Indecision Conundrum

"He's the best of the lot. He sees things others don't or at least things that others ignore & takes the final call." I heard a resident speak of a junior surgeon in my hospital the other day. He also commented on how others are scared of committing themselves to a line of treatment. Fellow interns, how many times have you gone through a file and read, "Dr.ABC has assessed the patient and suggested continuing conservative line of management with review if any change in condition"? It's definitely easier on the surgeon, it's easier on the relatives, but most importantly, quite often it's easier for the disease. 

Every few weeks, each hospital holds a Mortality & Morbidity meeting, to reassess what went wrong with the selected cases for review & offers advice on how to best manage similar situations in the future. I am yet to attend such a meeting, but have been told that every care is taken to be sympathetic to the state of the presenting doctor & avoid such terms as "accuse" and "blame". People die, that's the harsh reality of our profession, it's worse when they die due to human error; and mistakes do occur regularly. The worst errors are those of omission. But, sadly these are seldom discussed at these meetings. Not operating is often the easiest choice that a surgeon makes. This is most true when a problem is often complex and survival considered bleak. His morality rates are kept in check, he goes on perform surgeries where the prognosis is optimistic and everybody goes home happy, including the patient, albeit not for long. 

From what I can see, some of these surgeons ought to grow a pair. If they were so interested in watching from the sidelines, they should've become physicians instead. There's no sense of discovery, no enthusiasm of finding the unknown. What's so great about opening a patient for an appendectomy & finding an inflamed appendix? Nothing! Ever been in a massive surgery where they operated for something else instead? It's magical. You hope for a fruit and find a fruit tree instead; every surgeon's dream, or at least I used to think so. And while I'm at it, people need to stop treating the pancreas like it's the fucking plague. I agree it's insanely difficult, the protocols aren't well-defined & predicting a prognosis is often more difficult than the surgery itself; But, still! I'm sick of hearing people go on about what "should have" been done two, three weeks ago and how how the patient is now inoperable. This rant is dedicated this awesome surgeon who joined us at rounds today. I wish he'd come 10 days earlier, I would've witnessed one awesome surgery!