WHAT AND WHO ARE THE GENERAL SURGEONS?
ROJoson QI (Questions and Issues): In the current setting (modern times), what and who are the general surgeons?
Note: To get a local context, November 14, 2018, I tried to look for the definitions of "general surgeons" in the websites of the Philippine Society of General Surgeons; the Philippine Board of Surgery (which is in charge of certifying graduates of general surgery residency programs into Diplomates of General Surgery); and the Philippine College of Surgeons (which used to take care of the general surgeons and their residency training programs until 1999). I could not find what I was looking for.
I tried to look at my old files. I saw this definition in 2008 from the General Surgery Curriculum Manual of the Philippine Society of General Surgeons (I saw it also in the 2017 version of the PSGS Accreditation Manual):
DEFINITION OF GENERAL SURGERY
The Philippine Society of General Surgeons, Inc. defines General Surgery as requiring:
- A basic knowledge of surgical anatomy, physiology, pathology, oncology, metabolism, wound healing, surgical bacteriology and sepsis, shock and resuscitation, immunology and organ transplantation, fluid and electrolytes, nutrition, burns and critical care.
- A sound understanding of the principles of radiology, ultrasonography, CT scan, MRI, and other diagnostic aids including the use of radioactive isotopes and mammography.
- An adequate practical experience in proctosigmoidoscopy and indirect laryngoscopy. The general surgeon must have participated in a variety of endoscopic examinations such as direct laryngoscopy, bronchoscopy, esophagoscopy, gastroscopy, choledochoscopy, colonoscopy and laparoscopy.
- A comprehensive skill in diagnosis, preoperative, operative and postoperative care of patients with diseases of the a)alimentary tract, b) abdomen and its contents, c) the head and neck, d) breast, e)the vascular system, f) the endocrine system and g) skin and soft tissues.
- Adequate knowledge and skill in all phases of care of the injured patient, including care provided in the Emergency Room and Intensive Care Unit. The general surgeon must show competence in the emergency management of trauma, including trauma to the head and neck, chest, abdomen and the extremities.
- An appropriate clinical experience to include operative and nonoperative care of common problems in the special disciplines of thoracic and cardiovascular, gynecologic, neurologic, orthopedic, plastic, pediatric and urologic surgery and anesthesiology, acquired by exposure in these disciplines.
My answers to the question - "In the current setting (modern times), what and who are the general surgeons?":
In the current setting (2018), a general surgeon in the Philippines is a physician who has undergone further training, after being licensed as a basic physician by the Philippine Board of Medicine, in a general surgery residency training program recognized by the Philippine Society of General Surgeons and after being certified by the Philippine Board of Surgery. [Note: there are graduates of general surgery residency training program who did not take or pass the certifying examinations of the Philippine Board of Surgery and yet are allowed somehow to practice general surgery in the Philippines.]
In terms of what surgeries or operations are being done by graduates of general surgery training programs or general surgeons, as stipulated in the definition by the Philippine Society of General Surgeons, their primary specialties are in the following areas:
- Alimentary tract
- Abdomen and its contents
- Head and neck
- Breast
- Vascular system
- Endocrine system
- Skin and soft tissue
- Emergency management of trauma
- Surgical intensive care
Thus, the primary surgical specialties (multiples organs and systems) of general surgeons are: a) alimentary tract, b) abdomen and its contents, c) the head and neck, d) breast, e) the vascular system, f) the endocrine system and g) skin and soft tissues. Additional subspecialties: emergency management of trauma and surgical intensive care.
The secondary surgical specialties of general surgeons are (acquired by exposure): thoracic and cardiovascular, gynecologic, neurologic, orthopedic, plastic, pediatric and urologic surgery and anesthesiology. [Usually general surgeons do these only in community where they are no specialists in thoracic and cardiovascular, gynecologic, neurologic, orthopedic, plastic, pediatric, and urologic surgery and anestheiology; and they have prior experience because of their exposure during their training; and on an emergency basis.
In an urban community, nowadays, where there are already a lot of surgical specialists and surgical subspecialists, the general surgeons usually are confined to the following: a) head and neck inclusive of thyroid; 2) breast; 3) abdomen and its contents inclusive of the alimentary or gastrointestinal tract); and 4) skin and soft tissues.
Different subspecialties of general surgery are now being developed such as head and neck surgery; breast surgery; colorectal surgery; hepatobiliary surgery; trauma surgery; surgical oncology; etc.
There are unavoidable overlaps of general surgery with other surgical specialties, such as hernia being done by general surgeons and urologists; thyroid surgey being done by general surgeons and otorhinolaryngologists; endoscopy being done by general surgeons and gastroenterologists; etc.
The public should be aware of at least the following:
1) General surgery is a surgical specialty by itself. As mentioned, in the urban community nowadays, the general surgeons usually do operations on the following organs and regions: a) head and neck inclusive of thyroid; 2) breast; 3) abdomen and its contents inclusive of the alimentary or gastrointestinal tract); and 4) skin and soft tissues.
2) Different subspecialties in general surgery are now being developed such as head and neck surgery; breast surgery; colorectal surgery; hepatobiliary surgery; trauma surgery; surgical oncology;' etc.
3) There are overlaps with other surgical specialties
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ROJ@18nov14;18dec4