Category: Surgery

Surgery was, and still is, a very important aspect in medicine. The development of surgery has come a long way, but it is important to look back at its roots. Looking back and understanding the changes that occurred allow us to see the different advances in surgery, the mortality rate for surgeries, and how surgery lead to the understanding of bacteria and its relation to infection. As surgery increased, so did the fatalities. It is these fatalities that led Joseph Lister to devote his time to figuring out more about operative infections.

Surgery started out being viewed as inferior, the work of hand not head (Porter, p.110). Today, surgeons are well respected and viewed as the upper class. This was not always the case. Surgery was very limited because it was so dangerous and painful. Surgeons were often barbers and would lance boils, cauterize, and set fractions. Bloodletting was also a very popular practice. Illnesses were mostly treated with herbal medications. Surgery was usually the last resort, especially amputations. The Greeks discovered that certain infections, like gangrene, required amputation. Even though amputations were necessary, they were still constricted to below the knee because of the lack of resources. The closer to the body the amputation was, the more likely the patient would die. The battlefield is where many people performed and learned more about surgery. Paré was a war surgeon and introduced vascular ligature. Surgery was so risky and constricted because of the high risks of infection and the lack of anesthesia. It was way too painful for people to endure. Surgery started to develop as more knowledge and resources became known.

Surgeons were often trained by observing or apprenticing. Soon enough, anatomy schools provided more education about the body and surgeries. Surgeries were performed in operating theaters and observed by crowds of people. People not even involved in medicine would come to watch the procedures. The environment these surgeries took place in were filthy. Fitzharris (2017) described the operating table as a wooden table stained with the telltale signs of past butcheries, and said that the floor was strewn with sawdust to soak up the blood. Today we know that this is extremely dangerous, but in the 1840s they had no idea this was doing harm. They did not know about bacteria and that it would cause deathly infections. Outside germs were brought in by all of the people, and the surgeons themselves were covered in bacteria. Surgeons never washed their hands, equipment, or their aprons which were covered in blood. Fitzharris wrote that surgeons believed pus was a natural part of the healing process rather than a sinister sign of sepsis. Surgeons thought pus was normal after surgery. There is a lack of knowledge because the dangers of bacteria have not yet been discovered. Along with the bacteria and infections, pain was still a problem. Alcohol and other plant-based substances were used but were still not good enough to numb the pain or keep the patient alive during surgery. This was until the use of ether. Before ether, surgeries had to be very quick because they could not keep the patient open long. Porter (2002) said the breakthrough in anesthetics came when William E. Clarke used ether to extract a tooth. Even though Porter said this was the breakthrough, in 1842, Crawford Williamson Long became the first documented doctor to use ether as a general anesthetic. Robert Liston then completed an amputation using ether. When ether was first used, it was referred to as the Yankee dodge due to its being first used as a general anesthetic in America. Because of ether and new anesthetic techniques, surgeons were able to dive deeper into the body. Surgeries did not have to be constricted to superficial procedures now that they can successfully numb the pain. Surgeons are able to work slower and cut access areas in the chest and abdominal cavities. This was a huge milestone.

The use of anesthetics led to an increase in surgeries which ultimately led to more deaths. Patients are no longer dying from the pain, but from infections like septicemia. The infections came from thing like the unsanitary tools, the surgeons, and the operating theater. Ignaz Semmelweis realized how infection was spreading. Porter (2002) said that in 1848 Semmelweis realized infection was being spread from people working in post-mortem then going to directly delivery rooms. Mortality rates dropped when he implemented the rule of washing hands and tools in between autopsies and seeing patients. Many people disagreed with the idea that doctors were spreading diseases, but people became more aware of the spreading of infections. A few substances were being used to try to prevent infections, but the first antiseptic technique and surgery was done by Joseph Lister. He also discovered more about germs. In 1867, Lister insisted on two points: germs caused infections; and infection and pus-formation were not inevitable, still less beneficial, stages in wound healing. Lister learned that so many patients who underwent surgeries and amputations were dying from sepsis. The mortality rate dropped after using his antiseptic spray. The effects of the antiseptics and having a new understanding of bacteria and germs, drastically improved surgery. Porter also explained how by 1900 doctors prevented the risks of infection by wearing protective wear like gloves, gowns, and masks.

Many developments throughout the evolution of surgery led to this understating of bacteria. Surgeons and barbers did their best with the knowledge they had. It makes sense that there were more deaths after the increase in surgery. They did not have the knowledge at the time to know how to prevent infections. This part in the history of medicine and surgery is very important. All of these deaths are what led to the discovery of bacteria and prevention of infection. It is these deaths that led people like Joseph Lister to strive for an answer to what was causing these infections. The discoveries of anesthetics, like ether, and antiseptics, allowed for surgery to continue to develop. All of the negative outcomes that occurred were experiences to learn from. It is incredible that these people could discover all of these things with the resources they had.

Unequal representation of women in the health sector starts from the field of education itself. Ever since the right to education became a fundamental right, several barriers that were present in the past have been removed but however a few barriers still exist for women through academic institutions. These barriers could be understood through the phenomena of the leaky pipeline. Though a lot of women are educated, sever of the candidates gradually leak out of the educational system due to the flaws in the channel and only a few attain the intended goal. For example, in the UK, 50% of enrolment in medical schools are women, but only 21% of them end up becoming surgeons, and even fewer women enter into specialties (Park, 2005).

One of the reasons for the working of the leaky pipeline in the field of medical education could be the structural barriers that exist. One of the recent investigations in 2018 found that a few medical schools in Tokyo manipulate the entrance exam scores of female candidates. The scores of the female candidates were lowered by 20%, and the scores of the male participants were increased. It was reported that the school did not want female doctors, since it was anticipated that they would shorten their career after having children. Nevertheless, the authorities of the institution denied having any prior knowledge about the incident. Similarly, a few medical colleges in Andhra Pradesh reserve around 120 seats for women in fields like gynecology and dermatology, but only 12-20 seats in specialties like neurosurgery and orthopedics. However, now, most of the medical schools have removed gender-based reservations. During clinical internships, surgeons prefer male interns for assisting and suturing. Since female interns get lesser opportunities to work, they have limited scope for developing skills.

Every society has a sexual division of labor based on the perceived characteristics of a gender. We can understand the sexual division of labor through Sandra Bem’s gender schema theory. According to this theory, there are certain schemas or mental frameworks which describe the characteristics of male and female. Surgeons describe themselves as active, strong, decisive, brave, detached and aggressive. All these characteristics come as a part of natural and embodied knowledge for men, but not for women. Women tend to be more nurturing, caring and cooperative, so they are believed to be more fitted to be nurses rather than surgeons. This could also be one of the major reasons for male surgeons to have a profound distrust on the performance of women, and this attitude is carried by patients as well.

Joan Cassell conducted a study on female surgeons in 1996. She conducted an elaborate survey on the attitude of female surgeons towards relationship with male surgeons and patients. A few of the findings from the study was that, women surgeons were not allowed to engage in ‘doctor fits’, whereas male surgeons who threw tantrums were let go as being under pressure or high strung. Women in the medical sector were also more likely to face stronger consequences from the authorities if something went wrong in the surgeries. While on one side female surgeons are treated harshly and disrespected in the work space, there exists the other side of the spectrum as well, wherein the male surgeons sometimes adopt female surgeons as daughters or sisters and keep them away from challenging tasks – this is problematic as it undermines the abilities of women. Female surgeons also face a variety of issues while dealing with patients. The term ‘doctor’ is almost always associated with men. In the mass media, men are always portrayed as mental health professionals and women as assistants or nurses. So, when a patient walks into a hospital they do not expect a woman to be a doctor or surgeon. Female surgeons are usually mistaken as nurses. In the study conducted by Cassell, a few of the surgeons shared their experiences of instances when patients have denied treatment from a surgeon because she was a woman. Patients prefer to hear about their surgeries from male surgeons, even if they are just interns or junior residents.

“The wrong body in the wrong place”. This is a phrase that Joan Cassell keeps reinforcing throughout her book ‘The Woman in the Surgeon’s Body’ (1996). She uses the idea of hegemonic masculinity to understand why women are underrepresented in the field of surgery. A woman’s body is considered to be a misfit to the idea of masculinity. According to her, the major characteristics of masculinity include dominance, assertiveness, aggressiveness, etc. During surgery the body of a surgeon dominates the body of the patient; the surgeon dominates the body by piercing and cutting through the body, making irreversible changes in it (Cassell, 1996). This is considered to be a power that is held by the epitome of masculinity but when a woman performs surgery it disrupts the power structure. Men are also considered to be life givers; semen is considered as a source of life, as it has the power to impregnate or not. A surgeon also holds this supreme power of giving life or taking away life. When a woman performs surgery, she also holds this power. The idea of a male patient being vulnerable at the hands of a female, even if she is a surgeon is unfathomable. According to Cassell, this is the reason for the patriarchal system to limit surgery only to males.

Work-life balance is also important. A surgeon must always be on the go because they will be immediately called if something goes wrong in their patients, no matter what they are doing. Since women also take family responsibilities, it becomes very difficult to maintain a work life balance. Studies suggests that, female surgeons have decreased levels of relationship and parenting satisfaction compared to job satisfaction (Hebbard, 2009). Job satisfaction of women surgeons reduced after they had family and children (Incorvaia, 2005). Female surgeons say that residency, which is the most important face of a medical career, is the most difficult phase of the medical training because it is around this time that women give birth and take up other family responsibilities. Female surgeons who have children are less likely to pursue surgical specialties; they have fewer publications and slower career growth (Sood, 2010). Crucial years of personal life collides with the crucial work years of professional life, forcing women to choose between the two.

Within surgery the highly paying specialties are dominated by men. For example, orthopedic surgery has 80 4.6% men, neurosurgery has 82.5% men, cardiology has 80.8% men whereas other fields like gynecology, pediatrics and dermatology is dominated by women. This again reinforces the gender stereotypes. Aspiring female surgeons do not find female role models in fields like orthopedics and cardiology, so they also pursue the female dominated surgical fields, continuing the cycle.

In recent times the number of female surgeons is slowly increasing however, the power positions are still held by men. Surgery to this day remains a ‘male sport’. There is a long way for women and men to attain equality in the surgical field.

A shortage of orthopedic surgeons performing joint replacement is expected in the next several years. “By 2025, there will be a projected shortage between 25,200 surgeons and 33,200 surgeons” which is an extreme shortage of practitioners in this field (Rechtoris). This is one of the reasons that I want to become a surgeon along with helping others. ‘When a patient gets well his doctor ‘feels’ good–a personal warm glow that tells him once again what being a doctor is. This pleasure never dulls with age or time but remains vital and strong after decades of practice. ‘Becoming a doctor’ is acquiring this ability to help a sick person get better. It is one of the most precious skills one can acquire in a lifetime.” says Frank C. Spencer, a Cardiothoracic Surgeon. An orthopedic surgeon’s ultimate goal is to better the lives of their patients, making a difference one person at a time, and overall improving the lives of hundreds, if not millions.

Orthopedic surgeons are devoted to the diagnosis, treatment, and prevention of disorders of the joints, bones, tendons, ligaments, and muscles. They examine, diagnose and treat diseases and injuries of the musculoskeletal system with surgery and corrective mechanical devices. They work on everything that allows you to move and be active. Orthopedic surgeons produce a better life for people who are suffering, in pain, or may have weak bones and help them feel better. They accomplish the ability to improve others’ lives by creating new ways that can improve medicine to better the lives of future generations. Surgeons are expected to be able to stand throughout the day, have steady hands, be able to withstand stressful situations and be able to grieve the death of a patient. They must have a thorough understanding of current medical ethics, medical technology, and current pharmacology and physiology. To be a surgeon, the person should also have an aptitude for musculoskeletal health, disease prevention, and treatment is essential.

A surgeon’s typical work day is from 8 a.m. to 4 p.m. when they typically see 20 patients. This makes at least a 40-hour work week. Orthopedic surgeons work longer hours than the average American worker and their work hours may be irregular. A big part of an orthopedic surgeon’s workday involves consulting with patients and other doctors to determine if it’s appropriate to treat the disease or injury with surgery or to treat it with something less invasive such as exercises or injections. Many orthopedic surgeons specialize not just in musculoskeletal surgery, but in specific parts of the body. For instance, some may specialize in the spine, the knees, or the feet and ankles. Depending on their area of specialization, the surgeon may or may not perform surgery on a typical workday. They also try to Improve the lives of their patients through orthopedic surgery. A surgeon should have a caring and personable attitude towards their patients. An example would be getting to know the patient one-on-one, understanding them, hearing them out, and caring for them. You want to be able to help them and feel sympathy towards your patient. You must be motivated and satisfied despite the challenges of long hours and high levels of stress. As a surgeon, you must have flexible days because you never know what can come up, especially when you are on call. You must also be willing to learn, study, think, and piece together items after hours about your patients.

As a surgeon, you must work at least 8 hours a day and must be on call on certain days that are assigned to you. Your schedule can change a lot due to emergencies that you can be called into, including holidays, especially if you are scheduled to be on call that day. The average median pay for an orthopedic surgeon is $315,000 and you are paid by the hour. However, by the end of my career, I could be making upward of $553,537.

To become a surgeon, you need to complete a 4-year bachelor’s degree program in biology, pre-medicine, or a related field. Then, aspiring orthopedic surgeons must complete four additional years of medical school, followed by a 4 to 5-year orthopedic surgery residency in a hospital. A medical internship typically lasts one year for all professions. Internships are usually transitional or specialty tracks. After a physician has completed an internship and the USMLE or Level 3 of the COMLEX-USA, they can be a general practitioner. Orthopedic surgeons complete more than a decade of training, including an orthopedic surgical residency in a hospital. They must pass the complex USMLE exam to earn their medical license, then take an exam to become board certified as an orthopedic surgeon. To help prepare for a career in the medical field as you are in High School, you can take some courses to help you prepare for a medical career such as medical terminology and anatomy and physiology.