Surgeons, Surgery, Operations, and General Surgeons

Before a physician embarks on training to be a general surgeon, he must know the concepts of surgeons, surgery, operations and general surgeons.

There are varying perceptions and concepts, not to say confusion, of of these terms among the lay people and physicians and surgeons as well.

WHAT IS A SURGEON?

ROJoson QI (Question and Issue): In the current setting (modern times), what is a surgeon among physicians managing human beings? in other words, what is the meaning of a “surgeon”? Who is the surgeon?

A surgeon is a physician who manages human beings with surgical operations or manual procedures.

If above is the definition of a surgeon, loosely speaking, practically every physician is a surgeon because somehow he does surgical operations or manual procedures on his patients when he treats manages patients. Injection of medicines is an example of a manual procedure which all physicians are expected to know how to do and he usually does this. Insertion of intravenous fluid is an example of a manual procedure which all physicians are expected to know how to do and he usually does this. In this sense, every physician is a surgeon.

Strictly speaking, in the current setting, a surgeon is a physician who spends more years after his basic medical education to specialize in certain surgical operations or manual procedures. After the further training, he devotes his medical practice in doing certain surgical operations or manual procedures in the management of patients needing such operations or procedures.

Thus, strictly speaking, in the current setting (modern times), a general practitioner, a pediatrician, a family medicine specialist, an internist, a psychiatrist, a physiatrist, a radiologist, a pathologist; an anesthesiologist; and other medical specialists who do not do “special” surgical operations or manual procedures are not surgeons. However, as mentioned earlier, loosely speaking, especially if they do certain manual procedures, they may be considered surgeons also. Examples are gastroenterologists doing endoscopy; cardiologists doing heart stenting; radiologists doing ultrasound-guided biopsy;and radiotherapists – because they train in doing certain surgical operations and manual procedures, may be considered surgeons.

In the current setting (modern times), the following are conventionally considered surgeons:

– General surgeons

– Breast surgeons

– Colorectal surgeons

– Head and neck surgeons

– Hepatobiliary surgeons

– Orthopedic surgeons

– Urologists

– Plastic and reconstructive surgeons

– Neurosurgeons

– Pediatric surgeons

– Thoracic and cardiovascular surgeons

– Ophthalmologists

– Otorhinolaryngologists

– Transplant surgeons

– Obstetricians and gynecologists

– Dentists

– OTHERS (that I may miss)

Traditionally, surgeons refer to the general surgeons. However, surgeons other than the general surgeons, strictly speaking and nowadays, are also considered surgeons (see list above).

In the hospital setting, the medical specialists are usually grouped by departments, such as department of pediatrics; department of medicine; department of obstetrics and gynecology; department of surgery; department of orthopedics; department of anesthesiology; department of ophthalmology; department of otorhinolaryngology; etc. A department of surgery, at present time (these may change overtime), usually consists of general surgeons; breast surgeons; colorectal surgeons; head and neck surgeons; hepatobiliary surgeons; urologists or urologic surgeons; plastic and reconstructive surgeons; pediatric surgeons; neurosurgeons; thoracic and cardiovascular surgeons; and transplant surgeons. Outside the department of surgery, the other departments may contain medical specialists who are strictly speaking, surgeons also, those who do special surgical operations and manual procedures. Examples are the department of orthopedics; department of obstetrics and gynecology; department of ophthalmology; and department of otorhinolaryngology.

As one can sense from above explanations, there is no absolutely correct or wrong answer to the question posed. There is no single definition or meaning of surgeon. It all depends, whether loosely or strictly speaking and on the usage in the community and in the hospital. What will remain as the basic meaning of a surgeon is that he is a physician who manages human beings with surgical operations or manual procedures. What will remain as the essential meaning of a surgeon is that he is a physician who spends more years after his basic medical education to specialize in certain surgical operations or manual procedures. What surgical operations or manual procedures he specializes in will dictate what kind of surgeon he is and the descriptive label he wants to use (cxample, breast surgeons; colorectal surgeons; neurosurgeons; etc.)

Last note: Although the basic meaning of a surgeon is that he is a physician who manages human beings with surgical operations or manual procedures, it does not mean he operates on all patients he sees. He operates only when indicated. For those patients,who do not need operations, he can either treat them with non-surgical means or refer them to the non-surgical medical specialists.

Any other opinions?

I welcome sharing of opinions, feedback, comments and suggestions.

SURGERY VS OPERATION

ROJoson QI (Questions and Issues): In the current setting (modern times), what is surgery? what is operation? What is the similarity? what is the difference?

Surgery (in medical parlance) is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury and to help improve bodily function or appearance, An act of performing surgery may be called a surgical procedure, operation, or simply surgery. Thus, surgery and operation are medical terms that are commonly used interchangeably and they connote the same thing. However, “surgery” is more medical in perspective and “operation” is more lay or laypeople in perspective.

Examples of interchangeable usage: “surgical operations”; “surgery”; “operations”; “operating rooms”; “surgical theatre”; “operative technique”; “surgical technique”; etc.

Any other answers?

I welcome contributions, feedback, comments, suggestions and sharing of information.

OPERATIONS

ROJoson QI (Questions and Issues): What is an operation based on medical perspective? Since operation and surgery are often used interchangeably, what is surgery or surgical operation?

Here are some definitions from the Internet:

Operation – any action performed with instruments or by the hands of a surgeon; a surgical procedure – https://medical-dictionary.thefreedictionary.com/operation

Operation- a procedure performed on a living body usually with instruments especially for the repair of damage or defect or the restoration of health – https://www.merriam-webster.com/dictionary/operation

Operation – a surgical procedure – medicineNet

Surgical operation – a medical procedure involving an incision with instruments; performed to repair damage or arrest disease in a living body – https://mnemonicdictionary.com/word/surgical%20operation

Surgery – a branch of medicine that is concerned with the treatment of injuries, diseases, and other disorders by manual and instrumental means – https://www.britannica.com/science/surgery-medicine

Surgery – the treatment of injuries or diseases by cutting open the body and removing or repairing the damaged part – https://dictionary.cambridge.org/…/dictiona…/english/surgery

Questions:

Does surgery or operation always involve cutting of a patient’s body? For example, endoscopy just to visualize something does not involve cutting or incision. Is it considered a surgery or operation?

Does surgery or operation as a procedure always involves the uses of some form of instruments or equipment? For example, manual reduction of a dislocated shoulder may not involve the use of instrument or equipment. Is it considered a surgery or operation?

In the PhilHealth Procedure Case Rates, the list includes diagnostic endoscopy and closed reduction of dislocation. Thus, currently, the concept of operation or surgery includes those without cutting or incision and manual procedure without use of instrument or equipment.

What do you think?

Welcome contributions of opinions.

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:

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