The Purview of Surgical Practice

Surgery has become a commonplace concept, a household term, even a cosmetic high school graduation gift, but after spending two months delving into surgical practice, I still find it a fundamentally stirring concept. A surgeon takes a blade and cuts into another person's body with the assurance that doing so will leave that person better off than before he or she came in. That takes a lot of confidence (and people with confidence self-select into the field).

It amazes me. I never think of this in the moment, when I am handed a scalpel and told to make a careful premeditated incision (a euphemism for cutting on a dotted line). But afterward, I realize I had to have enough confidence in my medical judgment, knowledge, and skill to justify intentionally cutting someone. Of course as a student, my supervisors really make the decisions, but it is my responsibility to object or refuse to do a procedure if I am not convinced that the patient needs it or that I can do it safely.

This can be extended to all of medicine. Over the last six months, I've seen many patients: diabetics started on oral hypoglycemics, hypertensives that needed medication management, cuts that needed stitches, patients who needed drugs for pain. In all cases, doctors actively do something to the patient with a degree of confidence that they are doing what's best for that person's well being. Even simpler things have this quality: deciding to X-ray someone or doing a pelvic exam or taking a history. When I feel for lumps in a middle aged woman's breast or ask a man to undress to assess for hernias or ask a teenager when she last had sex, those patients trust that I am invading their privacy because I can help their health, and I, too, have to have that certainty that I can justify what I'm doing.

Surgery is the extreme. We take a naked person, we put them to sleep, we cut them open with a knife, poke around their belly, and then sew them up again, sometimes for an optional, elective procedure. Doctors have the unique position of being able to do this with the schooling that prepares us, the legal right that backs us, the experience that hopefully tells us when invading someone's body or someone's privacy can be justified. There is something quite thrilling as well as something quite scary about having that privilege.

Image is in the public domain, from Wikipedia.