* * Anonymous Doc: Confessions of a Surgeon

Monday, January 2, 2012

Confessions of a Surgeon

A Twitter follower asked if I could put titles on the posts to make them easier to share. Anything to please my Twitter followers... :) And, really, anything to make the blog easier to share... so I've gone back and added titles to the last half-dozen posts or so, and I'll make a post title for new posts going forward. Happy to do whatever would make the blog easier to share with others, so let me know if there's more I should be doing.

A friend sent me an book excerpt today from The Wall Street Journal-- from a book called Confessions of a Surgeon, that's apparently coming out tomorrow.

"Get this thing out of my operating room!" The colon stapling device exploded into pieces when I hurled it against the operating room wall.

Basically seems like the stereotypical surgeon. A bunch of the comments on the piece are either (a) What a mean guy, I don't want him operating on me, or (b) Oh, nothing like that would ever happen in my hospital, at least not in the present day.

I don't know. (a) I don't know if I care so much about how nice a surgeon is, as long as he's good at what he does, and (b) Maybe they don't throw things, but they definitely still scream.

It may be silly, but I think bedside manner does matter a lot more on the medicine side than surgery. They're not forming relationships with patients, they're not following them through the entire course of treatment, and certainly not for months and years and decades. They're technicians, in large part. They need to be good at the specialized skills they practice and when they're dealing with you, it doesn't matter if they're screaming, because you're under anesthesia anyway. "Seems like a surgeon" isn't a compliment, if you're talking about someone's personality. The personality to want to be surgeon is like the personality to want to be an investment banker. You are important, you are skilled, but it's about adrenaline and power and technical skills, not necessarily about comfort and hand-holding and relationships. There are exceptions, sure. Personally-- and obviously this is a generality, since I've read a lot of terrific books by surgeons-- I'd rather read a book by someone on the medicine side than a surgeon, because I'd expect it's more likely they have feelings. The excerpt in the WSJ neither shocked not surprised me. I guess it only surprised me that so many people commented on it, and were in fact surprised. Then again, if I could figure out how to get 351 comments on a post over here....


  1. Commented!

    Pay no attention. The WSJ article was egotistical and sloppy, clearly hoping to be a Richard Selzer, but not coming even close. A talking colon? Paul may have learned that rhetorical device in 6th grade, but it doesn't mean the colon should have an equivalent vocabulary.

    Your posts are always refreshingly simple and direct. A sort of daily "The House of Demigods," if you will. I share this blog widely and often. Thanks so much for posting!

  2. your posts are great! keep up the good work

  3. meh, that excerpt was pretty sensational and that guy sounds like a tool trying to sell a book. Atul Gawande he is not.

    Does that kind of stuff happen? Sure. We get SUPER pissed when we are "encouraged" by the hospital to use some fancy schmancy tool that doesn't even work properly. When those staples don't fire properly, it can be a shit storm (figuratively and literally). He seems like he is harping on his patient's Obesity, which is definitely a work-out to deal with in the OR. but in this era of 35% of America being overweight/obese (http://www.cdc.gov/nchs/fastats/overwt.htm) he needs to get over it, or offer everyone a bypass.

    I do resent the fact that you don't think we surgeons have feelings. We take it personally when our patients dont do well/die, thus the yelling and throwing of fits. This obnoxious behavior has been tolerated for many years, but seems to be dying out as the face of surgery is diversifying. Dr. Greenfield (yes THAT one) was forced to step down as incumbent President of the American College of Surgeons due to some sexist crap he wrote in the news letter... I definitely do follow my patients through the course of their treatment. Just because I am not titrating their bp meds for a bazillion years, doesn't make my work less valid.

    I resent being labeled a "technician." I can cure cancer with my Hands (I know I know, "thus the God complex" but it is True!) I have definitely met some Internal Med docs who were a-holes; and from your posts (albeit edited and seemingly for humor) doesn't sound like you are "into" that much hand-holding yourself.

  4. Some one who SHOULD write a book is this guy http://ohiosurgery.blogspot.com/

  5. SurgeryChick: Didn't mean to generalize-- absolutely there are surgeons with feelings and plenty of medicine docs without. The responsibility and stress on the surgery side would kill people like me (...not to mention that the hours even post-residency aren't always so friendly...). It's one thing to come up with treatment plans, it's quite another to know that if that stitch comes loose, well, that patient's dead.

  6. "I resent being labeled a "technician." I can cure cancer with my Hands (I know I know, "thus the God complex" but it is True!)"

    In what way does being able to cure (some instances of) cancer "with your hands" mean you aren't a technician? Can it not be the case that the resection of a malignant mass is technical in nature?

  7. Here's another comment for you! I enjoy your blog, but I just don't have much to say. And I'm sure there are many more like me (at least 350 more)!

  8. Anon Doc - I love your blog and read it religiously. It's bookmarked on my bookmarks bar next to the New York Times. I recently decided not to go to medical school (not because of your blog), but I'm sure I'll continue to read this while I pursue my other life trajectory

  9. I think the bedside manner is probably still important for surgeons, though I agree that it shouldn't really matter to the patient what they act like when the patient is under anesthesia. I recently had an experience with a breast surgeon whom I really didn't like -- she didn't explain things to me and generally acted like she thought I was trying to get away with something... it was weird -- and so I never went back to her.

    I do have to agree with the technician bit -- I know surgeons like to think of themselves as artists, but they are also a lot like carpenters, plumbers, and electricians. Not to downplay what they do at all, but surgery is a trade just like many other fields.

  10. I didn't go through all of this pain and suffering (and $250,000 worth of loans) to become a plumber. Thanks.

  11. Hey, plumbers make more than residents do. And, uh... end up dealing with some of the very same bodily fluids. Then again, I would neither want my surgeon fixing my toilet nor my plumber fixing my spleen.

    Thanks to the folks who've commented. Sometimes just like to feel like there are people out there. Much appreciated.

  12. @Surgery Chick -- Of course being a surgeon is not "the same" as being a plumber. That doesn't mean that surgery isn't a trade. A plumber can't do an electrician's job, and you can't do what a pulmonologist does either.

    I don't get why saying surgery is a trade is so offensive to you.

  13. It may be silly, but I think bedside manner does matter a lot more on the medicine side than surgery.
    Not sure I agree. If the surgeon is only dealing with emergencies, maybe bedside manner doesn't matter. Otherwise, it does. When I was referred non-emergently to a surgeon, he criticized both GI docs I'd seen, then criticized my PCP's treatment plan, then yelled at me for waiting instead of having the surgery years ago. I did not get the impression that he was a wonderful surgeon who I wanted cutting holes in me; I thought he was an arrogent jerk. I returned to my referring doctor to get a referral to someone else. I want a doctor who is both highly skilled and socially adept.

  14. One of my best friends is a surgeon. As she put it to me, if you're going to take a knife and cut into someone's living body, you had better think you're the best person to be doing that, or you have no business being a surgeon.

    I've had health-related interactions with surgeons over the years; I've met a couple of jerks, but on balance my favorite doctors are surgeons.

  15. Anon MD, I love your blog.

    I mean, I REALLY, REALLY love your blog. Please, never change. (Especially to white text on black background - not if you love us back, that is.)

    I don't have much relevance to add this discussion (like most discussions), but I will share a little bit about my dad.

    He's a retired airline pilot. I spent most of my 20s outraged and indignant about his complete lack of social skills, brusque manner, and compulsion to ALWAYS BE IN CONTROL. Then someone pointed out that he used to steer a tin can stuffed with hundreds of people through the sky.

    Good thing he's always in control.

  16. Hello Anon,

    Lurker here. I read your blog religiously and absolutely love it. Also I stepped on a glass this year and had to have 8 pieces surgically removed (the surgeon only found 6 pieces). He was magnificent, both in the OR and with his bedside manner. Guess I got lucky.

    Keep up the good work!