Re-inventing the cardiac surgeon
As I was perusing through some nicely laid out flyers which I received over the past week, I was impressed by the eloquent titles : "Reinventing the cardiac surgeon", "Catheter skills all cardiac surgeons should master", "Mastering Atrial Fibrillation Surgery" etc. One brochure even included the word "Renaissance".
All this stuff is completely misleading. Yes, it is great to master these skills. But what is even more important is to be able to do bread and butter cardiac surgery and to do it well. If it takes you all day to do a simple AVR and the patient ends up in the unit at 5 in the afternoon on five drips and an intra-aortic balloon pump, knowing how to exchange a glidewire for a Rosen wire through a vertebral sheath will not make you a cardiac surgeon, nor will it provide you with any job security. Along the same lines, you can call yourself an atrial fibrillation specialist if you canclamp the left atrium next to the pulmonary veins and press a foot pedal, but you can't call yourself a heart surgeon if you can't fix a mitral valve.
I think it is admirable that some programs are providing their residents with catheter skills. At the same time, I think it is abhorrent that many programs graduate residents who are unable to independently do a standard open heart case.
Comments
I completely agree with your comments and observations. I was fortunate enough to train at a program that included a board certified vascular surgeon who was also a board certified cardiodiothoracic surgeon and I did more than 150 purely peripheral vascular/endovascular cases during my 2 year CT residency in addition the CT cases. I now am thankful to the extra years spent in learning mechanical assist devices and transplant operations, managing sick post op patients at the bed side, and doing re-do's, the transections and dissections etc, that really build the confidence in handling real life patients with multiple co-morbidities. I have yet to see a patient that needs stand-alone A-fib ablation, or someone I can help make better simply by catheter skills. My catheter skills are potentially seen as a threat by the cardiologists, vascular surgeons and interventional radiologists alike.
Posted by: M. Salik Jahania | December 18, 2007 12:12 PM