On the uniqueness of surgery

As the divergence between medicine and surgery increases, the author traces its beginnings not to the recent past, but as far back as the Middle Ages and the Renaissance. Even at that time, physicians rarely came in physical contact with the patients and made their diagnoses from looking at flasks of urine from the patients. Skilled physicians allegedly could make approximately 1000 diagnoses from examining a flask of urine. On the other hand, barber surgeons were relatively unskilled and unrewarded, at a much lower class in society, and laid hands on the patient by draining abscesses, cauterizing, dealing with bladder stones, etc.

Despite the Quincentenary of the Royal College of Surgeons of Edinburgh this year and the rendering of the first guild to the barber surgeons, this schism between medical and surgical practice has remained. The author attempts to fit this schism into medicine today by addressing continuity of care and the 80-hour workweek, stating that this schism is not a new development but has existed for many years.

The proposal is made that medicine and surgery should work together as much as they can. However, if surgical patients are not well served by the lack of emphasis on continuity of care brought forth by the leadership of medicine in this country, who the author claims of intentionally distancing themselves from patient care, then surgery may need to go its own way. The patient comes first.