Trust in surgeons is high

Surgery is thus not merely about carrying out operations on patients – for patients are people, and people like to know that the surgeon is not just a technician, but a true-blue professional with warmth and feelings too

By Dr R Neerunjun Gopee

In general, the health sector and the medical profession in particular are the frequent targets of negative criticisms. Common in normal times, this was boosted during the Covid pandemic, when health services in all countries including the most advanced ones with the highest healthcare expenditures. Overwhelmed, they came under fire for their inadequate organizational response and incapacity to cope with the quasi-tsunami that the pandemic was. In many countries its protracted impact is still being felt, in terms of lengthy appointment times for consultations and needed interventions.

So, it was a redemption of sorts to see the positive vibes on the bright cover of the American Newsweek magazine recently. Below the headline ‘A Cut Above’ one could read the following reassuring words – ‘Why surgeons are the most trusted health care operators.’

Since I am a surgeon, that message naturally warmed the cockles of my heart, as the saying goes.  And just as naturally I promptly went on to read the extensive article that expanded on the topic to find out the details. Along with the views of several prominent surgeons in different specialties, it also had the typically American ‘Ivy League’ list of the best surgeons in major specialties across the country.

Two well-known common words came to the fore: trust and touch. Not a mystical or a magical touch, but just a warm, comforting human touch that signals healing, and that flows from the trust on which rests the sacrosanct doctor-patient relationship. Unlike in other specialties, where the doctor treats either with medications or intermediary procedures such as XRays/scans/ laboratory investigations, in surgery the patient literally hands over his body to the surgeon to operate upon, most often under general anaesthesia, and has no control whatsoever over what is being done: which he perforce assumes must be for his good.

And that is the reason why that fundamental element of trust is an absolute.

But before that stage in the patient-surgeon consultation is reached and successfully seen through to the expected outcome, many other factors come in: attentive listening and questioning, clarity in communication between the two parties, empathy and compassion, understanding, confidence, availability – these are some of the essential variables that colour the human and humane dimension that is the hallmark of any surgical endeavour. It can lead the ‘parties’ into a partnership that can even at times blossom into life-long friendships. Certainly, for me and a few of my seniors in our country, this has been our fortunate and happy experience, and that has contributed to make our lives mutually more purposeful and meaningful.

Surgery is thus not merely about carrying out operations on patients and being done with it – for patients are people, and people like to know that the surgeon is not just a technician, but a true-blue professional with warmth and feelings too, over and above being competent. In other words, humans like him or her.

On the other hand, surgery does not mean treatment solely by means of operation, for there are three stages that a surgeon goes through in the course of his professional career:

1. How to operate – i.e. learning the techniques of operating, ideally in an apprenticeship system, but nowadays supplemented by training in virtual reality mode where this is available;
2. When to operate – what surgeons call the ‘indication’ for operation, which includes its timing; and
3. When not to operate, perhaps the most critical of the three stages, which comes with experience and where the advice of an experienced colleague may need to be sought by the surgeon newly embarking on his career.

For often the young surgeon wanting to prove himself quickly is keen to do as many operations as possible, what in the jargon is called being ‘knife-happy’.

The fact is, however, that operation may not always be necessary even if this appears to be so initially. A judicious period of waiting and close observation may lead the careful surgeon to change his opinion about the need for surgery.

Further, any kind of surgery can be associated with complications, both during the procedure and afterwards, in what is known as the post-operative period. One must be trained to recognize and deal with these. For example, one of the most feared complications in any kind of surgery is unexpected and sometimes uncontrollable bleeding, which not only stresses the surgeon but poses an enormous challenge as he attempts to stop the bleeding.

In this context, the words of two famous surgeons come to my mind. Prof John Bailey, whose ‘Textbook of Surgery’ (co-authored with Prof Love) was the standard text for generations of medical students and trainee surgeons (at least in the Anglo-Saxon world) wrote in his account of emergency appendix operation in his other book ‘Emergency Surgery’: ‘I can train a monkey to do this operation in seven days, but if a complication were to develop during the operation, it will take me seven years to train that monkey to deal with it!’

The other surgeon is Prof Francis D. Moore, who was on the cover of TIME magazine when I was in HSC and had already decided then that I would be a doctor. In reply to a question from the journalist, he said, ‘There is no such thing as minor surgery or major surgery; there are only minor surgeons and major surgeons.’ Not until I became a surgeon did I fully understand the import and importance of these words, amongst others that even minor surgery can be complicated by an adverse event that requires as much skill to handle as when tackling a major procedure.

Of course, we are far from the days of the bloody wars such the Crimean War or the American Civil War, when surgeons had to, among others, amputate mangled or gangrenous limbs without anesthesia, with attendants holding down the screaming soldier despite a dose of opium or of a strong alcoholic drink. For the advent of anaesthesia has dramatically transformed the practice of surgery, which is now carried out painlessly and in a much safer environment to minimize the risk of infection.

The goals of surgery are universal: 1. Save life 2. Save Limb 3. Prevent infection 4. Prevent deformity – and they are aligned with the core objective of all medical treatment, namely: returning the patient to the community in the fittest state possible to fulfil his role as a useful member of society.

Readers interested to explore further these dimensions of surgical practice in the Mauritian context may wish to go through ‘My Most Memorable Patients’ (available on Amazon.com in Kindle format), which details the surgical encounters of about 70 patients selected from the thousands that were treated over a lifetime of practice.

Mauritius Times ePaper Friday 21 June 2024