[General] Surgery

What does it mean to be a general surgeon? In my eyes it has always been a surgeon capable of many operations involving a wide range of organ systems. "The jack of all trades, master of none" really described their work to me. However, the metropolitan hospitals in Australia had compartmentalised the specialty. It was broken down to subspecialties including head and neck, upper GI (gastrointestinal), breast, endocrine, hepatobiliary, colorectal, surgical oncology, trauma, transplantation. During their training, registrars were exposed to most if not all of these disciplines after which they could decide the range of operations they would practice for the duration of their careers. The very essence of the word 'general' was lost in a knowledge storm; an influx of knowledge impossible to keep up with.

So then, was it possible to practice as a generalist in the true sense? I asked myself repetitively. Could there be a way one could still be capable of performing a wide range of operations competently? Safely? Apparently it was still possible but limited to the rural and remote areas of the country; where thousands of people were begging for medical attention. Unfortunately the majority of doctors have consolidated into the major cities of most developed countries, leaving developing countries and country-towns up to the loyal locals... the people with the moral fibre and courage to fight against the odds.

Given my elective term is in general surgery at a metropolitan hospital in the capital of Turkey, I expected the same compartmentalisation. It could not be possible to perform a wide range of operations on such a large population. The consultants must share the workload based on the disciplines, I thought.

When I started, it was quite the opposite. The general surgical department's medical staff were divided into four groups of consultants, residents, interns and medical students irrespective of the subspecialties. Of course, certain surgeons performed more types of the same operation than others and vice versa. There were no subspecialties.

The operating list on my first day in theatre included:

1. Laparoscopic cholecystectomy, indication: cholelithiasis
2. Laparoscopic Nissen fundoplication, indication: gastro-oesophageal reflux disease non-responsive to conservative therapy
3. Abdomino-perineal resection, indication: T3N2Mx ano-rectal carcinoma 
4. Total thyroidectomy and right lateral neck dissection, indication: papillary thyroid cancer and lymph node metastasis 
5. Exploratory laparotomy and Hartmann's procedure, indication: large bowel obstruction on a background of abdomino-perineal resection for T2N2M3 ano-rectal carcinoma

I couldn't believe my eyes. After scrubbing into all of those operations on my very first day, it was clear to me: it's possible to be a 'general' surgeon. 

Hope is kindled.