Diagnostics comes first
It turns out that the outpatient surgeon is very popular among the population. Firstly, because a doctor of this specialty, along with a therapist, is a primary care doctor. This means that you can get to it without directions. Secondly, many believe (and not without reason) that a surgeon understands human anatomy better than any other doctor. Therefore, he can accurately determine what and why “stabbed” in a particular place. And the surgeon, whose responsibilities include diagnosing and “sorting” patients, gives fairly clear recommendations as a result of the examination. Which specialist should you contact, what examinations should be performed, etc. The surgeon also issues directions. For example, for X-ray examination, MRI, ultrasound, etc.
Educational program with a psychological bias
The clinic surgeon monitors patients with hernias of various locations, calculous cholecystitis, diseases of veins, pathologies of arteries. The surgeon systematically examines such patients, palpating them. And after the results of the examinations prescribed by him, he either carries out conservative (medicinal) treatment or refers the patient to a hospital for surgery. In this case, the outpatient surgeon often has to act as a psychological driver. Simply because many people, at the mere mention of surgery, go into a state of panic and, out of fear, do not want to go to the hospital. Others, out of frivolity, put off such an unpleasant event, sometimes needing to act immediately. The surgeon also has to reassure the patient by talking about his achievements modern medicine in a specific area of surgical intervention, and explain to him the need to perform the operation within a certain time frame. Many are afraid general anesthesia, donor blood transfusions. And here the clinic surgeon also removes all the patient’s doubts, putting him in a positive and decisive mood.
Paper surgery
The surgeon is responsible for selecting a hospital or clinic that serves patients in the county where they live. To go to hospital for planned surgery, the patient needs to have a whole set of certain “papers” on hand. This is a referral from a clinic surgeon with a clearly stated diagnosis, a set of certificates with the results of tests and studies. All this preparatory work the surgeon must perform it very precisely. Otherwise, the patient may simply not be admitted to the hospital. Even if just one analysis is not enough.
Let's go to the operating room
The clinic surgeon himself provides some assistance to patients. To do this, he must have an operating room connected to the primary reception room. And some clinics even have more than one operating room. The main thing that distinguishes a polyclinic surgeon from his colleagues from hospitals is that he can only perform such manipulations and operations for which local anesthesia is sufficient. General anesthesia is not within the competence of polyclinic surgery. Surgical procedures are performed without tissue dissection. At operational assistance tissue is dissected under anesthesia.
Often a clinic surgeon performs a puncture knee joint to inject an anti-inflammatory drug directly into it. In this case, the surgeon observes the effect of such manipulation and determines how many such injections should be performed.
Often the outpatient surgeon has to remove foreign bodies from the skin of patients. These are splinters of various origins, fragments of plastic or glass, metal shavings, etc. Especially often specialists involved in repair and construction work deal with such problems. However, similar troubles happen in everyday life. But dressings, treatment of burns and trophic ulcers, removal of postoperative sutures is usually performed by a surgical nurse. But only as prescribed by the clinic surgeon and often under his supervision.
And the outpatient surgeon must exercise so-called “oncological alertness” in case of the slightest suspicion of a tumor disease. " Once a 65-year-old patient came to see me. She had axillary hidradenitis (in everyday life it is often called " bitch udder"). It would seem a simple matter. However, any surgeon knows that the hormonally dependent glands in women of this age actually do not function. Therefore, having treated her surgical care, I referred her to an oncologist and a gynecologist. They must examine her so that a serious illness is not missed behind a banal illness.", - a surgeon at a Moscow regional clinic shares his experience Victor Kuzkin.
And, of course, the outpatient surgeon performs a number of operations. They are divided into “clean” and purulent. In the “clean” format the following is deleted:
- lipomas (benign formations in the form of capsules filled with adipose tissue);
- fibroids (benign tumor formations, which arise from connective tissue or mucous membrane);
- papillomas (a benign tumor that forms on the surface of the skin in the form of a nipple-like growth).
- abscesses (purulent inflammations accompanied by the formation of a cavity filled with pus);
- boils (acute purulent inflammations hair follicle and surrounding soft tissue);
- carbuncles (a combination of several boils on a small area of skin);
- phlegmon (acute purulent inflammation of fatty tissue);
- panaritium ( purulent inflammation which arise as a result of infection entering deep into the tissues of the fingers or toes as a result of abrasions, small cuts, poor-quality manicure, pedicure, etc.).
In cases where the patient does not have fractures after an injury, but hematomas have formed, the clinic surgeon opens them. It is often necessary to perform operations for onychocryptosis (ingrown toenail). After each operation, the outpatient surgeon must prescribe a series of dressings and explain how to prevent similar diseases in the future.
Operating operating discord
Of course, operating rooms in different clinics are equipped with different equipment. The most modern equipment allows operations to be performed at a higher level. Take, for example, a disease such as onychocryptosis. It is characterized by the ingrowth of the nail plate into the lateral edge of the nail fold. In most cases this happens with thumb legs and causes a lot of inconvenience: pain when walking, inflammation, redness, swelling. Often with onychocryptosis, infection and suppuration of the nail fold occurs. Ingrown toenails are very dangerous for patients diabetes mellitus and people with circulatory problems in the legs. After all, infection can trigger the development of gangrene thumb. Therefore, surgical treatment for onychocryptosis is simply necessary.
There are three options for surgical treatment of an ingrown toenail - using a scalpel, laser and radio wave apparatus. Equipped with a scalpel operating room any clinics, but removing an ingrown nail using this traditional surgical instrument is very traumatic and does not exclude relapses.
Nowadays, laser removal of ingrown toenails is widely practiced, which is slightly traumatic, and relapses after it are extremely rare. However, not all district clinics, but almost all outpatient clinics of private clinics have a laser installation.
Radio wave technology causes even less trauma to the nail and practically does not cause relapses. Such surgical treatment is performed only on on a paid basis and only in private medical institutions. In any case, the operation is performed on an outpatient basis and under local anesthesia.
In rare cases, a polyclinic surgeon visits bedridden patients at home, where he excises non-viable tissue that occurs with bedsores.
There are clinics, mostly large, departmental, private, or operating in hospitals, where a surgeon paired with an anesthesiologist provides care to patients. This medical “tandem” performs operations of the so-called low complexity category. For example, associated with hernia, varicose veins veins, transverse flat feet, deformation of the first toe. As a rule, such clinics have a special room day hospital. There, after surgical treatment, the patient is under the supervision of a doctor for several hours.
Of course, a polyclinic surgeon, in order to master new methods of surgical treatment, systematically improves his qualifications. This is very important because... In a clinic, a surgeon most often works alone and without assistants. Therefore, he has no one to get professional advice from if necessary. You need to decide and do everything yourself. But accurately and competently.
Chief freelance specialist surgeon of the Moscow Department of Health, chief physician of the State Budgetary Institution "City Clinical Hospital named after. S.P. Botkin DZM", Corresponding Member of the Russian Academy of Sciences, Doctor medical sciences, Professor
IN vocational training A surgeon needs knowledge, the ability to apply it in work, and so-called manual skills (basic surgical techniques). Simulation technologies today make it possible to work out both. Indeed, training in manual skills (“getting your hand”) is of particular importance for surgeons.
Modern surgical simulators are simulators for working with real instruments on models, as well as virtual simulators in which a computer program simulates operations in different clinical situations. The combination of these types of training helps to master modern medical technologies and improve surgical skills.
In addition to mastering new skills, the surgeon must continue to maintain them at a high level. Simulation technologies also help with this.
Possibility of simulation training for surgeons medical organizations Department of Health of Moscow implemented in the Training Center for medical workers– Medical simulation center Botkin Hospital(MSC) – unique educational institution, created as a multidisciplinary virtual clinic on the basis of the largest hospital in the capital and Russian healthcare.
The MSC has organized about 20 virtual clinics, including surgical ones (clinic of laparoscopic surgery, clinic of robotic surgery, urology, gynecology, traumatology, neurosurgery, etc.). Among the more than 90 professional advanced training programs for practical healthcare specialists implemented at the MSC, a number of unique programs, developed for surgeons:
The transition from working on a simulator to a “live” operation is always a responsible step: both technically and emotionally. World practice shows that the higher a surgeon’s performance on the simulator, the fewer mistakes he makes when working with patients.
Today, thorough training of surgeons in a simulator before performing operations on patients is considered mandatory throughout the world. There are generally accepted criteria for the surgeon to perform certain actions on the simulator (exercises, operations), which the doctor must master before moving further in training. For operations, such criteria are, for example, the total time of the intervention or its specific stage, the presence of technical errors and their severity.
These criteria are included in computer programs simulators, and the program itself evaluates the surgeon’s actions. For example, a “passing” grade is a score of at least 4 points (with a 5-point system) for all main indicators. The result is considered stable if it is repeated over five attempts. To achieve this level of skill, the surgeon performs an average of 20-25 repetitions of the operation.
The medical simulation center of the Botkin Hospital is equipped with the necessary equipment for training endoscopic surgeons. Experienced teachers help doctors master modern surgical technologies. The training program for endoscopists includes both initial skills and technically advanced courses, including unique ones today:
Virtual reality technologies are becoming increasingly common in surgical training, but it cannot be said that training mannequins will now become a thing of the past. Virtual reality devices and training dummies have their own training function; they do not replace, but complement each other.
The combination of virtual reality and working with mannequins provides more effective training for the surgeon.
To get closer to real conditions It is very important to create a “feeling of tissue resistance” in the body, which the surgeon experiences in real operations. Increasing the realism of manual sensations when teaching operations is an important task for the creators of simulation technology. Then the transition from training to working with patients will be faster.
Another direction in the development of simulation technologies is the team interaction of doctors, including in cases where the work of specialists of different profiles is necessary, the so-called “interdisciplinary interaction”, which will allow achieving better treatment results in complex clinical situations. For example, a team might practice providing medical care patient with severe combined trauma of the abdominal organs and chest after an accident. Such a patient needs the coordinated work of teams of various specialists: ambulances, resuscitators, surgical specialists: surgeons, urologists, neurosurgeons, traumatologists, as well as specialists in instrumental diagnostics.
Life itself dictates the need to acquire new knowledge and master modern technologies. Even experienced doctors face difficult situations. The ability to apply knowledge and advanced treatment methods requires repetition, which is what simulation technologies provide.
Here are 10 topics that you should definitely discuss with your surgeon to ensure that the outcome of the operation is as favorable as possible for you.
1. Medications and dietary supplements
The surgeon should know about all the medications you are taking. This applies to both those that are available with a prescription and those that do not require a prescription. Be sure to list all herbal supplements and vitamins. They are often overlooked when listing medications, but the surgeon needs to be aware of dietary supplements to determine how they will interact with anesthesia and whether they may increase bleeding.
2. Smoking
The patient should tell the surgeon whether he currently smokes or has smoked in the past. Some smokers need to be kept on a ventilator for longer when they first begin to breathe on their own. Smoking can also impair wound healing and cause large quantity scars.
3. Alcohol
It is important that the patient openly talks about the amount of alcohol consumed. Alcohol-dependent patients may shake or have seizures during surgery. If the surgeon realizes that the patient is chemically dependent on alcohol, he will prescribe medications that will relieve symptoms and prevent some of the more serious complications.
Alcohol-dependent patients are often less sensitive to pain medications, so they need a higher dose than usual to achieve anesthesia. If the surgeon is unaware of alcohol use, the prescribed dosage may not be sufficient to achieve successful anesthesia.
4. Previous illnesses and surgeries
Surgeries leave both external and internal scars that can alter the course of the upcoming surgery. The surgeon should be knowledgeable about all previous operations, especially those performed on the same part of the body as the upcoming one.
Past illnesses may affect tolerance to anesthesia.
5. Drugs
Past or current drug use affects anesthesia. Narcotics can either affect the effectiveness of the painkiller and the dosage needed, or they can interact with the anesthesia in special ways and cause serious complications.
6. Allergies
The patient should tell about all types of allergies that he has. This includes allergies to foods, medications, and those that cause skin irritation. The doctor will share this information with service personnel hospitals so that the patient is not given an allergen in a pharmacy or cafeteria.
A good example is an allergy to eggs, which are included in some medications, which, naturally, can cause unwanted reactions both during and after surgery.
7. Problems encountered during the previous operation
The surgeon should be aware of any problems associated with the previous operation, including anesthesia. Was there any bleeding after surgery? Did the patient wake up briefly during the operation? Was there anything else unusual? Also tell your surgeon if you have felt sick or vomited after surgery in the past.
A person who has had problems in the past will not necessarily have them during the upcoming surgery. After all, they can be prevented if the surgeon and anesthesiologist know about them.
8. Current illness or fever on the day of surgery
If you feel unwell on the day of surgery or have a fever in the days preceding surgery, be sure to inform your surgeon. The doctor will either decide that there is no danger or postpone the procedure if he sees any risks. Fever is a sign possible infection, and its reasons must be revealed.
9. Health status
Tell your surgeon about any health problems. For example, if you are having knee replacement surgery, your doctor will need to know if you have diabetes and if you take insulin. Without this information, it will be more difficult for hospital staff to eliminate anything that could harm you.
10. Religious issues
Some religions prohibit blood transfusions and others medical procedures. If this is the case, the surgeon should be aware of the conditions under which the patient agrees to cooperate. In some cases, some operations may be canceled, in others they may be replaced with alternative methods of treatment.
Honesty and openness can improve the outcome of surgery!
At first glance, it may seem insignificant if the surgeon does not know that you have a habit of drinking two glasses of wine every night with dinner, or that you have a history of smoking. But in fact, this is the type of information that directly affects the operation and subsequent rehabilitation. Try to answer the doctor's questions in detail and honestly and do not invent lies when filling out forms.
What operations does a surgeon perform for various diseases?
Nowadays, there are a variety of types and options for surgical interventions for almost any disease. Even commonplace, frequent colds can be associated with a deviated nasal septum or chronic infection of the lymphatic tissue in the throat. Then the treatment will be, accordingly, septoplasty ( plastic surgery of the nasal septum) or removal of tonsils - and these are already surgical operations. It is very difficult to classify types of surgical interventions in general due to their enormous diversity. Most often they are classified based on the purpose of the operation. Depending on the goals pursued by the doctor, operations are divided into the following groups:
- Radical. With such interventions, surgery is the main method of treatment and leads to full recovery. For example, in case of appendicitis or cholelithiasis, the inflamed organ is removed, and the person recovers.
- Symptomatic. IN in this case The operation does not lead to a complete recovery of the patient, but it can eliminate certain symptoms and promote recovery. In other words, surgery is only part of the overall treatment.
- Palliative. Such operations are performed in cases where the patient cannot be cured completely. The main task surgeon is the temporary restoration of any organ functions or improvement of the patient’s quality of life. Palliative surgeries are common in oncology.
- Diagnostic. Operations for diagnostic purposes are rarely performed, since in any case this is a great stress for the patient’s body. The most common is laparoscopy, in which a special camera is inserted into the abdominal cavity. However, when serious illnesses the surgeon can diagnostic purposes not only open the abdominal or chest cavity, but even perform craniotomy.
Rhinoplasty
Rhinoplasty ( nose job) is a fairly common operation in otorhinolaryngology and plastic surgery. Often patients are dissatisfied with the shape of their nose. During the operation, the doctor can shorten it somewhat, lengthen it, “lift it up” or remove the hump. Rhinoplasty can also be performed by medical indications. For example, the nose may be broken, bitten off, or destroyed due to injury. Also for some diseases ( for example, advanced syphilis) destruction occurs cartilage tissue nose In these cases, the patient not only has serious cosmetic defect, but nasal breathing is also severely impaired.Rhinoplasty nowadays is performed by ENT doctors or plastic surgeons. They are most familiar with the anatomy of the nose and can achieve the best results. Operations can be performed either through the nostrils, without external incisions, or with dissection of the facial skin, and even with the use of artificial materials.
It should be noted that nasal tissues are finally formed only by the age of 18–20, so this operation is not recommended for children without serious medical indications.
Rhinoplasty should also be distinguished from septoplasty ( plastic surgery of the nasal septum), which is usually performed for difficulties with nasal breathing.
Blepharoplasty
Blepharoplasty is a type of eyelid surgery that is most often performed for cosmetic purposes. This operation can be performed by both plastic surgeons and ophthalmic surgeons. Usually it comes down to “tightening” the skin or changing the shape of the eyes. Blepharoplasty is performed on the upper eyelid ( overhang, swelling), on the lower eyelid ( swelling and bags under the eyes) or both at once ( for congenital defects, etc.). Sometimes eyelid surgery is performed for medical reasons. For example, with some eye injuries, the eyelid may not be functional.Mammoplasty
Mammoplasty is a reconstructive operation on the mammary glands. IN plastic surgery this is one of the most common operations. However, mammoplasty can also be performed for well-founded medical reasons ( for example, after breast removal due to cancer). There are several types of this operation.Plastic surgeons can perform mammoplasty for the following purposes:
- breast enlargement ( usually symmetrical);
- organ reduction ( including in men with gynecomastia);
- return of elasticity;
- “tightening” of the mammary glands;
- reconstruction and return of symmetry after operations and injuries.
Liver transplant
Liver transplant is the only effective method treatment for many severe pathologies of this organ ( cirrhosis, tumors, autoimmune processes, etc.). The necessary surgical intervention is carried out by a team of transplant surgeons. If necessary, it is possible to transplant a whole liver or part of a liver from a living donor.Liver transplantation requires long-term observation and careful preparation of the patient. The transplantologist in this case is not the primary treating physician. After surgery, the patient is monitored by specialized specialists for the rest of his life ( hepatologist, etc.).
Heart transplant
Heart transplantation is one of the most complex operations in transplantology. It is performed by a team of surgeons, among whom the main role belongs to cardiac surgeons and transplantologists. During the operation diseased heart removed, and for some time the blood is pumped through the vessels using a special apparatus ( artificial circulation). Surgeons transplant a donor heart, sew vessels to it and start it using electrical impulses. A heart transplant can take 8 – 10 hours or more. After this, patients for a long time must take medications to suppress the immune response ( against organ rejection) and be observed by cardiologists for the rest of your life. These days, in developed countries, this surgical procedure is performed relatively frequently. There are people who have successfully performed several heart transplants throughout their lives.Heart surgery
Cardiac surgeons perform heart operations. This area surgery is quite extensive, as the range of possible heart problems is very wide. In almost every big city There are clinics with the equipment necessary to perform cardiac surgery. Currently, there are two main methods. The first is directly in the dissection chest cavity to provide access to the heart. This is usually necessary for large-scale interventions. The second method is to bring devices and instruments to the heart through large vessels ( an incision is made in the subclavian or femoral artery).Most often, cardiac surgeons perform following operations on the heart:
- bypass surgery and stenting of coronary arteries;
- elimination of heart defects;
- heart valve replacement;
- installation of pacemakers.
Removal of a tooth
Tooth extraction can be considered a surgical procedure, but this procedure is usually performed not by a surgeon, but by a dentist. Oral and maxillofacial surgeons or oral surgeons may be involved in tooth extraction if there are any complications. For example, removing a tooth root from the gum tissue involves tissue dissection. Also, the help of a maxillofacial surgeon may be needed if a tooth is removed due to a cyst or granuloma, or in case of purulent complications.Ordinary dentists try not to remove teeth if this involves various surgical complications in future. However, in general this procedure is not dangerous and rarely leads to serious problems.
Gallbladder removal ( cholecystectomy)
Cholecystectomy is routine operation in surgical departments. This operation is usually performed by general or abdominal surgeons. Currently, cholecystectomy is performed in the classical way ( incision of the anterior abdominal wall), and endoscopically, through small holes. Not all specialists can perform endoscopic gallbladder removal, and not all hospitals have the necessary equipment.Cholecystectomy may be necessary for the following pathologies:
- presence of stones in gallbladder (cholelithiasis, cholelithiasis);
- tumors of the gallbladder and biliary tract;
- inflammation of the gallbladder ( cholecystitis);
- fistulas ( pathological holes);
- bubble rupture;
- accumulation of pus inside the organ ( empyema).
Mole removal ( nevus)
Surgeons can remove moles various directions, as well as dermatologists ( who are not surgeons). In most cases, such an operation does not involve any risks for the patient. However, it is recommended that all removed moles be sent for histological examination, since nevi could potentially be an incipient cancerous process. In addition to the usual “cutting off” of the mole and surrounding skin, more gentle methods are now widely used. First of all, this is laser surgery and cryosurgery ( freezing).Thus, to remove a mole, you can contact the following specialists:
- general surgeons;
- plastic surgeon;
- laser surgeon;
- oncologist;
- dermatologist.
Facelift
A facelift is a very common procedure in plastic surgery. Most often, it is carried out to eliminate various signs of aging, to smooth out wrinkles and give the skin elasticity. This can be achieved in various ways ( “suturing” loose skin, placing synthetic materials under the skin, etc.). In parallel with a facelift, for example, lip augmentation or changing the size of the eyes can be performed. All these operations are performed by plastic surgeons.Circumcision
Circumcision ( circumcision) is a very common operation that is most often performed on boys in childhood. Contrary to popular belief, circumcision is not only done for religious reasons or tradition, but also for medical reasons for certain diseases.The procedure can be performed by a urologist or another surgeon experienced in performing such operations. However, even a flawlessly performed operation can lead to some complications ( changes in the shape of the penis with age, rough scars, decreased sensitivity). At the same time, many studies show that circumcised children have a reduced risk of future infections. genitourinary tract and some other diseases.
Laparoscopy
This operation is diagnostic and is used relatively rarely. Laparoscopy is prescribed in cases where doctors cannot make the correct diagnosis for a long time, and the patient’s condition does not allow waiting. Small holes are made in the patient's abdominal wall, through which a special camera on a flexible wire is inserted. With its help, doctors visually examine internal organs, avoiding serious tissue injury.Laparoscopy can detect the following diseases and problems:
- inflammatory process;
- internal bleeding;
- adhesive process ( usually between loops of intestine);
- damage internal organs;
- disturbances in the functioning of internal organs ( for example, with intestinal obstruction).
For what symptoms should you contact a surgeon?
There are many diseases that require surgical treatment, and their symptoms are also varied. Each type of surgery has its own symptoms. In addition, for many pathologies, you should contact a therapist or other specialized specialist, and only he can refer the patient to a surgeon. However, there are a number of symptoms that speak quite eloquently about the need for surgical treatment. You should contact a surgeon if the following symptoms and complaints appear:
- sharp pain in the abdomen;
- acute inflammatory process on the skin;
- purulent processes;
- fractures and wounds;
- the appearance of formations under the skin.
Surgeon consultation
Consultation with a surgeon may be necessary for patients with the most various diseases. In most cases, the patient first turns to a family doctor, therapist, or calls an ambulance. These doctors make a preliminary diagnosis and, if necessary, refer the patient to a surgeon of a certain profile. Surgeons consult and examine patients in an office rather than in an operating room. In most cases, the consultation decides whether the patient needs surgical treatment. In some cases, surgeons may refuse to operate on a patient.
The following conditions may be contraindications to surgery:
- severe chronic diseases of internal organs;
- advanced age;
- high risk of complications ( for large-scale operations);
- advanced forms of the disease ( For example, late stages cancer) and etc.
Is it possible to make an appointment for a consultation online? via the Internet, by phone)?
Most medical institutions provide patients with the opportunity to schedule a consultation by telephone or online. However, it is not the doctor himself who is responsible for the recording, but the receptionist. Sometimes it is difficult to make an appointment with a specific specialist. Also, the recording can be several days or weeks in advance. If the patient's condition does not allow waiting ( severe pain in the abdomen, injury, bleeding, etc.), then you should call an ambulance. Currently, many sites offer online consultation with a surgeon. Usually it comes down to a simple interview with the patient. In the vast majority of cases, there is practically no real benefit from such consultations. It is simply impossible to examine a patient or make a preliminary diagnosis in surgery without ever looking at the patient.Online consultations with surgeons have the following disadvantages:
- the doctor cannot examine and examine the patient;
- patients often do not provide complete information;
- doctors are not responsible for services provided via the Internet;
- many surgical diseases require urgent treatment, and there is no point in delaying the examination.
How to get a consultation?
In private clinics, it is quite easy to get a consultation with a surgeon. To do this, you just need to sign up at the registration desk in advance. Many clinics also clarify the reason for contacting this specialist. In public medical institutions, you also need to make an appointment with a general surgeon. Another option is to obtain a referral from a doctor of another specialty ( for example, from a family doctor or local internist). A referral is also necessary for consultation with a more specialized surgeon. For example, a cardiologist usually refers a patient to a cardiac surgeon, and a neurologist to a neurosurgeon.In case of injury or emergency, the patient is transported to the hospital by ambulance. Here he is examined out of turn by an on-duty surgeon or traumatologist.
Do I need a voucher or referral to a surgeon?
The need for a voucher or referral to a specialist depends on the health care model adopted in any state. In most cases, the first contact occurs with a family doctor, local physician or through the ambulance service. These doctors conduct initial examination and may provide a referral to a surgeon or other specialized specialist at their discretion. In some clinics you can make an appointment with a surgeon without a referral ( at the place of residence).If we are talking about private clinics or doctor's offices, there is no need for referrals or coupons. The consultation will be paid, without compensation from the state or insurance companies, but the doctor will accept the patient in any case.
Is there a surgeon on duty in hospitals and clinics?
Regular clinics and family medicine centers have surgeons' offices, but these specialists are not on duty 24 hours a day. Typically, there are on-duty surgeons in large hospitals and specialized medical institutions ( traumatology, obstetrics and gynecology, etc.). There are ready-made operating rooms where the doctor on duty can perform emergency surgery if necessary.Where does the surgeon receive and examine you?
Surgeon – very common medical specialty. Surgeons' offices are located in all clinics, hospitals and medical centers. As a rule, general surgeons work in small institutions. They have private consultation rooms, patient examination rooms and treatment rooms ( for various medical procedures). The presence of a surgeon’s office does not mean that operations are also performed in this clinic. For serious interventions, a well-equipped operating room and intensive care unit are needed, which are usually not available in clinics.Is it possible to call a private surgeon at home?
Many private medical centers provide counseling services to patients at home. If necessary, a surgeon can also come to the patient. It should be noted that such a need arises quite rarely. Firstly, the patient does not know exactly his diagnosis and cannot know which specialist he needs. Secondly, the initial examination can be easily carried out by an emergency physician or local physician. At this stage, there are no advantages from being examined by a surgeon. Thirdly, no surgeon will perform any surgical procedures at home. He simply does not have the necessary tools and appropriate conditions.It is advisable to call a surgeon at home in the following cases:
- to consider surgical treatment in the future;
- after surgery;
- for various postoperative complications ( to find out if hospitalization is needed);
- if transporting the patient for any reason is impossible or extremely difficult.
How does the surgeon examine?
When planning a consultation with a surgeon, you must take with you the results of previous tests and examinations. This will allow the doctor to look at the dynamics of changes and draw certain conclusions regarding the course of the disease. This often helps in making a diagnosis.The examination itself by the surgeon takes place in several stages. First, the doctor inquires about the patient’s symptoms and complaints, collects information from the patient’s words ( anamnesis). After this, the surgeon proceeds directly to the examination. This stage depends on the disease. For example, for wounds or injuries, the doctor examines the surface, feels ( palpates) tissue for damage. Sometimes palpation can be painful.
At the end, the surgeon usually reports his preliminary conclusion and prescribes various diagnostic examinations and tests to confirm the diagnosis.
Surgeon's office equipment
The surgeon's office, unlike the operating room, differs little from the offices of other doctors. There must be a desk with a personal computer, several chairs and a couch for examining the patient. There should also be a negatoscope on the wall - a special light panel for viewing x-rays. In addition to the main office, clinics and hospitals usually have utility rooms and a treatment room, where some simple surgical procedures are performed. The utility rooms contain cabinets with spare instruments and equipment for sterilizing instruments.In addition to the couch and table, the treatment room has the following equipment:
- stadiometer;
- tonometer;
- surgical instrument set;
- scales;
- Shants collar;
- resuscitation kit;
- thermometers;
- various splints for fixing limbs;
- at least 2 ballot boxes ( for household and medical waste).
Why go to an outpatient appointment after surgery?
After being discharged from the hospital, a patient who has undergone surgery must see the attending physician who performed the operation several times. This is necessary for the specialist to look at the results of his work. The surgeon may also notice the first signs of various complications and prescribe necessary treatment. The schedule of visits is usually drawn up by the doctor himself before the patient is discharged. Sometimes, before a second outpatient visit to the doctor, you may need to take some tests.Do they undergo examination by a surgeon at the military registration and enlistment office, at school or kindergarten?
The surgeon is one of the obligatory members of the medical commission in military registration and enlistment offices and educational institutions. Its purpose is to detect some visible problems ( hernias, hemorrhoids, etc.). The surgeon also evaluates the development of the body as a whole, looking at posture and spine. An experienced doctor can suspect a particular disease based on the smallest anatomical defects. If the surgeon has suspicions about the health of a conscript or student, he gives a referral for additional examination.Surgeon's diagnostic methods
In surgery the most significant role play diagnostic methods that allow you to see organs and tissues in various ways. Such examinations greatly facilitate the operation, since the doctor better understands what exactly he has to do. However, diagnostics is not limited to identifying the problem. As a rule, before any surgical intervention the patient is carefully examined. The fact is that any operation ( as well as concomitant anesthesia or anesthesia) - This huge pressure for the body as a whole. Doctors need to know about any health problems, even if it is not directly related to the disease for which surgery is performed.
What tests need to be taken before surgery?
There is a standard set of procedures and tests that are performed before the operation begins. This allows you to detect various problems health and minimize the risk of complications during surgery.Patients are usually prescribed the following tests and examinations before surgery:
- General blood analysis. This blood test is important diagnostic method research. In many surgical diseases it will show signs of inflammation ( high level leukocytes, C-reactive protein, etc.). Low level red blood cells or platelets may be a contraindication to surgery.
- Blood chemistry. Using this analysis, it is possible to more accurately determine which organ is affected. For example, with pancreatitis, the level of alpha-amylase in the blood increases, and with cholecystitis, alkaline phosphatase increases. Before surgery, it is important to check your hemoglobin and blood sugar levels ( especially in patients with diabetes mellitus).
- Blood clotting study. Blood clotting is tested to ensure that the patient does not experience severe bleeding during surgery. If the blood clots slower than it should normally, certain medications will be used or surgery will be delayed.
- Analysis of urine. A urine test shows how your kidneys are working. Patients with kidney disease may have problems eliminating drugs used for anesthesia from the body.
- Electrocardiographic study ( ECG). Many patients with weak hearted Complications may occur during the operation. This is due to painful shock, blood loss or pharmacological drugs for anesthesia. Doctors need to know about possible problems, so an ECG is done in advance.
X-ray ( radiography)
X-ray is one of the most common methods for examining tissue. Devices of various models that use X-rays to produce images are available in almost every hospital or clinic. In surgery, radiography is used to identify signs of certain surgical diseases and confirm the diagnosis.The following surgical diseases can be identified using radiography:
- intestinal obstruction ( The picture shows accumulations of air and fluid in the abdominal cavity);
- neoplasms;
- abscesses and cysts;
- the presence of stones in the kidneys, bladder or gall bladder;
- bone fractures, etc.
Ultrasonography ( Ultrasound)
In surgery, ultrasound is used mainly to examine the abdominal organs. This method is based on obtaining images using ultrasonic waves. Unlike radiography, it is completely harmless to the patient and can be prescribed to pregnant women at any stage of pregnancy.The following surgical pathologies can be confirmed using ultrasound:
- gallstones ( cholelithiasis, cholelithiasis);
- stones in the kidneys ( urolithiasis, urolithiasis);
- accumulation of fluid in the abdominal cavity;
- extensive inflammatory processes;
- intestinal obstruction;
- neoplasms in the abdominal cavity;
CT scan ( CT) and magnetic resonance imaging ( MRI)
CT and MRI are not prescribed for all surgical patients. These research methods are the most accurate, as they provide a very good image of a specific organ, vessel or tissue that will be operated on. However, the high cost of tomography and the limited number of devices do not allow it to be used as widely as x-rays or ultrasound.CT and MRI in surgery can be used for the following purposes:
- detection of tumors;
- detection of cracks and fractures of bones;
- vascular examination ( for blood clots, aneurysms, etc.);
- preparation for non-standard operations ( for example, detailed examination of the tumor before removal);
- diagnosis of many diseases of the central nervous system, etc.
Treatment by a surgeon
Treatment by a surgeon is not always related to the operation itself. Sometimes patients are admitted to the surgical ward for observation, evaluation, or preventative treatment. For example, when acute pancreatitis Patients are usually taken to a surgical hospital, but not all are operated on. Does the experience and age of the surgeon play a role? old, young)?
Of course, experience in surgery, as well as in other areas, is very great importance. The more experienced the doctor, the more standard operations he has performed during his career. This allows him to be better prepared for various complications and make more accurate diagnoses. However, it should be noted that the training of surgeons takes quite a long time ( 8 – 11 years), therefore, without the appropriate minimum experience, a surgeon does not receive a license.Yet age is of secondary importance in surgery. On the one hand, older specialists have more experience in terms of the number of patients operated on. On the other hand, young specialists often have skills in working with more advanced technology. This is reflected in the methods of diagnosis and the methods of surgery. For example, laser surgery, cryosurgery or endovascular surgery are relatively “young” areas.
How does the surgeon perform the operation?
The surgical operation is performed in several stages. At the first stage, an anesthesiologist works with the patient. It numbs the area to be operated on or puts the patient into a medicated sleep. After this, the surgeon prepares the surgical field by covering the patient's body with sterile drapes so that only the incision surface remains open. This surface is treated with special disinfectants that kill germs. The operation itself begins with a tissue incision to provide access to the required organ. In neurosurgery, this may require craniotomy, and in thoracic surgery, sawing of the sternum or ribs. This is followed by direct therapeutic manipulations aimed at eliminating the problem.During the operation, the surgeon performs the following therapeutic actions:
- removal of dead tissue;
- release of pus;
- removal of an inflamed organ or part of an organ;
- treatment of tissues and cavities with special solutions;
- fixation of organs or their parts;
- restoration of intestinal patency ( ureter, esophagus, vessel, etc.);
- restoration of blood flow, etc.
Are there assistants and nurses in the operating room?
Each operation requires a certain number of medical personnel. The more complex the surgery, the more doctors are needed to perform it. For example, during organ transplantation, the operation may take place in several stages, and several teams of surgeons will work.In principle, the following specialists may be present in the operating room:
- Surgeon. Each operation has a chief surgeon who is responsible for the operation itself. It can be one or several.
- Anesthetist. This specialist is present during operations where anesthesia or anesthesia is required. He is responsible for the patient’s vital signs and maintains him in the condition necessary for the operation.
- Assistant. Not all operations have assistants. As a rule, these are students or young, less experienced surgeons. They can hold dilators or perform simpler manipulations ( apply sutures, clamps, etc.).
- Nurse. The operating room nurse is responsible for preparing the operating room, surgical instruments, and the availability of necessary medications. During the operation, she provides the surgeon with the necessary instruments from a special table. The nurse is usually not directly involved in the operation, since she does not perform the same thorough hand cleaning as the surgeon or his assistant.
What happens before surgery?
Preoperative preparation most often begins about a day before the operation itself. The patient is given sedatives that relieve stress and anxiety associated with the upcoming surgery. Also, before the operation, doctors inform the patient about the manipulations that will be performed during the operation and obtain the patient’s consent.About a day before the operation, the anesthesiologist talks with the patient. He finds out whether the patient has any chronic health problems, allergies to certain drugs, etc. This helps the doctor choose the method of anesthesia or anesthesia and prepare for possible complications.
Also, before the operation, the necessary tests are done ( usually blood and urine).
What happens during the operation?
The operation itself takes place in several stages. First, the patient is given anesthesia. This is done by an anesthesiologist. The degree of pain relief and type depend on what kind of surgical intervention will be performed.Distinguish the following types pain relief:
- Local ( local) anesthesia. Used to numb a small area of tissue. Usually consists of one or more injections. Such anesthesia can be performed by the surgeon himself without the help of an anesthesiologist.
- Regional anesthesia. Anesthesia is given at the level spinal cord. It consists of an injection into the space between the vertebrae at the lumbar level. The injection itself can be quite unpleasant or even painful. The patient remains conscious, but loses sensitivity ( usually below the chest). This anesthesia is used for minor operations on the abdominal organs.
- Anesthesia. Anesthesia involves turning off the patient’s consciousness and putting him into a medicated sleep. This method of pain relief is usually necessary for large-scale surgical interventions.
What happens after surgery?
The postoperative period begins with the patient emerging from anesthesia. After major operations, patients are usually placed in intensive care so that in case of complications, the necessary assistance can be provided in a timely manner. When the condition has stabilized, the patient is transferred to a regular ward. His condition is initially monitored by an anesthesiologist-resuscitator. The surgeon will check the patient’s condition as necessary. He must make sure there are no complications ( postoperative wound suppuration). The surgeon may also remove stitches or drainage tubes after some time. After this, the patient is usually discharged home.The length of patient hospitalization after surgery depends on the following factors:
- severity of the operation;
- patient's condition;
- Availability chronic problems with health;
- presence of complications;
- conditions in which the patient will be at home.
How is the surgeon's hands treated?
Since the surgeon performs manipulations directly in the patient’s body cavity during the operation, his hands must be perfectly clean. This will avoid infection in the wound and prevent postoperative complications. The technique of treating surgeon's hands has been improved over centuries. Nowadays, all specialists adhere to certain basic principles.Before the operation, the surgeon’s hands are treated as follows:
- wash hands under warm running water;
- must be used special soap or other disinfectants;
- use a hand brush;
- wash your hands for at least 5 to 10 minutes, keeping them constantly bent at the elbows and raised so that the water flows from the fingertips to the elbows;
- hands are treated with a sterile swab soaked in alcohol, chlorhexidine or substances with similar properties;
- wipe hands with a sterile napkin.
What instruments are available in the operating room ( surgeon's kit, gown, suit, etc.)?
The operating room is a room adapted for performing surgical operations. There are usually several rooms adjacent to it. Operating room equipment may vary. It depends on what kind of operations are carried out in it. For example, the operating room setup in a gynecology department is very different from the operating room setup in an ophthalmology clinic.Most important elements in the operating room are:
- special table, height adjustable;
- table for tools;
- special lamps with directional light.
Surgical instruments used by the doctor are divided into the following groups according to their purpose:
- for administering liquids ( various syringes and droppers);
- for cutting tissue ( scalpels, scissors, surgical saws, etc.);
- to stop bleeding ( surgical clamps various shapes, devices for installing clips on vessels);
- for tissue fixation ( dilators, probes, surgical mirrors, etc.);
- for connecting tissues ( needle holders and needles of various models).
What kind of suture material is used? surgical threads)?
There are several types of suture material in surgery. Each of them has its own advantages and disadvantages. As a rule, the surgeon himself chooses which material to use, and the patient is not informed about such subtleties of the operation.In general, the following requirements apply to suture material in surgery:
- mechanical strength;
- impossibility of rotting or developing infection directly in the fibers;
- minimal trauma ( the thread should not “cut” the fabric when tightening the knot);
- flexibility to allow necessary manipulations;
- hypoallergenic.
For suturing, threads from the following materials are most often used:
- catgut;
- silk;
- nylon;
- lavsan, etc.
Can a surgeon's mistakes cause a patient's death?
The profession of a surgeon is associated with great risks for both the patient and the specialist himself. First of all, this is due to the extreme responsibility that lies with these doctors. Indeed, surgeons’ mistakes can lead to serious consequences (the need for reoperation, disability or death of the patient). It should be noted that many surgical interventions are “standard” and the technique for performing them is well known to every surgeon. However, in the field of traumatology or oncology, where each patient is “unique” in his own way, there are no templates for performing operations. Therefore, the risk of various complications increases.Regarding medical errors, the law protects both the patient and the doctor. All surgeons have extensive insurance, which covers the cost of patient lawsuits if necessary. If patients suspect a medical error, they can turn to forensic medicine specialists. Then a special commission will be created to investigate the case, the conclusion of which will be submitted to the courts.
In principle, there is no uniform advice or recommendations for all surgical patients. Each area has certain features, and doctors themselves usually explain in detail to the patient what can and cannot be done after surgery. If the surgeon has not told this to the patient or his relatives, then you can make an appointment yourself and clarify these recommendations with him.In most cases, the following tips and recommendations are available for patients:
- after abdominal surgery ( hernias, appendicitis, pancreatitis, etc.) do not strain or lift heavy objects ( more than 3 – 5 kg);
- after some heart operations it is necessary to limit the consumption of water and salt for some time;
- It is not recommended to lie down for a long time; the patient should begin to walk a little when his condition allows him;
- at the first sign of complications ( the appearance of pain, redness around the suture) you need to contact a specialist;
- You can't take some medications ( if necessary, you should notify your doctor).
Do robot surgeons exist?
Currently, there are several prototype robots that help perform some surgical procedures. The problem is that the operation of these machines must in any case be monitored by a specialist. Not a single computer can independently correct the diagnosis during the operation and recognize various complications. It is expected that in the future robotic assistants will be able to perform part of the operation in parallel with surgeons, but all these projects are still at the development stage.Jokes about surgeons
Conversation between two surgeons: - Well, how did the operation go, was it fun?
- No, the patient is under anesthesia...
On the street:
- Girl, let me help you!
- No, no, I’ll carry the bag myself.
- No, I’m a plastic surgeon...
****************************************************************************************************
After the operation, the patient recovers from anesthesia.
Doctor:
- Well, the operation ended well, you will live!
- I’m a plumber... They called the tap into the operating room to fix it!
*********************************************************************************************************************************************************
After the operation, the patient is brought to the ward. There are other patients there as well.
- Wow, looks like everything went well, no more surgeries!
First patient:
- Well, don’t tell me, they operated on me and they forgot the tampon inside, so I had to cut it again.
Second patient:
- And they actually left the clamp on me, and then they took it out too.
Surgeon enters:
Most surgical operations are performed by general surgeons or specialists trained in various subspecialties - neurosurgeons, gynecologists, urologists, etc.
The anesthesiological nurse takes part in the administration of anesthesia, monitors breathing, pulse, blood pressure during the operation and helps with postoperative care for the sick. In the absence of a doctor, some simple (minor) operations can be performed by a paramedic (catheterization, venipuncture, incisions, suturing) and a midwife - internal examination, manual separation, application of forceps, etc. (see Midwife, Paramedic).
Surgery is associated with danger for the patient, arising from the possibility of blood loss (see), development of shock (see), wound infection, damage to nerves and internal organs. Danger may arise due to the anesthesia used (see Anesthesia, Narcosis). Modern types of anesthesia make it possible to perform surgery without haste, with careful and careful separation of tissues, taking into account their anatomical structure and preventing damage to important anatomical structures (nerves, blood vessels).
Loading...