The fake surgeons

June 8, 2008 at 12:03 pm (Clinical rotations)

A few months ago I wrote a post about psychiatrists’ being fake doctors.  I stated that their inability to manage diabetes and hypertension disqualifies them from using the term “physician.”  Today, I would like to extend that similar reasoning to the obstetrician/gynecologist: the ob/gyns are fake surgeons.

All throughout medical school ob/gyns promote their specialty by saying, “We practice both medicine and surgery.  We see patients from across the lifespan.  Praise us because of our vast repertoire of knowledge.”  Things simply don’t work like that.

One immediate example is the multitude of second-year and third-year residents who are unable to tie suture knots.  The ability to properly place sutures (“stitches,” as they’re called outside of medicine) is a skill that every doctor needs to acquire before graduating medical school.  Certainly, I would expect all surgeons to be able to tie knots and appropriately perform simple surgical techniques.  However, I have seen residents who time and time again must be re-taught methods of one-hand and two-hand knot tying.  During many of these operations once the attending leaves, the third-year medical student takes over and finishes closing the patient.  That perfect line on your belly from your C-section?  That was me.

I’ve seen simple surgery such as laparoscopic hysterectomies take many hours solely because the attending in charge does not know how to use the equipment.  If you’ve ever seen the bariatric surgeries on television, you’ve noticed that the surgeons hold one instrument in each hand to perform the operation.  They then control the movement of the instruments using only fine finger motions.  My own attendings are so inexperienced that they grasp the entire instrument with one hand to prop it up, and then use the other hand to manipulate its movement.  The result is a need for additional hands (additional surgeons), wasted effort leading to fatigue, and an almost doubling in the amount of time necessary to complete the operation.  In one particular case I was extremely annoyed when the attending tried to teach me anatomy by turning around the camera within the patient’s abdomen so that she could point out the liver and gallbladder.  Well holy shit, lady!  I would’ve never been able to figure out where the liver and gallbladder are.  Thank you for halting the operation, singling me out as a medical student, and then showing me such basic anatomy as far as where the liver and gallbladder are.  All of that time on my general surgery rotation I had imagined that those organs were within the legs.  Thanks for correcting my ignorance.

Due to the need for additional hands (more residents), these cases get so overcrowded that the students take no part.  When I did surgery, students typically held retractors and a conversation flowed with the attendings.  Now, I don’t touch anything, I can’t see anything, and on several occasions I have had to completely step away from the surgical field because of all of the bodies pressing around the patient.

Perhaps the most annoying comment is the one about treating patients from across the lifespan.  Given that they only see women who are of either childbearing age or postmenopausal, I would say that they have a very small subset of the population.  Further, their lack of medical knowledge is astounding.  For a specialty that promotes itself as performing both medicine and surgery, I would expect them to better able to manage hospitalized patients.  When asked on rounds how to work up a patient with tachycardia (a fast heartbeat), my resident replied, “Consult with internal medicine.”  His name was instantly added to the growing list of physicians that I would never let my family visit.

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22 Comments

  1. medschoolmemoir said,

    Thanks for the awesome post!

  2. guest visitor said,

    Perhaps the quality of physicians with whom you interact is a reflection of the quality of your medical school and its affiliations.

  3. Blast, MD said,

    Thanks for the post, Half. Can’t wait to start rotations next month. So many stereotypes, so little time.

  4. Bostonian in NY said,

    Wow…just wow. I don’t have OB until January, but I’m not looking forward to it.

  5. Matt said,

    Yawn.

    Man, that’s pretty crumby to stereotype entire specialties based on the small subset of people you’ve worked with and cases you’ve seen. Whatever, you’re entitled to your opinion.

    Now, I’m off to write a blog post about medical students who pose as tech-savvy writers when they can’t even change the basic, default WordPress theme on their site. [Insert over-dramatic eye-roll and exhalation.]

  6. Graham said,

    Yeah dude, not cool to randomly rip on other specialties. Just because you have some bad residents, you as a med student are going to evaluate the field? Come on. Get off that high horse.

    Clearly you haven’t had enough clinical rotations to see things from any other perspective but the one you’re on. Learn to judge a little bit less.

  7. Supremacy Claus said,

    Yo, Half: Psychiatrists can manage hypertension and diabetes. That pays too little, wastes their time, when less trained people, such as nurse practitioners, do an excellent job of that basic medical treatment.

    Let’s see you manage a schizophrenic who beat up the police, running about naked, in a foot of snow.

    This is not well known. Psychiatry is just about the highest paid medical specialty, when done properly. I include a comparison to such lucrative fields as a plastic surgery practice in Hollywood. That is an endorsement of its value as a medical specialty, by the public.

  8. Cataract Cowboy said,

    Dear half.md. Anyone who has to suture a wound obviously made the incision too large.

    In my specialty no entry wounds are larger than 3.00 mm and self sealing.

    Supremacy Clause: I agree, I tried to get into a psych residency, but only was accepted to an eye program. I even tried severe depression during my training period..No Go.

    Why would anyone want to be a surgeon?

  9. GingerB said,

    “Given that they only see women who are of either childbearing age or postmenopausal, I would say that they have a very small subset of the population.”

    Humm – women who are of child bearing age or those who are post-menopausal. Last time I considered that it’d be about half the population.

  10. Ch3MD said,

    You have issues. Sounds like you’re either a very angry person, or think you know everything. I’m so glad you’re there to save the case “That perfect line on your belly from your C-section? That was me.” Now I’d like to see you do a stat repeat C/S on on a 300 pound patient with an anterior placenta previa that is abrupting, and deliver the baby alive.

    You should go back to your basic statistics course and review a few basic concepts. First the “bell curve”. In any medical specialty, any field/career, med school class, or any population, there are superb / exceptionally gifted people, there are good people, there are average people and there are really bad people. Then you should review the concept of sample size, and how it is hard to accurately describe a population with a small sample size.

    You have the nerve to trash and denigrate an entire specialty based on your “vast” experience. Let’s guess, you have probably rotated with maybe 5-10 residents at one hospital in one program, and maybe (if you’re lucky) had contact with 10 attending physicians.

    I’m really sorry if you have had a bad rotation in Ob/Gyn. My rotation in internal medicine and peds was really lousy, abusive resident and abusive attending. But I don’t hold it against the entire field.

    You may be booksmart, but based on your post, you lack the maturity to function “in the real world” of clinical medicine, to accurately evaluate people and avoid stereotyping.

  11. Mike said,

    Supremecy Clause

    Please make sure you ask specifically for NP’s and NEVER ask for an Internist. Since the NP’s are so “excellent” at treating medical disease, I wouldn’t want you to accidentally be treated by a doctor.

    Only NP’s and PA’s for you…only the BEST!!!

    (If only the truly brilliant “Supremecy Clause” knew how the NP’s at my institution actually treat patients. Here’s a clue: it’s a lot of GUESSWORK on their part)

  12. Ch3MD said,

    “Thank you for halting the operation, singling me out as a medical student” – Sounds like you are embarrassed to be a student, or is it that in your mind, your really an attending.

    “In one particular case I was extremely annoyed when the attending tried to teach me anatomy” – what would you like to be taught in the OR?

    “Given that they only see women who are of either childbearing age or postmenopausal, I would say that they have a very small subset of the population.” – well this covers age 13 to death. I like to think that the span from 13 to death is the majority of one’s life and not a “small subset” of it.

    “When asked on rounds how to work up a patient with tachycardia (a fast heartbeat), my resident replied, “Consult with internal medicine.”” – This is an example of defensive medicine. You have no idea how it feels to have every decision, every judgement criticized when going through a malpractice lawsuit. IF you haven’t noticed, but Ob/Gyns get sued often.You function in that very safe cocoon of being a medical student where nothing can hurt you. It’s very different when your the one who is truly responsible.

  13. halfmd said,

    The value of psychiatry by the public? The public thinks that shrinks are a bunch of whack jobs who are sleeping with their patients. Insurance reimbursement rates for psychiatrists are extremely low, if that’s your indication.

    Indeed, practitioners can become very wealthy as you noted, but that’s only when they go to a cash-only business.

    And yes, I can manage a schizophrenic who’s been hitting police officers. It’s called a five and two. Our attendings were very fond about doling it out.

  14. Blast, MD said,

    I’m sorry, but I’m lost as far as the comment from Supremecy Clause goes.
    Last time I checked, psychiatrists are NOT well paid. There is potential to be well paid if, as stated above, the psych were to run a cash-based practice, but that would mean that you would NOT be taking care of “schizophrenic who beat up the police, running about naked, in a foot of snow.” – That would be left for the poorly reimbursed psychiatrists and the Emergency Physicians.As far as useful utility goes, if you base your benchmarks for usefulness of specialties based on what Hollywood thinks and compare yourself to plastic surgeons, then you should know that the rest of us in medicine think you’re full of it. Really? Comparing yourself to plastic surgeons because Hollywood decides they are both necessary. Like every other subject, Hollywood is clueless. But I’m sure plastic surgeons are just as good at managing diabetes and hypertension as the psychiatrists….good luck with that.

    Somewhere above someone commented that the Ob/Gyns called the Internist to manage tachycardia out of “defensive medicine.” That’s Greek for “I don’t know what Im doing and I’m too scared to look it up like I should, so i will drive up the costs of medicine on useless referrals that a competent physician could handle.” I’m not saying we don’t need to work as a team, but let’s get real–defensive medicine because you are scared of being sued? maybe you should read up on the AMA’s research about what patients are really looking for when they sue–> admitting there was a mistake and apologizing– this has been shown to actually decrease lawsuits if patients and physicians can meet on common ground.

  15. IVF-MD said,

    Most of the REAL med students I work with are nice optimistic people with kind hearts and positive attitudes. But every once in a while, there are a few FAKE med students who are bitter and hyper-judgmental. =)

  16. nyublog said,

    Psychiatrists are seriously a joke. I once had to visit one for three sessions. I was suppose to go to a fourth, but, after enduring the first three – I had enough. We talked about how the brain functions. What did I walk away with? Knowing that some people make $400 for discussing crap you talk about in a coffee house. Pathetic.

    Oh, and I had to endure a waiting room with total depression morons who couldn’t laugh for anything. And, some REALLY bad jazz music. Oh god.

    -x-

    As for the other posters – Oh, quit it. You guys are really annoying. Half MD speaks from a very nice perspective. So what if they are full of themselves? I rather have a CONFIDENT person cut me, over someone who sooths me and tells me everything will be fine.

    Half – Keep up the great work. I’ll be checking daily. :D

  17. Maggie said,

    Half – I feel sorry for you. You sound so bitter and unhappy, although maybe that’s just that you vent in the blog and in real life you are a happy, confident person.

    It sounds like you have hit a bad area, that doesn’t mesh at all with your personality, and maybe have even hit some bad residents/attendings. Sucks, but it does happen. This, too, shall pass.

    Re: psychiatry. Depending on where you work you can make lousy money or really good money. I know at least 1 who makes a better income than most surgeons in the area; xe is employed by a major city to see arrested persons.

    OB/Gyn: Yes, most OB/Gyns CAN treat hypertension. But, look at it this way: since their MAIN focus is OB/Gyn, they may not be totally up to date on the best treatments for new onset HTN. And maybe that new onset HTN is more than just essential HTN. Maybe it’s renal. Maybe it’s a brain tumor. Wouldn’t you want a team effort to make sure the patient is getting the best care? Oh, and by the way…women make up half of the population, in case you hadn’t noticed. Women in their child-bearing/menopausal years, as pointed out above, can be from 12 or so till death. That’s FAR more than a “small subset of the population”. And yes, OB/Gyn’s DO see women as young as first menarche (no age given because the range can be so great).

    Nurse-Practitioners: Like most medical people, there are good ones and there are bad ones. The good ones can treat common problems as well as an MD, IF the cause is a common one (i.e. once a patient has been dx’d with essential HTN, it is easy for an NP to maintain tx. If a Quick-Strep is positive, an NP could easily prescribe antibiotics.) The education may not be as rigorous as a physician’s; that’s why NP’s, in most states, practice under a physician’s guidence or mutually agreed-upon protocols. They save the MD time and money – cheaper pay than another MD, cheaper malpractice insurance – allowing the MD to spend more time on people who really need his expertise.

    After all, Half, you are bitching and moaning about your future residency. Wouldn’t you love to let a NP see all the colds, ear infections, flu symptoms, allowing you to see all the neat, really SICK people who need a physician’s monitoring?

  18. Fareed said,

    Hello halfmd! I’m a fellow med student and I have been reading your blog recently. I have just started my own blog (http://medschoolishard.blogspot.com/ … yes, that’s “med school is hard”) and I was wondering if you would be willing to link to my blog in your links section. In return, I would be happy to do the same! (My blog is kinda a satirical look at everything medical school stands for. Also, it’s not supposed to be personal, so I don’t have my name on it anywhere :P ) So yeah, that’s all I wanted to say, so please let me know! Thanks so much!

  19. Sharon said,

    Wow, you’re well on your way to becoming the arrogant surgeon you desire to be. Good luck with that.

  20. David said,

    The most burned out and bitter residents I’ve worked with, during medical school then elsewhere during residency, was ob-gyn. Many consider themselves good at medicine and surgery, despite that their claim to fame is checking lipids on patients during a yearly physical. Once I asked a resident about one of our patients with a heart murmur and she was like “I don’t care, I’m a surgeon not a doctor!”

    I worked with some good obgyns that really enjoyed teaching, and I worked with some attendings and residents who were beyond awful, mean, hated their lives and just wanted to take it out on the students that were stupid enough to show up.

  21. Jennie said,

    I agree with IVF–MD and Maggie.

    I do enjoy reading your blog. It reminds me that medical education is difficult and long. I know, though, that it will all be worth it.

    Why are you even pursuing medicine? for money and prestige? I hope I never have you as a doctor. All the doctors I have come across were kind and compassionate. From your bitterness and anger flowing from your blog, it seems like you are well on your way to burnout before your training is even complete.

  22. Anonymous said,

    I’m a 4th year medical student, like yourself. I must say though, this is quite an arrogant post of you to say that psychiatrists and ob/gyn’s are not real doctors/fake surgeons/etc.

    Seriously…Can you make such a harsh generalization with 1 year of clinical experience or even with 50 years down the road? You have no place to be calling your peers and colleagues fake physicians.

    Even the psychiatrist could teach you some stuff. Remember, they are board certified by the ABPN – American Board of Pyschiatry & Neurology. 50% of the boards are in Neurology. I’m pretty sure they know a thing or two.

    -Anonymous, MS IV
    Future Hospitalist (the “real doctor” for you)

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