Cardiac surgeons operate on the heart, replacing diseased heart valves and bypassing coronary arteries (the blood vessels that supply the heart itself). They also may surgically correct congenital deformities, although pediatric (children) heart surgery is a sub-specialty all its own. Cardiac surgeons usually require a two-year fellowship in addition to the regular surgery residency.
Plastic and Reconstructive surgeons take several years training in their specialty to do cosmetic surgical procedures, such as breast augmentation and reduction, facial plastic procedures (face lift, brow lifts, rhinoplasty [nose job], and acid and laser skin peels), liposuction, and abdominoplasty. They also do reconstructive surgery after trauma, congenital defects, breast reconstruction after mastectomy, and complex skin grafts and “flap” procedures, which I will explain later and which include Tram flaps, Pedicle flaps and Rotation flaps.
The Ophthalmologists, in addition to the medical management and examination of the eyes, also perform the delicate and often complex procedures including cataracts, retinal and eye muscle surgery, trauma, and the new laser and LASIK procedures.
The Otorhinolaryngologists must learn to pronounce their specialty first and then learn how to take care of problems involving the ears, nose and throat, including sinuses, parotid gland, tongue, tonsils and adenoids, and facial nerve, and have special training in removing cancers in this area.
Pediatric surgery emphasizes that children are not just little adults, but people with special problems all their own. They have a host of congenital deformities, as well as the usual problems of hernia and appendicitis, and these specialists are specially trained to handle the delicate management of tiny infants.
In Part II of this book we will discuss these surgical specialties and their procedures including the diagnostics, anatomy, techniques, and complications.
Chapter 5
THE SURGEON'S OFFICE
My surgeon has an office on the ocean in a barge.
The place is kinda dirty, the reception room is large.
He doesn't have a license, but he has a lot of saline,
He says it's from the ocean, he collects it when he’s whaling.
He's not too highly skilled, and his hands are quite a fright,
But hey, you can't have everything, and wow...his price is right!
When I asked my office manager to list what she considered most important about an office, she gave the following comments. First, she stressed location, and that included parking. If you're sick and not feeling well or if you've had surgery, you don't want to have to travel a long way to see your doctor and then not be able to find parking. Simple but important!
Next, when you walk into someone's home, one glance will give you a good idea as to whether the person is well organized or not. Similarly, when you walk into an office you should get a feeling of professional organization, with decent lighting, seating, and tasteful decorations. If the doctor and his staff don't care enough to take an interest in the details of his office, it may reflect on how he will take care of you! The office should be clean and orderly. Now, this doesn't mean it has to be expensively decorated and superhigh tech; many physicians can't afford this. But it should reflect a care and concern about presenting a good face to the public.
Another point brought up was that this office should have personnel who appear pleasant and happy with their jobs and surroundings. Disgruntled staff may reflect poorly on the “boss” and, in a setting where tests are ordered and surgeries are scheduled, job dissatisfaction can lead to mistakes and unpleasantness. The patient is usually not ecstatic about going to see the doctor, and to have to put up with moody or cheerless staff is unacceptable. The staff should be polite, helpful, efficient, and knowledgeable. Though it sounds banal, YOU are the customer and should be treated well whether you are the CEO of a major corporation, an unemployed day worker, or a single mom with kids in tow.
The last point my office manager stated was that the office personnel should know their business. They should know about disability and health insurance and be able to answer questions to make you feel “okay” about your upcoming surgery arrangements or about problems you are having after a procedure. The office staff is the doctor's upfront representatives, and their failure to be polite on the phone or in person is unacceptable.
I have seen some doctors who routinely keep patients waiting several hours for appointments, and I don't understand why patients tolerate this. Of course there will be times when unscheduled surgeries or emergencies arise, and I always call my office to let the patients know. They can wait or reschedule, as the case may be. When I return to the office, I always personally apologize to any waiting patients and give a brief explanation for my tardiness. Common courtesy is often forgotten by busy physicians and is not excusable!
Now, I wanted to present this chapter for two reasons. First, to let you know what goes on in the doctor's office (what you see and don't see) and second, to give you my own ideas as to what should be the rule of thumb in taking care of the needs of patients.
Most surgeons' offices are located near a hospital complex so that, if any problems or emergencies arise with patients, the doctor will be immediately available and can call for assistance if needed. Different surgeons have different types of facilities in their own office, in some instances, complete operating suites or maybe just the ability to remove small lumps and bumps. This necessitates either disposable instruments or a sterilization unit. Many physicians find it easier to take their work to a nearby emergency room, outpatient surgical center, or hospital and not have to concern themselves with the problems of maintaining a sterile operating facility. Nevertheless, all surgeons have the equipment and instruments needed to remove sutures and skin staples, remove drains, and change dressings. Most also have needles and syringes to do local biopsies, give injections, and aspirate fluids or blood samples. They will have appropriate facilities for disposing of toxic waste materials, and the offices are checked by OSHA which is a governmental agency inspecting for cleanliness and safety provisions. In today's world of serious infections and AIDS, patients deserve to know that the office they are in is safe as well as comfortable.
I think it is important for any physician to have some type of reference library, either consisting of books, journals or computer access to information, for help in dealing with day to day problems and to keep up to date with advances. Many hospitals have excellent medical libraries with librarians available to do searches for physicians on any topics. Affiliation with regional medical centers or university centers and teaching hospitals will assure the interested physician a place for continuing medical education, as well as additional consultation.
Now, why do I mention these things? Merely because medicine is a never-ending educational experience and, if your physician is not on the “cutting edge” of the newest advances, he's soon relegated to the “glue factory” because you shouldn't and won't seek out his opinion and care. When you look for a surgeon, keep these factors in mind and don't be shy about asking questions about the office if you are interested. Proximity to a hospital and a source for continuing education is important.
The doctor's consultation room should be comfortable and private, and the patient should be able to sit and talk if he or she wishes. Understandably, in some high volume clinic situations this may not be possible, but at any time you should be able to say that you want to talk about the proposed test and procedure and have your questions answered to your satisfaction. You're not buying a car or a house; it's your body we're talking about!
We will talk more about the physician-patient interaction in Chapter 10.
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