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The surgeon will (quickly) see you now

surgeonThe common critique of surgeons lobbed from their medicine colleagues is the scant amount of time spent with their patients. As the argument goes, surgery is more impersonal than other specialties and those who practice it see their patients in one dimension.

In some sense, they aren’t wrong.

For those who wield the scalpel, speed and efficiency are priority, a philosophy perfectly illustrated during morning rounds, the daily tour of patients and perhaps the patient's only meaningful encounter with doctor of the day. For the surgery team, rounding on a patient requires only a fleeting moment to gauge a pain level and to examine dressings. The entire ritual is done just as the morning sun peeks over the horizon. The medicine team would be lucky if they were to finish before noon.

This apparent disconnect between surgeon and patient doesn’t end there. In fact, it grows wider in the operating room as the patient’s body is covered with layers of sterile drapes and disappears from view. The face is hidden behind a blue curtain and only a football-sized area of skin is unveiled. The patient is reduced to a mechanical collection of wires, tubes and tissues. And though the surgeon may share intimate quarters with the patient’s body for several hours, they are in two different worlds.

One of the stubborn trends that the medical community appears to have grudgingly grown to accept is the slow erosion of face time with patients, siphoned away by the need to document every medical detail for insurance companies and the pervasive rise of electronic medical records. According to one study, residents now spend a paltry 12 percent of their time on direct patient care. And though most patients clamor for more personal time with their doctors, and doctors would like to spend more time with their patients, those who eventually receive the most attention from a surgeon are the ones who really need it, the ones whose situations are most dire. To have to go under the knife usually means all other treatments were exhausted, that safer, less invasive measures have failed, and that drugs couldn't rid the body of disease, which can now only be cured by resection.

And therein lies the contradiction in the relationship between the surgeon and the patient: Less face time with a surgeon, whether in the operating room or afterwards in clinic, means the surgery was without complication and the recovery is going well.

After finishing my surgery rotation, I can spot the patients who will eventually need more care and attention. They’re the ones with novel-thick medical charts who have been bounced back and forth between specialists and whose medical history reads like a grocery list. Most tellingly, they come to clinic with an unmistakable desperation in their voices, willing to risk anything to have a modicum of relief from their illness. Relief will come for many of them, but because their surgeries were so complicated, their recoveries will be long and fraught with danger as they remain in the hospital, vulnerable to catching more disease.

And so I've found the stereotypes somewhat true: Surgeons don’t spend as much time with their patients -- at least not the more fortunate patients -- as their medicine colleagues do. But for those less fortunate, the ones who do demand most of a surgeon’s time and attention and focus, whose operations require the most planning, and whose recoveries will need constant and careful surveillance, that face time might not always be welcome.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category

Steven Zhang is a third-year medical student at Stanford. When he’s not cramming for his next exam, you can find him on a run around campus or exploring a new hiking trail.

Photo by marionbrun

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