I appreciate your input. I'm not as versed in the foot world as I am in other parts of medicine. And I do know that there are excellent, excellent physicians at big institutions. I've been on the patient end of several, and I know other great institutional physicians personally.
But there are horror stories too -- and big institutions are more capable than unprotected private practitioners of covering up for their physicians. People are very afraid of speaking out against well positioned institutional physicians because of potential career and reputational repercussions.
And while your institution may be benevolent, as may you, there are a number of places that use residents to bang out as many surgeries as possible with a lot less attention by the attending than patients would ever imagine. I'm not making this stuff up, and I won't name names -- maybe the podiatry world is better bred than other parts of medicine.
In so many procedures it takes one millimeter error to produce a horrifying result. I just don't know if I can totally agree with your position on guiding residents making a much better surgeon. I can understand how it can make you a better surgeon, but you would still have to be doing a ton of your own work to stay sharp.
A physician who won't tell me how many he does of a procedure a year, or has done in his career (obviously it can be an approximation), sets off a red flag in my mind. Do you do one a year? Ten? Fifty? What percent of your practice is this type of work? If I cannot get a ballpark out of the person -- I get very worried. Doctors know their numbers, approximately. You don't blank on that kind of stuff, even if you can't say "I did 13 last year, 11 the year before, 79 in my career" -- you know you do roughly 10 a year, over 50 a year.. ballparks.
You could argue that putting an IV in is pretty uncomplicated. It certainly is compared to most surgical procedures. But.. you get that nurse that hasn't done it for a year, or six months.. versus the one who is doing three a day -- and I'd wager that most of the time, there's going to be a difference. Having your hands in there and doing it yourself over and over keeps you fresh. Simple things that an RN does everyday, but a very talented surgeon only did back in medical school, are much more likely to be done better by the RN. He or she is doing it on a daily basis.
Ok, that's my rant for the week. I'm passionate about this stuff because I've seen a lot of doctors, patients, and people of all walks getting in bad positions with their healthcare, or that of their loved ones, because they never understood or picked up on these principles until after they had a horrible, life-changing experience in the OR. It doesn't just apply to the OR, actually. Any aspect of your care. Or, even further, any service of any kind!
Proficiency in a highly complex task does not guarantee proficiency in a less complex task of a similar nature. If an ENT can do some nasty, nasty head and neck cancer surgeries, but then tries to do a theoretically "less complicated" surgery that he has much less repetition with, he can still do an inferior job or screw up, when compared to an ENT who does much less complex cases, but does a ton of that specific sort. I use this example because I can think of a lot of incidences with head and neck cancer where this is the case.
Thank you for the doctor recommendation. This has been a fun discussion.
