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Sunday, May 22, 2011
cardiovascular surgeons vs. neurosurgeons
From where I sit, I have the interaction with many surgeons and nurses and perfusionists.
All of them are needed to do neurosurgery (with cell saver) or cardiac surgery.
The differences between these two groups of people are striking. BOTH do very delicate work at saving lives.
What are the jokes about them in the hospital?
1. What is a neurosurgeon? Someone who takes a patient who is doing this (decerebrate posturing) and turns them into someone who does that (decorticate posturing). In lay terms, it is someone who works with hopelessly damaged people and raises their function significantly but they are still pretty messed up.
2. A man was sitting in coach on an flight, when the flight attendant from first class came in, looking very worried, and asked if there was a cardiac anesthesiologist aboard the plane. The gentleman sitting next to him said he was, got up, went into first class, and came back five minutes later. Dying with curiosity, the passenger asked his neighbor what was the big emergency. "It was a cardiac surgeon. He needed to have his seat adjusted."
Neurosurgeons are focused, quiet, incredibly intense people who for the most part love their work above everything else. They play classical music often, and do not like to be disturbed. Every now and then, they ask, "is everything going okay with my patient?" and I reassure them that they are doing well. Sometimes blood loss can be massive. Everyone is prepared for it The most picky thing, besides having everything the way they like it, is when the patient wakes up from anesthesia, the surgeon wants to have them really awake so they can make sure that everything moves and works. That the patient follows commands.
When asked why he does not yell, one of my neurosurgeons looked at me with surprise, then the look changed to disdain, and said, 'anger is counterproductive.'
That is a neurosurgeon for you. Sometimes more angel than human. Not always with the best bedside manner (emotional support). I tell the patients 'you go to them for their skills, not their personality' when they have that bewildered look after they talk with their surgeon. Neurosurgeons are really, really smart.
Cardiovascular surgeons are the last of the 'old boys school' for the most part. There are notable exceptions, which I will discuss later. They are emotional, angry titans who split sternums and work on some really sick people. Some contain it better than others. But most hate to have a woman in their OR. Every group I know in private practice has some woman cardiac anesthesiologist who is better at transesophageal echo than ANYBODY they work with, but they tolerate her, make fun of her skills (why doesn't she say anything USEFUL?), and abuse her verbally. They don't trust her. In academics, it is different. Women are tolerated more. But at most centers for surgery, abuse is the norm.
I have seen patients die from pride of the surgeon and the anesthesiologist and the rest of the team.
Pride is an element in the heart room. Ego reigns. Dominance, aggression, control, continuity. There is NO COMPASSION. Not for anyone. When a case goes bad, the doctors are in for twelve hours, straight, with no breaks. It is barbaric. It has to stop. And for the most part, it is...the cardiologists are advancing catheter-based technology, and the patients prefer a small leg puncture over any opening of the chest. What is left are very complex patients, at high risk, for very little pay. Medicare pays a surgeon one fee in the hundreds of dollars for pre-op, six hours of surgery, all hospital care, and one follow-up visit. The only way for a practice to succeed is to do high volume of cases efficiently. Some work at three different hospitals in one day.
The exceptions are the cardiovascular surgeons of VERY high ideals. Most were trained under the giant, Dr. Norman Shumway at Stanford. They are gentleman of the highest sense. I never would have gone in the field if it weren't for one I worked with during medical school. Dr. Mehmet Oz is another that comes to mind. Another, is a catholic of very deep faith, I have known for years. The rest are Indian, Vietnamese, and don't have that attitude like the caucasians. (Some patients are flying to India for their cardiac surgeries now. The care is excellent, it is affordable, and the insurance company throws in a nice hotel, too.)
Verify your heart surgeons' lineage. There is a hospital in the area that is exclusively run by a group of Shumway's. Watch the surgeons' support team in the office. Is everybody walking on eggshells? Is it very 'old school' with the big library mahogany in the office? Is it an older surgeon? Does the surgeon also work on pediatric hearts? (most that do have better skills, but they can still be cruel. I know one. He was a piece of work.)
As Scotty on Star Trek once said, 'they still do this?! This is BARBARIC! Get out of the way and let me work!"If you are sick, your energy body and regular body need the best healing available. Go for it, and seek the very best.