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Surgeons no longer ignore patients’ medical needs

I am a first year core surgical trainee (CST) working in South West London. I recently attended a ‘Leadership and Management’ course with the aim of understanding my leadership style, building on my existing skills, and understanding more about the organisation and structure of the NHS.

It was an excellent course, but a comment was made by one of the speakers which incensed myself and my other surgical colleagues. The speaker suggested that surgeons do not manage the medical complications that develop in their patients and always defer to the medical team. Judging by the response from the vast majority of the audience who were core medical trainees, this was a view that was shared by most of the room.

Anybody who has worked in the hospital environment will appreciate that there can be some underlying tensions between the different specialities, in particular the surgical and medical teams. This can be related to administration, politics of departments, and management of patients. However, I feel that things have progressed and we are now faced with a different generation, attitude and approach to the care of patients within the medical environment. Gone are the days of a senior surgeon saying “Just call the medical registrar” to their team when a patient becomes unwell. The CSTs, registrars and consultants of today are able to deal with these cases appropriately.

I feel that this development is routed in the core surgery training programme that has been developed and then implemented in South West London. Training is not all about learning the surgical techniques which are of course essential to developing the skills needed to be a good surgeon. More medically orientated training is now compulsory for the trainees, for example, attendance and completion of courses such as “Care of the critically ill surgical patient” (CcRISP) developed by the Royal College of Surgeons. The course is delivered by groups of intensivists, anaesthetists and surgeons teaching the trainees to manage common surgical and medical problems that can develop with their patients.

All doctors, whichever speciality they are now working in have been through an approved medical school course. They will have progressed through two foundation years where experience and knowledge is gained in both surgical and medical specialities, learning to manage both acute and chronic problems. This knowledge and experience is not lost when entering specialist training years and is utilised on a regular basis. During my most recent surgical night shifts, I had to manage an upper gastrointestinal bleed, a case of chest sepsis and a patient who developed acute respiratory distress syndrome, two of which became unwell simultaneously on different wards. I did not call the medical registrar; I assessed my patients, gathered more information from the notes, organised appropriate investigations and stabilised my patients. It was only then that the medical team were contacted to discuss the cases and request review to make sure that appropriate care was continued.

We are currently working in an age of ‘super-specialisation’ where some specialities feel that they are only responsible for managing the particular organ they are associated with. However, change is now in the air, and the role of the generalist is beginning to see a return to the future success of the NHS (under investigation by the Future Hospital Commission). All specialities, both within surgery and medicine will need to develop and appreciate this, but maybe surgery is ahead of the field, more than the medical team give them credit for.

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