Memory + Concentration + Operation

February 23, 2006 2:41 AM

How much of a procedure, and how many individual procedures might a surgeon have memorized?

My brother asked me this today, and, not being a doctor, I had no answer for him.

The best I came up with is that a general ER surgeon probably has a solid repertoire that he has memorized, and those in specialized fields (most?) further have such applicable procedures memorized in addition to the basic ones.

How often might a (seasoned, reasonably experienced) surgeon need to reference some sort of material, be it a colleague, book or digital resource? Do they follow checklists or "manuals" during a procedure?

How many procedures might a surgeon know?

Please feel free to smack clear any wayward preconceived notions I have. I don't have any experience at all in this, and Google is producing a lot of noise with "memory" and "surgery" in the mix.

posted by disillusioned to health & fitness (4 comments total)

One incomplete anecdotal point: My dad's a general surgeon and I remember that while I was growing up every once in a great while he would have to pull out one of his textbooks to review something before a case. Almost never though, as it was noteworthy enough that he would mention it when it happened. Much of his practice seemed to be dominated by some core cases, though: gallbladder, appendix, bowel obstruction, hernia repair, myriad ports, catheters, and access lines.

My (only slightly better than uninformed) sense of this is that rather than memorizing a detailed series of steps, you really have an objective in mind, an internalized sense of how to get there, a set of generally applicable techniques, and a knowledge of how things should go in theory, but in practice not infrequently you have to do a fair amount of thinking on the fly, as people can look quite different from the textbooks on the inside, combinations of disorders can cause special problems, and there is tremendous range in how difficult it can be to fix a given disorder. But on the other hand, it also sounds like some procedures were quite routine.
posted by epugachev at 4:45 AM on February 23, 2006

It's not surgery, but when working on cars, the only procedures that are memorized *exactly* are bits that spring out, and computer diagnostics. Otherwise, it's more of a generalized "get to the covers off so you can see the parts, unbolt, gaskets, rebolt" sort of thing. Most doctors have enough of the anatomy internalized that they just kinda *do* it, I imagine.
posted by notsnot at 8:21 AM on February 23, 2006

There are routine surgeries and non-routine surgeries. A surgeon typically follows his/her own approach to routine surgeries step-by-step, same way each time, with variances according to roadblocks and individual differences. How many surgeries a doctor knows depends entirely on both the specialty and doctor. I have never ever seen a surgeon consult a book during a surgery, but I'm sure there are occasional times when they read up on something beforehand. What I have seen is teamwork: a surgeon asks for the presence of another who has had more experience with something or another. I assume that, before surgery, a surgeon might simply transfer a patient into another surgeon's care, if it was the most advantageous thing for the patient.

Non-routine surgery works a bit like epugachev described in his second paragraph. The surgeon has a very strong background in what needs to happen where to get the desired result, and applies that to what is wrong. So much so, in fact, that calling it "non-routine" surgery is misleading; I used it for lack of a better term. It's incredibly rare for a surgeon to encounter something he/she hasn't dealt with a number of times before, one way or another.

This is all very simple and basic and missing a ton of stuff. And I'm no surgeon. Maybe ikkyu2 is around to correct and clarify.

In the end, I don't think you can actually put a number on it.
posted by moira at 11:48 AM on February 23, 2006

Don't forget that they have learned a huge amount of anatomy in School. So when they learn a body of techniques and tools they apply them to that base.
Here in the UK we are very, very concerned that due to the Working Time Directive we have to train surgeons within a 48 hour week by 2009 (currently a 56 hr week).
In the USA I believe it is closer to 80 hours a week or whatever the boss tells you it is. Surgery being a craft specilaity, the amount of exposure to cases is critical.

Although surgeons here have traditionally spent way too long training, between 11-15 years on average from leaving Med School, there are current Gov plans to reduce this time. (historical structures issue)

Slight de-rail but maybe interesting to somone reading this.

Many surgeons will look up procedures they haven't done for a while or where they feel it may be a tricky case. Also, there may be case conferences with radiologists, oncologists etc., beforehand where the approach is decided. I've heard surgeons completely change their mind about a procedure based on these case conferences.

I think it is more like the pilot of a jet fighter-- once you learn the basic science behind your machine, once you've practised enough hours that every movement and check is second-nature, then you will do the best when something presents completely out-of-the-blue. More that than a rote-learning of procedures.
posted by Wilder at 9:06 AM on February 24, 2006