9 Things Your General Surgeon Wants You to Know

If your doctor recommends a common operation, or if you need emergency surgery, you may well be operated on by a general surgeon. Many people are not aware of the skills a general surgeon has or the important role they fill in medical care. Here’s a look at what some general surgeons say about their field. 

General surgery is “one of the most demanding specialties intellectually,” says Dr. Tim Nelson, MD, professor of surgery at the University of New Mexico. “It takes massive skill acquisition and maintenance,” he adds. “The general surgeon is a kind of a quarterback. If people have multiple problems, then the general surgeon, along with their primary physician, will make sure that everyone is coordinating their care.” 

“We say ‘We operate on the skin and all its contents,’” says Dr. Nelson. “I could get called in for a gunshot or stab wound right now—or for bowel obstruction, appendix, bleeding ulcer—and I’d have to jump up and get going,” says Albert Kwan, MD, a general surgeon in Clovis, N.M.. “General surgeons quite often do a lot of things other people can’t do or are unwilling to do,” adds Edward Lin, MD, who leads the Division of General and GI Surgery at Emory University School of Medicine in Atlanta. “The general surgeon is always a good starting place because they are the most likely to be able to manage what you have.” 

“Don’t choose somebody just based on the certificate on the wall but by what they do most commonly,” says Dr. Lin. “ Before a procedure, when possible, look at a surgeon’s track record. “Surprisingly, [before a certain procedure] nobody ever asks me how many of those cases the surgeon has done, and nobody ever asks the surgeon’s personal outcome [history],” says Dr. Kwan. The surgeon’s office can give you information about how often a doctor performs a particular operation, and what technique he or she uses. 

“A general surgeon in a rural area averages 660 cases a year. A surgeon in a bigger city averages 420 cases a year,” says Dr. Kwan. “A small town general surgeon does a whole gamut of different procedures: digestive system problems, breast problems, abdominal pain, thyroid problems, circulatory problems,” he adds. Kwan also notes a recent study that concluded small town hospitals can have even better outcomes than larger facilities, because the care is personal and the surgeon deeply involved. However, “It’s difficult to recruit general surgeons to small towns, because it’s a tough specialty. We’re the number one specialty in high demand.”

In highly populated areas where there are many doctors, the general surgeon tends to have a narrower focus than his small-community counterpart, who has fewer peers and therefore must serve multiple needs, explains Dr. Nelson. In larger towns and cities with more general surgeons available, physicians often specialize in gastrointestinal surgery or pick a subspecialty. “I do a lot of hernia and gallbladders and then I take emergency surgery calls also, like bowel obstruction or necrotizing fasciitis,” says Dr. Nelson. “Some people do minimally invasive fellowships where they focus on using the small incision–the laparoscopes. General surgeons [in larger towns] tend to have [specific] areas of interest.”

Within the medical history you give before your operation, general surgeons will look for four main factors that will affect your surgery. “One is your heart condition,” says Dr. Lin. “Two is your lung condition because you don’t want to be put to sleep and can’t come off the respirator. Then, bleeding disorders, where you are more prone to clots or you are on blood thinners and tend to bleed a lot. And the last thing is previous surgical history, because by that we know how much you can tolerate, and we can know how difficult the operation’s going to be.”

Improving your general health before surgery by not smoking, eating a healthy diet, and exercising will help you get better faster post-operation. Patients “should be prepared to do a lot of work getting better,” says Dr. Nelson. “You need to be up, walking around and trying to push yourself back to your activities of normal living. Listen to your body, but be ready to do some things and get up out of bed—that’s going to be one of the keys.”

After your operation, you will be encouraged to get up and start walking even while you’re in the hospital. It may seem difficult, but it’s important to help avoid complications. “There are two good reasons to get up out of bed after surgery,” says Dr. Lin. “One, it gets the circulation moving and it prevents blood clots from forming in your legs that can become fatal if they go into your lungs. The second is to get your lungs to open up. The gravity will get your lungs to expand and you will get the oxygen you need for healing and to prevent pneumonia.”

“Most hospitals, if they have an ER, need a general surgeon, because the general surgeon has the broadest look at the patient and can see what’s going on,” says Dr. Nelson. says Dr. Nelson. “Many general surgeons do additional specialization where they learn critical care and to run an ICU, and they’ll do acute care surgery, which is trauma and other emergencies.” That said, not all general surgeons handle emergencies, especially in larger cities where the overall population of doctors is higher.