How can I become an excellent surgeon?
First, be a safe doctor.
Medical schools in Britain and Australia are almost crazy to teach young doctors who are "safe". The word safety represents the patient's demand for safety.
This requires young doctors:
Do not pursue individual heroism;
Do not make cricothyroid incision immediately when the airway is threatened;
Don't open your chest and massage your heart after watching two American dramas.
A good surgeon is not afraid to tell others: "I don't know", "I didn't do it", "Please help me" and "please teach me" because he puts the safety of patients above self-esteem!
Be an artist who decides life and death.
Surgeons make decisions that affect life and death, quality of life and the future of others every day. This is the real courage.
Surgeons make life and death choices every day, which determines the quality of life and future of others. This is real courage.
Doctors have to go through life and death choices, but many choices made by surgeons are made in minutes or even seconds. This is not only a bold decision-making ability, but also an art of seeing through life and death.
Lung cancer patients with hypercoagulable pulmonary embolism, anticoagulation treatment of tumor will lead to catastrophic bleeding, anticoagulation treatment of pulmonary embolism will take away his breathing ability, anticoagulation?
The abdominal cavity in front of the trauma patient is a bottomless blood pool, and the patient's blood pressure cannot be measured. The monitor makes harsh noise, and your mind may flash 10 suspicious bleeding spots and 20 ways to stop bleeding, but the patient is only 2 minutes away from the gate of hell. What should I do?
Migrant workers who move bricks for a living are crushed by machines, and amputation makes their families lose their only labor force. Three children may not even be able to eat, but if they are conservative, they will lose everything. Even if their medical skills are superb, they may still be unable to escape amputation, okay?
An old man with ruptured aortic aneurysm will die on the operating table if he is operated, or 100% will die if he is not operated. Will he have an operation?
Traffic accident, you are the only doctor on the scene, you only have two hands, but you have to save 30 patients with different injuries. Who do you choose to save first?
These examples can be experienced by every surgeon. In order to make the best decision, we need to consider patients, their families, quality of life, survival opportunities, economic ability and so on, and more importantly, respect patients' own choices.
The most difficult and difficult decision can only be understood by excellent peers-the decision not to operate.
Knowing when not to take action is ultimately the most difficult of all decisions, and sometimes the most humane thing is to let nature handle it.
Knowing when not to treat is actually the most difficult decision of all, and sometimes the most humane way is to let nature take its course.
Be a disaster prevention person
A good surgeon should not always perform a last-second heroic rescue operation, but should predict and prevent it.
A good surgeon should not always perform remedial heroic acts, but should predict and prevent these unnecessary acts.
Remember the story of the three brothers Bian Que?
According to classic records, King Wen of Wei once asked the famous doctor Bian Que for advice: "Your three brothers are all good at medical skills. Who has the best medical skills? " 」
Bian Que: "The eldest brother is the best, and the second brother is worse. I am the worst of the three. 」
Wang Wei said inexplicably: "Why? Please elaborate. 」
Bian Que said:
"Eldest brother treated this disease before the onset. At that time, the patient himself didn't feel sick, but eldest brother took the remedy of radical cure, which made his medical skills difficult to be recognized, so he was not famous, but he was highly respected in our family.
My second brother was treated at the early stage of the disease, and the symptoms were not obvious, and the patient did not feel pain. My second brother can cure the disease with medicine and make the villagers think that his second brother is only effective for minor illnesses.
When I was treating a disease, I was seriously ill. The patient was in great pain and his family was in a hurry. At this time, they saw me puncture the meridians, draw blood with a needle, or smear poison on the affected area, or perform major surgery to point at the focus, so that the condition of severe patients was relieved or cured quickly, so I became famous all over the world. 」
Wang Wei realized.
A surgeon should know how to face disasters. A good surgeon will nip disasters in the cradle and rarely put himself in danger of collapse.
It's awesome to open the chest for a few minutes to take out pulmonary embolism, but a good surgeon will stubbornly use low-molecular-weight heparin to anticoagulate every hospitalized patient, put elastic socks on the patient, install leg compression airbags for high-risk orthopedic patients, and let the nurse walk the patient at least twice a day, so that he may never have to perform pulmonary embolism resection for patients with a mortality rate as high as 90%.
During the operation, a good surgeon will wear two pairs of gloves to protect the sharp weapon when delivering it, turn the sewing needle to the jaw of the needle holder and put it into the sharp weapon delivery basin to protect other players, and will check the bleeding point like obsessive-compulsive disorder in the later stage of the operation to prevent postoperative hematoma infection.
A good surgeon:
Every patient will be given enough reasonable painkillers and chest physiotherapy, so that they can take deep breaths painlessly every day to prevent lung infection and atelectasis.
It will prescribe preventive antiemetic drugs and anti-constipation drugs to every patient who uses morphine to relieve pain, so that they can live a hard life and suffer less from the side effects of drugs.
With limited resources, we will try our best to arrange an air cushion bed for every patient in need to prevent bedsores.
Will strictly abide by the World Health Organization's hand washing standards, and wash hands quickly before and after contact with patients.
If you can't solve the medical problems yourself, you will consult the attending physician immediately during the perioperative period, and in case of emergency, you will seek help from the serious illness and superior consultation in time.
These small and routine movements of surgeons are our culture, our norms, our awareness of disaster prevention, and ultimately the safety belt for escorting patients.
Become a leader, communicator and negotiator.
I have always felt that the hospital is a particularly complicated place. Everyone has his own small abacus, his own work life, his own joys and sorrows. And medical care is not a lone wolf movement. You need to work with many people with different backgrounds and temperaments. You need to have enough leadership to lead the team to help patients.
How to discuss with the operating room manager who will operate first?
How to get other departments to take over patients you can't help anymore?
How to make other busy departments give priority to the examination and consultation that you think is urgent?
This requires communication and negotiation skills, personality charm, speaking skills, logic and evidence.
Anesthesiologists, anesthesia nurses, equipment nurses, visiting nurses, residents, attending doctors, operating room technicians, equipment representatives, cleaners ... everyone can directly or indirectly affect the surgical process, perioperative care, postoperative complications, and ultimately affect the reputation of a surgeon.
Finally, is surgical technique important?
The answer is of course important, but:
Surgeons in China have mastered the world's top technology because of the large number of patients, and African medical students can skillfully perform many basic laparotomy as soon as they graduate from medical school. But whether in China or Africa, there are few world-renowned surgeons.
Why on earth?
The Royal College of Surgeons in Oceania listed surgical technique as the last of the nine training indexes. Their reason is that technology is just muscle memory, and anyone, including the butcher, can master a technology skillfully after repeating the same action countless times.
The earliest operation was performed by a barber. Why do surgeons need to go to medical school now?
Because only a medically trained brain can make proper thinking, such as where to cut, why to cut, how much to cut, what is the next layer, what unexpected situation may be encountered, what should be done if it happens, what impact will it have, what adjustments the team should make, and whether it needs help-this series of thinking is the essence of surgery.
A well-trained butcher can master the technology we accept, so that we know how to make decisions that are in the interests of patients.
A well-trained butcher can master surgical skills, but the world needs us surgeons, because only we know how to make decisions that are beneficial to patients.
In the words of a British vascular surgery director during my last class in the intensive care unit:
In the final analysis, the technology is spinal cord reflex, and only the scheme is brain reflex.
Of course, it is undeniable that technology is very important, and a skilled surgeon will always be a beautiful scenery in the operating room. However, a surgeon who "holds the brain and spinal cord with both hands" is the strongest backing for patients.
The quality of an excellent surgeon can be summarized in one sentence, that is:
abstract
A good surgeon should have eagle eyes, a woman's hand, a lion's heart and an iron will.
An excellent surgeon has an eagle eye, a girl's hand, a lion's ambition and an iron will.
Associate professor, deputy chief physician, doctor of surgery, tutor of master's degree.
Deputy Director of Anorectal Surgery, Sixth Affiliated Hospital of Sun Yat-sen University
Yi Shu of Anorectal Meridian-Zhu Qun
Vice Chairman of the Youth Committee of the Professional Committee of Colorectal Anorectal Diseases of China Society of Integrated Traditional Chinese and Western Medicine
China medical doctor association anorectum professional Committee deputy director physician assessment branch
Member of the Third Council of World Zhonglian Anorectal Disease Professional Committee
Member of anorectal physician branch of Chinese Medical Association.
Member of the first professional Committee of transanal endoscopic minimally invasive surgery (research group) of the professional Committee of colorectal cancer of Chinese Medical Association.
Member of TEM (minimally invasive anorectal surgery) group of colorectal cancer professional committee of China Anti-cancer Association.
Standing Committee of Anorectal Professional Committee of Guangdong Traditional Chinese Medicine Association
Member of the Professional Committee of Gastrointestinal Surgery of Guangdong Medical Association.
Medical expert member of South China Medical Association of Guangdong Clinical Medical Association.
European Journal of Gastroenterology. Hepatology
Colorectal examination technique
He is good at the diagnosis and treatment of anorectal benign and malignant diseases, pelvic floor diseases, intractable constipation, complicated anal fistula, hemorrhoids, anal fissure and colorectal benign and malignant tumors.