The baseball model: post-WWII surgeons as young as age 18?

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Heterotopic Heart Transplant (this is rare)

And this is why you want to hire and train highly dexterous persons to be surgeons, as long as they're merely good enough in other areas.
That takes Klingon cosplay to a whole new level.
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I am actually rather stunned by this. While I absolutely accept that professional athletes have a God given gift well beyond the average person that does not translate, in any way, into the sort of knowledge it requires to be a surgeon. Yes some 18 year olds have exceptional motor skills, but can you even get a 12 year old to understand half the information a physician needs to acquire, even if you see surgeons as more highly paid meat-cutters (which BTW is entirely untrue) I would point out that the number of 18 year old highly trained butchers is fairly close to zero.

Perhaps the best way to ask this question is this: would you rather have an 18 year old with maybe two years of training, and the maturity if the average 18 year old or a 28 (or 38) yer old who has gone through the pressure cooker of STEM undergrad, Medical School, and Residency with all the knowledge acquired during all that schooling perform life or death surgery on the individual you love most on this earth?

Fairly sure I know how 99% of the population is going to answer.
I work in the medical field and deal with surgeons. Trust me, it's a learned skill and some of the docs aren't as good as you might think.

We separate docs between book smarts (research, clinic, etc) and hands on. The latter acquire the skill from training that the average person could pick up (it's an overhyped technical job, despite what many people will tell you). One doesn't have to know the chemical processes of the body to do surgical procedures (we usually have several docs in the suite to handle their defined field including anesthesia, reperfusion, etc). There is even a move towards replacing many physicians with nurses (which doctors are fighting despite no proof in a drop in care or outcome). We are also taking early steps into using robots to do procedures.

So yes, surgical docs could be replaced by those trained to simply perform procedures.
 
Having worked with 18 year old interns I wouldn't trust them with anything more complicated than screwing some bolts into a metal fixture and being simple manual labor. And even in those cases they have still managed to mess up on a impressively large number of tasks. Some of them even decided that playing baseball with sledgehammers and washers was a good way to spend time at work. There is no way I would trust surgery to an 18 year old kid who will likely decide to dick around rather than do any actual work.
 
@Inferus: When I was in medical school (admittedly 40+ years ago), our chief of surgery remarked "you can teach a monkey to take out an appendix, but when the "appendix" turns out to be a perforated cecal carcinoma, then what?" Or (in my case) how about microsurgical reconstruction of the brachial plexus in a 3 month old child, diagnosing and developing a reconstructive plan for someone with arthritis mutilans of the hands, or deciding in the combat zone, whether to try and salvage a limb or amputate it (hint its not just the wound but who else needs care, what's in the blood bank, and much more..). For many specialties (not just surgical ones) some of the minutiae you learn in medical school turns out not to be used much if at all, however knowing that makes you a better doctor.
 
... (it's an overhyped technical job, despite what many people will tell you). ...

May I ask what exactly you do in the medical field? If you think surgery of any sort is just some technical job I'd be surprised if you actually directly work with surgeons in the operating room. It'd be like me calling my circulating nurse an "overhyped secretarial job" which is most assuredly not true.

Robots in the OR are currently and will be for the foreseeable future extensions of the surgeon rather than direct replacements.

@Inferus: When I was in medical school (admittedly 40+ years ago), our chief of surgery remarked "you can teach a monkey to take out an appendix, but when the "appendix" turns out to be a perforated cecal carcinoma, then what?" Or (in my case) how about microsurgical reconstruction of the brachial plexus in a 3 month old child, diagnosing and developing a reconstructive plan for someone with arthritis mutilans of the hands, or deciding in the combat zone, whether to try and salvage a limb or amputate it (hint its not just the wound but who else needs care, what's in the blood bank, and much more..). For many specialties (not just surgical ones) some of the minutiae you learn in medical school turns out not to be used much if at all, however knowing that makes you a better doctor.

From someone only a fair bit closer to medical school I can say this is still the case.
 

Philip

Donor
I see where this is going...but how the shit would this actually work? Do we send high school kids to “surgery school” in the afternoons if they qualify? Do we have 14-year-olds doing practice surgery on pig carcasses or whatever the hell they do in med school these days?

I think this something that is being overlooked. A 20-year-old professional baseball player is likely to have 15 years of experience playing baseball, much of it at a highly competitive level. The attrition rate through that time is astronomical. This really does not seem like a good model for medical education.
 
I think this something that is being overlooked. A 20-year-old professional baseball player is likely to have 15 years of experience playing baseball, much of it at a highly competitive level. The attrition rate through that time is astronomical. This really does not seem like a good model for medical education.
Crap! As someone who's been following baseball closely for almost 70 years, I should have caught this one many posts ago. That 18yo pitching in the bigs or high minors is the product of a long and hard scrabble winnowing process, and many more people have played some baseball than Operation by Hasbro. Good catch, 1 L only...
 

Jack Brisco

Banned
I speak as someone who has had open heart surgery. The surgeon who did mine had been operating for a good 30 years. Knew his stuff, confident as could be. His nickname was "Doctor God". All the other surgeons/doctors/PAs/nurses were rather well experienced. Sure wouldn't have wanted it any other way, especially when there were apparently problems getting my heart going after the aortic valve was replaced. "Doctor God" had seen this many times and threw in a bypass that day.

Bottom line 1: The surgery was successful. I could now hear a heartbeat again instead of the sound of rushing water. That's one of the scariest sounds you can hear when it is coming from your own chest. Valve/heart still working fine, over six years later.

Bottom line 2: I was in the hospital a total of four days for this major-league surgery. In early on a Monday morning, out that Friday afternoon. I attribute this not just to my keeping my heart function strong through exercise and no alcohol/tobacco/drugs, but also due to the highly experienced professionals providing my care. The hospital has a Heart Institute, and these people know their stuff cold.

So, no, I would NOT accept some 18-year-old kid operating on me. As has been already said, anyone can do surgery when things are easy. But you need someone who knows what to do when things go south, which can happen in a heartbeat, no pun intended.
 
May I ask what exactly you do in the medical field? If you think surgery of any sort is just some technical job I'd be surprised if you actually directly work with surgeons in the operating room. It'd be like me calling my circulating nurse an "overhyped secretarial job" which is most assuredly not true.

Robots in the OR are currently and will be for the foreseeable future extensions of the surgeon rather than direct replacements.



From someone only a fair bit closer to medical school I can say this is still the case.
I work in cardiac so I deal with transplants (heart, valve), AAA (Abdominal Aortic Aneurysms), congenital defects (septal closures, coarctations), etc while also dealing with peripheral issues involving kidneys, pulmonary hypertension, etc. I AM quite hands on from putting in ECMO, balloon pumps, etc while also serving in a full fledged trauma hospital. I likewise handled the full on build of our inventory database, imaging servers, and serve as the liaison for digital monitoring of equipment/case recording. Forgive me if I am challenging your opinion on what actually occurs in a surgical suite. You might be surprised to hear how inept docs are (most times they don't know your name before they step into the room and they definitely don't know your name or issue when they scrub in as I have had to relay exactly why we are doing the procedure to a doc who shows up late and complains about doing paperwork while making private phone calls as we're trying to keep to a grueling schedule), how quite a few have to be corrected (I've had to, while in scrub, relay solutions and prevent mistakes as the doc becomes agitated when the case doesn't turn out as routine as expected), and I have had to read ECHO and gain access because some docs aren't competent enough to keep basic skills or acquire skills in new equipment. I once had to pull a doc off a patient when we shocked him out of V-Fib because the doc couldn't fathom that he would be affected by an electrical charge.

I have been doing this job over a decade. The average doc is not as skilled as you may think they are (and most need to be babysat since they are the most disorganized figures I have ever encountered and fairly unethical at times but I won't go into that). After all my years and dedication to my job, I know I can do what they do (and at times unofficially have).
 
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@ inferus: Doctors, like all other ares, have unethical, lazy, or downright criminal members of the profession. Having said that, I shudder to think of the place you work. Just saying.
 

Anchises

Banned
Just a laymans guess but with the way that modern medicine seems to be going:

Imho we need more qualification and not less. At some point in the not so far away future a good surgeon probably needs a fair ammount of knowledge in the field of robotics.
 
If it is like any other field, by the time the robots get good enough to replace doctors the humans will just be there to tick boxes and sell the product (in this case surgery).

Eg consider accounting. An AI can have a firmer understanding of taxes and laws than a human. It can autimatically check all your bank accounts etc as it will have access to everything the govt has on you. And it will be more ethical than a human, if only because the government's tax AIs will be double checking everything and the AI's progarmer's will be sued if it does anything illegal. All the accountant will provide is a smiling face to the customer. This is the future of every professional job.
 
@ inferus: Doctors, like all other ares, have unethical, lazy, or downright criminal members of the profession. Having said that, I shudder to think of the place you work. Just saying.
Worked in numerous facilities (all over the US and some abroad; been quite prodigal). Stop believing the bs of ER, Grey's, and House. Doctors are a fraternity that protect their own, will shuffle you off to other departments rather than deal with you, and at times even indulge in unprofessional activities (infidelity, deals with reps, unnecessary procedures). It is support staff (nurses, techs, PAs, midlevels) who do the work while predominantly for profit hospitals (and even non-profits) find ways to profit themselves.

The crazy thing about docs is they are like any other job: what is the fastest way to get through a problem? I have worked 72 hours straight only to watch a doc whine about 4 hours. I have been disrespected on a fairly regular basis while watching docs give false information to fawning patients. And don't get me started on doctors' wives.

Some info you guys should know: Emergency docs can't read ECGs, do not do surgery like ER pretends they do, and are quick to give false diagnoses to get you out of their department as they are more inept and lazy than general practitioners (imagine my fun when my three year old went into anaphylactic shock and I knew more than the moron assigned to me or when I get called in at 2 AM for cardiac arrest when it is actually flu). Not every doc is competent. My professional ratio is 50% in every hospital. In the move to digital, most docs still struggle as they are borderline computer illiterate (I have spent a year in this facility repeating myself over and over again). The majority of clinical work (75-80%) is done by support staff. Thank you for your platitudes to the doc who does not read your records, does not look at your PETs, MRIs, or labs, and who usually shows up at 9 when they should be in hospital at 7 (and then threaten my job with admin blaming me for why it takes so long to start cases). You might want to investigate how most hospital admins have changed protocol to force docs to ACTUALLY talk to you about your condition (they prefer to send midlevels like me to speak with you as they have better things to do).

I don't mean to be rude but if you believe the ridiculous views media sells you on medicine or actually think your doc is God (who do you usually deal with more in clinic?) then I worry. I have worked with docs I absolutely respect and I would trust my family with. I have also dealt with cretins of an incredibly self-centered, narcissistic bent I have had to be pulled off of. Use common sense when it comes to medicine.

A doc is just as fallible as you. Dispel the aura.
 
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If it is like any other field, by the time the robots get good enough to replace doctors the humans will just be there to tick boxes and sell the product (in this case surgery).

Eg consider accounting. An AI can have a firmer understanding of taxes and laws than a human. It can autimatically check all your bank accounts etc as it will have access to everything the govt has on you. And it will be more ethical than a human, if only because the government's tax AIs will be double checking everything and the AI's progarmer's will be sued if it does anything illegal. All the accountant will provide is a smiling face to the customer. This is the future of every professional job.
It IS like any other job (some are lazier than others; docs who DON'T put markers for grafts, mis-report procedural actions, even make moronic decisions such as using a RIMA rather than an SVG just in case).

Docs are petrified of losing ground which they currently are as their expertise is increasingly proving too expensive and unnecessary in current fields (wanna hear how anesthesiologists read novels while they dope you or how nurses correct reports for docs? Maybe about how docs are willing to prescribe scrips to family and friends?). Docs work best at diagnosing. I see the future of surgery removed from their hands (Stereotaxis is an example of moving away from physical intervention to gradual automation; lose the keys!).
 
Just a laymans guess but with the way that modern medicine seems to be going:

Imho we need more qualification and not less. At some point in the not so far away future a good surgeon probably needs a fair ammount of knowledge in the field of robotics.
The average doc doesn't know how to use a computer; you expect them to understand robots? The future is automation (robots doing the job). It is easier than you think and cheaper when you don't have to worry about someone claiming their experience warrants a mid level six figure income. A lot of responsibility has already shifted to computers and less invasive procedures (pumps, infrared, laser, percutaneous procedures, etc). The future is actually easier and simpler with stem cells, gene therapy, earlier intervention through Smart technology, etc. Docs will be needed less. That is the future. Not trusting MORE in the hands of a few.
 
Worked in numerous facilities (all over the US and some abroad; been quite prodigal). Stop believing the bs of ER, Grey's, and House. Doctors are a fraternity that protect their own, will shuffle you off to other departments rather than deal with you, and at times even indulge in unprofessional activities (infidelity, deals with reps, unnecessary procedures). It is support staff (nurses, techs, PAs, midlevels) who do the work while predominantly for profit hospitals (and even non-profits) find ways to profit themselves.

The crazy thing about docs is they are like any other job: what is the fastest way to get through a problem? I have worked 72 hours straight only to watch a doc whine about 4 hours. I have been disrespected on a fairly regular basis while watching docs give false information to fawning patients. And don't get me started on doctors' wives.

Some info you guys should know: Emergency docs can't read ECGs, do not do surgery like ER pretends they do, and are quick to give false diagnoses to get you out of their department as they are more inept and lazy than general practitioners (imagine my fun when my three year old went into anaphylactic shock and I knew more than the moron assigned to me or when I get called in at 2 AM for cardiac arrest when it is actually flu). Not every doc is competent. My professional ratio is 50% in every hospital. In the move to digital, most docs still struggle as they are borderline computer illiterate (I have spent a year in this facility repeating myself over and over again). The majority of clinical work (75-80%) is done by support staff. Thank you for your platitudes to the doc who does not read your records, does not look at your PETs, MRIs, or labs, and who usually shows up at 9 when they should be in hospital at 7 (and then threaten my job with admin blaming me for why it takes so long to start cases). You might want to investigate how most hospital admins have changed protocol to force docs to ACTUALLY talk to you about your condition (they prefer to send midlevels like me to speak with you as they have better things to do).

I don't mean to be rude but if you believe the ridiculous views media sells you on medicine or actually think your doc is God (who do you usually deal with more in clinic?) then I worry. I have worked with docs I absolutely respect and I would trust my family with. I have also dealt with cretins of an incredibly self-centered, narcissistic bent I have had to be pulled off of. Use common sense when it comes to medicine.

A doc is just as fallible as you. Dispel the aura.

The member you are talking is an surgeon and medical doctor himself. Perhaps you can be a bit more respectful?

And as someone who prosecute unprofessional doctors in disciplinary inquiries on behalf of the local Department of Health, where in earth are you located in?

Emergency docs can't read ECGs, do not do surgery like ER pretends they do, and are quick to give false diagnoses to get you out of their department as they are more inept and lazy than general practitioners (imagine my fun when my three year old went into anaphylactic shock and I knew more than the moron assigned to me or when I get called in at 2 AM for cardiac arrest when it is actually flu).
That's crazy.
 
Speaking as a currently retired specialty surgeon, this idea is completely nonsense. Depending on your educational model, the post secondary education for a medical degree is 6-8 years (European and North American models). Following getting your medical degree, the post degree training is 5-8 YEARS before you are considered competent to be on your own. The decision as to whether or not to perform surgery is done by the surgeon NOT by a non-surgeon - a non surgeon MD may refer a patient who may (or may not) be a candidate for surgery but the decision to operate or not and which surgery to perform is done by the surgeon. During my career I had a good number of patients referred for potential surgery where that was NOT the appropriate treatment as well as a fair number of patients who should have been referred and gotten their surgery much sooner than they did for the best outcomes. Diagnostic skills related to your surgical specialty are as important as surgical skills, and take place before you pick up the scalpel.

Experience counts. At the end of my postgraduate training (6 years) I was much better with diagnosis and technique than at the beginning. It is not uncommon that one can encounter an unexpected anatomic variation (there are lots of them) or something else unsuspected once you are in an operation and you then need to shift gears, often urgently. If you have a complex problem, if things go poorly, etc there is no time to go to the library and check things out - you need to act right away and if you don't bad, very bad, things happen.

The "teenage doctors" on a few TV shows are interesting fantasy but just that. Even if someone could cram their education through medical school in by the age of 18 (basically ASB - just too much stuff), and they had natural physical skills like some ballplayers, they now have to embark on the actually training to become a surgeon. You start small, assisting (often second assisting) at operations, caring for pre and postop patients, and in the clinic and gradually assume more and more responsibility for operations with a senior surgeon there with you. Ask yourself if you want an 18 year old who has just completed his private pilot training to take the controls, without a co-pilot, of a large passenger jet on which you and your family are passengers. Sure he has great reflexes and eagle eye vision but...

When everything is going well, its nice but in the middle of the night when everything with the patient is turning to crap, that is when you need all your skill, experience, and maturity - been there, done that more often than you can realize.

@GeographyDude

Now you know why I oppose so strenuously about this strange notion of yours.
 
There is another school of thought on this.

When you are having an angioplasty you want someone who is in at least the four figures of procedures done, ideally 5 digits (assuming you live in a major metro this isn't really difficult, some cardiologists seem to specialize in them, as I understand it it is one of those things that you get better the more you do). Dy dad's surgeon was somewhere north of 10K; when he needed a second one done it was by the REAL expert in the area who was north of 20K. All the bright young docs thought he needed open heart surgery, the Pro from Dover, who was on the teaching staff at Stanford (although he was also the Big Gun for Kaiser Northern California, God bless him and his to the 10th generation), told them to have a seat right in the corner, watch, and learn. That was 15 years ago, near as I can tell that doctor's work will outlast my Dad. Experience counts.
CalBear, I’m glad your dad found a good surgeon (perhaps with your help?) and am even more glad that it worked out so well for him! :)

To me, this is an argument for more practice on surgery and less on chemistry. For the surgeon, that is. For the research doctor in the lab, it would be rather the opposite.

And I think one could find the right kind of soft plastic which imitates cutting and sowing human tissue. Although in this case, I think what you’re talking about is threading up through an artery to the heart and doing what laypersons sometimes inaccurately call “rotor rooting.”
 
multiple-intelligences-theory


The person with high spatial reasoning . . .
Adrian Kantrowitz was involved in the race for the first successful heart transplant in the late 60s. But he perhaps did his most good later on with:

HeartViews_2007_8_2_70_63742_f3.jpg

Left Ventricular Assist Device (L-VAD)
(may or may not be Kantrowitz model)

And this is where we really lose out, when we don’t hire and promote people with high spatial reasoning for such things as new surgical echniques and interventional radiology.

But wait a minute, doesn’t a lot of this happen through engineering firms which make medical devices? But a lot of it doesn’t happen. And they’re plagued by a lot of the same tyranny of the “well-rounded person” and the belief in “generalized intelligence” which can flow in any direction and which is probably just not the case.
 
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Did I know doctors who were "bad actors" or less competent than they should have been. Yes, but they were very much the minority.

During my career, because what I did was quite specialized and often related to emergent trauma, my on-call schedule up to the day I retired was heavier than residents half my age were allowed (one reason I retired when I did because I could not cut down on call). I also spent decades as a reserve surgeon including senior staff positions and combat deployment doing combat surgery. Not to brag on myself, but during my entire career start to finish no patient ever had to skip surgery because they could not afford it - their fee was reduced to minimal or nothing if the circumstances warranted it, which basically meant the reduction came out of my own pocket. Yes, I made a very good living, however had I gone in to other endeavors like relatives and others I knew I would have made a good deal more money with a great deal less disruption in my life - getting up at all hours, missing many childrens events due to professional conflicts or emergencies, exposure to all sorts of diseases including HIV (lots of blood in surgery). I say all this because the picture painted by one poster is distorted - and btw if those folks were so bad, did any of the "good" non-MDs ever report them - I personally had some MDs restricted in surgical access.

However, in terms of the original OP - even if you took someone with the soul of Mother Theresa, the brains of Einstein, and the hand eye coordination and skills of a gold medal athlete, there is no way in the world such a person could be ready to be an independent surgeon at 18. Final word.
 
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