These views on what makes up a surgeon are only personal meanderings of someone who should probably know better but I’ll be interested to review back to this in years to come to see whether things have changed or altered with all the dramatic innovations and alterations that are coming soon in our profession.
Once you’ve reached the stage where you understand that to be human is the first and most important prerequisite to work in healthcare (if we think anyone is less than this they shouldn’t be allowed in or should be expelled) then understand the physician first is critical before we become a surgeon, followed by an understanding of business and entrepreneurship and creative development and efficiency and then ethics to tie everything up together then we can turn our attention to the job at hand.
In its essence surgery is a practical skill or a trade.
Whilst around the edges are enormous amounts of complexity, the job itself is no different to any trade such a cabinet making or electronics or car maintenance.
You have to learn the job by practise and reflection on things that go well and reflection on things that don’t but getting your ‘hands dirty’ is one of the most important aspects of becoming a surgeon.
25 years ago, we understood this entirely and the social contract that we had with patients understood that too.
Junior surgeons would be able to work on patients and if things didn’t go as well as we’d hoped people would be more understanding of outcomes which were less than perfect.
The world has changed dramatically in this regard and the training of young surgeons is much more difficult and much more controlled.
I remember nights when I was 18 months out of dental school, suturing up face after face in A&E at Queen’s Medical Centre in Nottingham with no supervision whatsoever as the ‘senior surgeon’ at A&E.
Whilst this might seem wrong it certainly set me up well to understand how to suture.
Even when we turned up for our elective in 1993 in Dallas, we were extracting teeth at Parkland Memorial Hospital as undergraduates still with a year left before we would qualify.
All 4 of the boys who did that in Dallas become successful dentists in their own right, one as base of skull surgeon in Glasgow, another as a successful owner of multiple practices and implant surgeon, another as a successful family practice principle placing implants and me.
The experience that we gained, not only taking out teeth but looking after the patients whose teeth we took out in another country was utterly invaluable.
Whilst there is a structure available for people to learn to train how to be an oral surgeon, the places and pathways associated with that are so scarce and hard to come by that many people have to train in an atypical way.
As I’ve stated before in many times in these blogs often atypical pathways create more rounded and general individuals and some of the most successful people you meet have the most atypical pathways behind them leading to where they are now.
For young dentists wishing to enter into the world of surgery it’s essential to do jobs where they’re exposed to surgery on a daily basis.
It’s absolutely essential to work with people who are prepared to share and to discuss and to reflect and always to keep their eyes open to the opportunities to do more work.
Becoming a good surgeon doesn’t happen on 3 days a week, it happens on 24 hours a day 7 days a week for the longest possible time in the early part of your career.
I learned to hand tie sutures on the leg of a chair in my doctor’s residences using a piece of string.
I did this weekend after weekend until my boss would let me hand tie it on a neck dissection in surgery.
When I hand tie in the practice now people think that I’m trying to show off and they wonder how I learned to do it.
They find it hard to believe that I taught myself.
As with any job, as with any craft or trade, it’s application to the process and experience of the procedures that makes it better.
No one is entitled to be able to do this, a dental degree does not allow you just to walk into surgery.
A dental degree is like passing your driving test.
Only then do you learn how to drive a car.
So, in the past 6 posts I’ve laid out some of the ideas I think are important for people becoming surgeons and some of the areas I think are important for all of us to try to continue to develop to stay as acceptable and reasonable surgical practitioners.
Time for me to go and work at all of them to try to be a little bit better before my hands and my eyes give out and I’m unable to be a surgeon anymore.
Blog Post Number - 3188
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