Wednesday, January 27, 2016

My response to a misguided opinion piece about surgery

"There is no place for the surgeon myth in modern medicine" says writer Alexis Sobel Fitts in Aeon Magazine.

Having a sister in medical school apparently qualifies Ms. Fitts to critique the specialty of surgery.

She starts with an old joke "An internist can figure out what’s wrong with you, but he can’t fix it. A surgeon has no idea what’s wrong with you, but he’s happy to fix it." If you read it carefully, you should note that it’s not that funny, and it’s wrong on both counts. No surgeon would ever fix something unless she knew why, and internists have these things called pills which can successfully treat a number of diseases.

She goes on, "After all, fixing problems is corporeal, often removed from the more intellectually nimble task of diagnosis." Apparently she is unaware that surgeons often make diagnoses—occasionally even correct ones, and I’ve written before about the misconception that doing an operation doesn’t require thinking [here and here].

"Surgeons are descended from the barber or the butcher," she says. That was hundreds of years ago. Nowadays, surgeons complete four years of medical school just like her sister and all the other doctors.

"Any missteps might incite devastating consequences, as the surgeon navigates around the vagus nerve, which dictates facial response…" I hope her sister didn’t give her that information. The vagus innervates many structures, but the face isn't one of them.

"Before anaesthesia and antibacterials, a patient undergoing surgery could be assured of two things: immense pain and the likelihood of infection and death." That’s actually three things. Of course without surgery, patients experienced immense pain, infections, and death anyway.

"Since the 1950s, laboratory science has increasingly been the origin of medical innovation. Which is why, over the past four decades, merely a 10th of the articles published in The New England Journal of Medicine have covered surgical innovation." Or maybe it's because The New England Journal is a medically, not surgically, oriented journal.

Here’s the winner. "Surgery’s place at the bottom of the medical hierarchy can be attributed to the crude cruelty of early surgical procedures." Other than Ms. Fitts, who has placed surgery at the bottom of the medical hierarchy? It’s certainly not US medical students who make the surgical specialties among the most competitive of all.

In the 2015 resident match, surgical specialties filled their first-year positions with 80% or more US medical school graduates. In fact, orthopedics matched with 94.3% US grads. Compare those numbers to internal medicine and family medicine, which filled their first-year positions with 49% and 44% US graduates, respectively.

Here's what Wikipedia has to say about its Aeon Magazine entry:

This article has multiple issues. Please help improve it or discuss these issues on the talk page.

The neutrality of this article is disputed.

This article contains content that is written like an advertisement.

This article contains weasel words: vague phrasing that often accompanies biased or unverifiable information.

That pretty much describes the Aeon essay about surgeons too.


Chris said...

I could imagine a thoughtful piece critiquing the "surgeon myth" per se... as in the red-faced, shouting master of the universe stalking the halls of the hospital berating and throwing surgical instruments at anyone who has the misfortune to get in their way. I think it's safe to say we ought to have moved beyond that.

She seems to be saying, "we don't need surgeons at all," which is not interesting or insightful. It's just baffling.

Skeptical Scalpel said...

Good comment. I don't know what her point was. She tried to build a case that surgeons and surgery are bad. I don't think she succeeded.

daco said...

Makes me wonder if a surgeon yelled at her sister once. Pure baseless speculation, of course, but just as evidence-based as any of the assertions she makes in her article.

Doesn't make me see Aeon as a site worth perusing.

Skeptical Scalpel said...

daco, you may be right. Or maybe her mom was scared by a surgeon when Ms. Fitts was in utero.

Ganesh Puttu said...

what if she goes into an RTA and came into the hospital with multiple injuries? would she prefer to have an internist "see" her then too?...but on the other hand-there is no arguing with idiocy- so waste of time to debate these kinda people further

Skeptical Scalpel said...

Ganesh, good question. I don't think she thought this through. Or she might have just been looking for clicks. If it's the latter, it worked.

Joe Niemczura, RN, MS said...

I don't pay such articles any heed. I'm glad you did, though. Persons on your list who wish to read a better description of what it takes to be a surgeon are invited to read my own book,

Anonymous said...

I was originally attracted to this article by the title - I think we need to move away from the 'hero' paradigm in all of medicine. However. I too was very disappointed by this poorly written 'thought' piece.

Anonymous said...

While I have had & seen surgeons who fit the "myth", there are also good ones. The article was way over the top.

NeuroTrumpet said...

It's satire, right?
Tell me it's satire...

Skeptical Scalpel said...

Neuro, I don't think so.

Anonymous said...

Couldn't imagine myself writing such an ill-informed piece on another profession if i tried.

Anonymous said...

Maybe you all spoke too soon? LOL.

Or maybe he had the backing of other health care workers AND patients?

Skeptical Scalpel said...

I think we've all felt that way about hospital administrators at some point. We just never said it out loud. He doesn't look to happy in that photo.

However, he is just one surgeon -- hardly an indictment of all surgeons.

Oldfoolrn said...

I don't think this person is being serious, just look at her name, Ms. Fitts = Misfit. Some of the very best surgeons I scrubbed with were fond of screaming at me, a lowly scrub nurse. It is one of the things I miss the most about working in the OR.

Skeptical Scalpel said...

Ms. Fitts? How did I not see that? Got a good laugh. Thanks.

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