What surgical specialties get ruled out by my step 1?

[DermViser]

They threw a little hissy fit here on SDN until we changed the name of their forum to Eye Surgeons.

Um, they do surgery on the eye, though. Neurosurgeons don't do it, even though the eye is an extension of the CNS.

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[VisionaryTics]

Why did the Mohs surgeon just forget to close it up? Or you mean Mohs surgeon expected it to close by secondary intention?

It happens pretty frequently. The dermatologist does frozen section after section after section until they get to a point where the patient either has 1) a defect beyond the skills/malpractice of the dermatologist or 2) positive margins in bone/cartilage/functional tissue/other things beyond a dermatologist's scope.

 

[DermViser]

It happens pretty frequently. The dermatologist does frozen section after section after section until they get to a point where the patient either has 1) a defect beyond the skills/malpractice of the dermatologist or 2) positive margins in bone/cartilage/functional tissue/other things beyond a dermatologist's scope.

So for 1) where malpractice is an issue isn't the Mohs surgeon's fault and 2) is definitely not within their scope for obvious reasons. This is hardly the norm but likely very very severe cases.

 

[Winged Scapula]

Um, they do surgery on the eye, though. Neurosurgeons don't do it, even though the eye is an extension of the CNS.

I understand but it was more about the fact that being called ophthalmologist wasn't good enough for them because they were afraid that even medical professionals would confuse them with somebody who dispenses eyeglasses and wanting to be called surgeons.

I don't see the urologists demanding to be called urologic surgeons or ENT throwing a hissy fit because their forum isn't labeled "surgeons of the head and neck."

 

[Winged Scapula]

Why did the Mohs surgeon just forget to close it up? Or you mean Mohs surgeon expected it to close by secondary intention?

No they routinely leave these large facial or other defects, cover them with the dressing, referring the patient to the plastic surgeon for a consultation and eventual closure.

 

[Gastrapathy]

I'm a polyp surgeon. Yeah.


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[member1000765]

Yeah, the plastic surgeons here would be surprised at that. They are frequently closing the large holes made by Mohs practitioners.

Just Wednesday I was watching a friend close a glabellar hole which extended from medial brow to medial brow.

Yea, around the parts I'm in the Moh's peeps don't fix their own defects. They either get sent to ENT/PRS for reconstruction, or they just don't get reconstructed. You'll regularly see people walk into your clinic with either chunks of ears missing (most common), notches in their alar rims, etc. They did their job, though, which was to get all the cancer out.

And whoever said that bilobed flaps, rhomboid flaps, v-y's, etc. are easy, you are either Shan Baker himself or you don't do them, because the planning it takes to achieve an optimal cosmetic outcome without your flap dying is significant and requires surgical training (refer to Baker's local flaps in facial reconstruction to get a sense of how expansive these simple little flaps are; you need to know what flap to use for what size defect in which location along what RSTL or shadow yada yada yada...it's not simple primary closure).

 

[rongeur]

Yea, around the parts I'm in the Moh's peeps don't fix their own defects. They either get sent to ENT/PRS for reconstruction, or they just don't get reconstructed. You'll regularly see people walk into your clinic with either chunks of ears missing (most common), notches in their alar rims, etc. They did their job, though, which was to get all the cancer out.

And whoever said that bilobed flaps, rhomboid flaps, v-y's, etc. are easy, you are either Shan Baker himself or you don't do them, because the planning it takes to achieve an optimal cosmetic outcome without your flap dying is significant and requires surgical training (refer to Baker's local flaps in facial reconstruction to get a sense of how expansive these simple little flaps are; you need to know what flap to use for what size defect in which location along what RSTL or shadow yada yada yada...it's not simple primary closure).

Out in the world there is wide variation of how much Mohs guys will try to do themselves, from 1) nothing at all to 2) things that can be closed with a little undermining and suturing (I think this is appropriate and the most common scenario) to 3) cowboys who think they can do significant facial flaps. I think the #3 camp is lulled into a false sense of security because you can get anything to close on the face even with secondary intention. But getting significant defects to reliably look like almost nothing was done is an art that requires a lot of reconstructive expertise which I would suggest is a bit beyond a one year training in "surgery" (most of which ought to be focused on the actual Mohs surgery and pathology, not reconstruction).

 

[KLPM]

This thread has rapidly degenerated into a schlong measuring contest. Good times.

 

[Winged Scapula]

This thread has rapidly degenerated into a schlong measuring contest. Good times.

Not really.

In the US, there is a very real problem of encroachment and not just by midlevels. It is offensive to those of us who have done a lengthy and physically and mentally demanding surgical residency to have others claim, either outrightly or by implication, that they have done the same.

Because you spend a lot of time in the Anesthesiology forum (oddly enough, asking surgical questions there [which raises a lot of questions for me. Why are you asking anesthesiologists about where the blood loss from a lung transplant comes from, or why surgeons put IABPs in, rather than asking surgeons?) you've surely seen what can happen when a field allows its name and practice to be co-opted by others. Some may claim that will never happen with surgery; I'm not so sure, so we have to be protective about our "product".

So when a interventional cardiologist calls himself a cardiac surgeon, or a Mohs proceduralist calls themselves a surgeon, I cry foul, even if they are talented and skilled practitioners in their own right.

 

[bobby6]

I understand but it was more about the fact that being called ophthalmologist wasn't good enough for them because they were afraid that even medical professionals would confuse them with somebody who dispenses eyeglasses and wanting to be called surgeons.

I don't see the urologists demanding to be called urologic surgeons or ENT throwing a hissy fit because their forum isn't labeled "surgeons of the head and neck."

Reminds me of the time when my patient told me she was having surgery and needed to reschedule her follow up appt. She made is seem like something major only to find out she was having it shaved off at a dermatologist's office. She kept referring to the doctor as a surgeon. "I rolled my eyes"

Also reminds me of the time when we were doing medial and infraorbital wall decompression for Graves disease. We had finished our part and the Eye plastics fellow was getting all hyped up putting on his loops and stretching to operate on a 1-2cm surgical field to do the cantholysis. I almost laughed as it was overly dramatic preparation when he was making micro-surgical movements in an surgical area the size of a quarter.

 

[Winged Scapula]

Also reminds me of the time when we were doing medial and infraorbital wall decompression for Graves disease. We had finished our part and the Eye plastics fellow was getting all hyped up putting on his loops and stretching to operate on a 1-2cm surgical field to do the cantholysis. I almost laughed as it was overly dramatic preparation when he was making micro-surgical movements in an surgical area the size of a quarter.

Well in all fairness, smaller movements tends to make one stiffer after a case, IMHO, so the stretching isn't totally out of this world but I'll agree that it seems a bit dramatic,

 

[DermViser]

MOHs is a procedure. Good grief Derm.

If it was just a procedure, General Derms would do it. It requires fellowship training.

 

[Pir8DeacDoc]

It's all semantics. No one that knows anything about being a surgeon considers Moh's guys surgeons. So whether you want to feel like the biggest tiger in the jungle or not doesn't really matter to me. I know the truth and so does everyone else.

#dontfeedthetroll

 

[Danbo1957]

If it was just a procedure, General Derms would do it. It requires fellowship training.

Sure, the MOHS procedure does require specific training, you can call it surgery, but it's not surgery. In the 1980's we were taught a lot of procedures that are "surgical" in nature (Internal Medicine), and I did a lot of them when I was working in the ER and in the office, but I'm not a surgeon by any definition. If you've ever taken out an appendix, you can call yourself a surgeon. It's not to late Derm, you can reclaim that MD and come back to SDN named Surge.

 

[DermViser]

Sure, the MOHS procedure does require specific training, you can call it surgery, but it's not surgery. In the 1980's we were taught a lot of procedures that are "surgical" in nature (Internal Medicine), and I did a lot of them when I was working in the ER and in the office, but I'm not a surgeon by any definition. If you've ever taken out an appendix, you can call yourself a surgeon. It's not to late Derm, you can reclaim that MD and come back to SDN named Surge.

No thanks. I like my personality just the way it is.

 

[Kahreek]

itt it is just sweet everyone lobbying around.