Surgicalness

We have a trainee just now who is very junior and we are as a department unanimous in our view that they probably don’t have the right sort of attitude, attributes, commitment and ability to cut it as a surgeon.

What is it that makes us so sure? Only a few of us have operated with this trainee and yet even if she was technically competent it probably would do little to change our view that she is better suited to general practice, or maybe radiology.

The selection process into specialist training has changed recently and without sounding like a grumpy old woman, they aren’t selecting them like they used to. Previously only years of commitment and slog would secure you a coveted specialist training number, it is significantly less arduous now and crucially there is no process of trying a trainee out before giving them a number.

People don’t like to hear it until they need an operation but surgeons are not like other people in many ways. Generally speaking they are very controlling, they like to “verify” things for themselves, expect high standards in themselves and others, work long hours, do long operations, go without food and water for long periods of time and generally put knife before wife before life.

This is especially true when you are a trainee and you are on an 8 year (previously longer) mission to go from most junior oik to consultant. Somebody has to have a word with our not up to it girl, so far the least sensitive person on earth has already told her that she is not suited to surgery. He is not the right person to do that, but at least it has been a warning shot across her bows that there may be a tricky conversation coming. I know that she has no respect for this person (a slightly more senior colleague with an attitude problem who is himself unsuited to his calling) and therefore will not take his criticism on board.

“A surgeon should be youthful, or at any rate nearer youth than age; with a strong and steady hand that never trembles; and ready to use the left hand as well as the right; with vision sharp and clear and spirit undaunted; filled with pity so that he wishes to cure the patient, yet is not moved by his cries, to go too fast, or cut less than necessary; but he does everything just as if the cries of pain cause him no emotion” Celsus wrote this in the first century in his encyclopaedia medicina. If only it was that straight forward.

The obvious qualities of leadership, decision making ability, compassion, team working and an ability to cope under pressure are easy to identify and to some extent to train for but these skills are common to A&E doctors and anaesthetists and many other specialties, not just surgeons. There is something else, some glimmer of something that marks somebody out as suitable for surgery. It is not very politically correct of me to say so I suppose, but not everybody meets the correct person specification. What that exactly is however, I don’t precisely know, I suppose it’s rather like the midichlorian count in Jedi selection….sorry!

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