (No wonder these people hardly ever get along) However, as surgeons are quickly discovering, this mentality is shutting them out of their future. You see it is medical disciplines that were first to adopt endovascular techniques. Surgeons have also perhaps mistakenly sought to improve their statistics by disqualifying people for surgery. As if that were not enough, surgeons have basically led the charge of hyperspecialization. No longer content with specializing in regions of the body, they have whittled themselves down to specific procedures on specific organs. What all this taken together means is that they are basically putting themselves out of a job.

The cardiac surgeons are acutely aware of this. They lament the short waiting lists to get cardiac surgery. They worry they will have trouble finding work. The problem is not new, but they are basically doubling down on the behavior that caused the problem. Notice I keep referring to cardiac surgery and not cardiothoracic surgery, because they have given up operations not specific to the heart and proximal aorta.

However, in one of my forest from the trees moments, I have noticed that there are really only a handful of surgical skills. The only real difference is where they are being applied. The fact is, you are either cutting something or sewing something. (Stapling counts as sewing) If you want to make this sound important you can call it “anastomosing.” I have read all of the literature on the idea of specialized surgeons reducing complications. But I sometimes wonder if it hasn’t become specialized to reduce an insignificant amount of complications or insignificant complications? The cost of training and supplying these hyperspecialized surgeons may far outpace the cost of complications.

I doubt that the respective medical disciplines are going to start turning over their endovascular procedures to surgeons to give them something to do. It may be the future of medicine is not only a combination of surgical skill and medical knowledge, but disease specific specialization?

One thing is for sure. Surgeons are definitely not on board with this future. It will be interesting to see how the future role of surgeons plays out.    


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