For non-surgeons, the surgical rotations are always a bit of a trial. The surgical/medical divide is real so spending months on the other side of it can be a challenge. I guess clerkship's worse for the surgical gunners though - I only spend 3 months or so in surgery, but they spend almost all of clerkship out of it!
Anyway, continuing on with my series, here is what I liked and didn't like about my surgical rotations.
1) I get bored during operations
I encourage everyone to step into an OR or two early in pre-clerkship. Surgery, despite it's terrible job market and long hours, is still very competitive overall and it's worth knowing whether you may need to push for it as a potential residency option. My guideline is that when you step into the OR, unless it's something obscure and weird, you have to love what's going on. Being interested isn't enough - the road to becoming a surgeon is too long and arduous to sustain mere interest, you need to be enraptured by the whole thing.
The first time I stepped into the OR I was, at best, mildly intrigued. I knew at that stage that I wasn't a surgeon. Now, after months in there, I'm downright bored. I understand the basics of what goes in the OR and the details don't interest me in the slightest. Definitely not a surgeon.
2) Love the surgical attitude towards medicine
When it comes to medical management of patients, nothing beats the typical surgeon attitude - they're clear on what they do and what they don't do. What they do they do quickly and efficiently. No debating things back-and-forth for half an hour - a decision gets made that's that. That does mean some things they probably could/should handle they pass off to others and, in an ideal world, physicians would take responsibility for the totality of their patients, not just the parts they want to manage. However, the alternative I've seen has been physicians trying to do too much and stepping on each others' toes, creating confusion for patients and providers alike. Again, in an ideal world, stronger communication between physicians would occur to address this problem, but clearly defined roles can be an enormous benefit whether proper communication occurs or not.
3) Don't love the surgical attitude towards people
Surgeons can be judgmental. Really judgmental. Of patients, of physicians (especially non-surgeons), of other healthcare staff. Don't get me wrong, physicians in general are fairly judgmental as a group, but surgeons seemed to be more blatant about it. Some of the attitudes and statements bordered on unprofessional. As with most places, it was a distinct minority who were the main culprits in these activities - in fact, some of the best staff and residents I've worked with were on my surgery block. However, that minority was entrenched enough and vocal enough that they seemed to influence the overall culture. A physician or resident who was needlessly harsh on a patient, subordinate or colleague was often encouraged or at least tolerated. On the opposite side, kindness and understanding were occasionally mocked. I have no doubt that these were meant as jokes without maliciousness, but that seems a distinction without a difference - in either case, a negative attitude towards others was fostered.
4) Long hours, little sympathy
It goes without saying, but hours in surgical specialties are LONG. 10 hours at the hospital is a short day. 12 is typical. 13 is within the normal range. All told, on average and after considering things like travelling to the hospital or doing the bare minimum to perform my clinical duties, I had between 10 and 11 hours of my own time for non-call days. That's as little as 10 hours to eat, sleep, study, exercise, spend time with my SO and my dog, and pretend to be a normal human being. I mostly ended up shorting myself on sleep and exercise to preserve a tiny amount of time with my SO and to study. It was sheer exhaustion and I feel like it's going to take a long time to recover from this level of fatigue.
Of course, as a student, you get zero sympathy. Residents work even longer hours, with more responsibility, and have been doing it for years. Staff went through the whole process and still tend to work long hours deep into their careers. Moreover, it wasn't too long ago when students had it much, much worse. Still, better doesn't equal good, and we're still a long, long way away from having anything resembling reasonable working hours in surgery.
5) Camaraderie
Surgical departments are small. There aren't that many staff and the number of residents coming through each year is considered large if it hits half a dozen. Many surgical residency programs take only one or two each year. Over the 5+ years, it does become obvious that the staff and residents end up knowing each other well. The residents especially seem to understand that as hard as it is to get through their residency, they're in it together. The best way I can describe surgery is like being in a frat, with both the good and the bad that come with it. The familial, laid back atmosphere was definitely a positive, and in sharp contrast to some larger specialties that weren't nearly as closely knit.
6) The Happiness Test
Are surgeons happy? Nope.
Ok, ok, it's not that clear cut. Many seem to really enjoy their work, especially when they're at the staff level and in the operating room. Yet, by and large, I didn't see many overly happy people. Frustration and exasperation were common occurrences. I wasn't the only tired person there, it was obvious on the faces of some residents and staff. They were determined and resilient, but it's hard to call someone happy when they're still in the middle of the fight.
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