Health Matters

When is a surgeon not a surgeon?

When is a surgeon not a surgeon? The short answer is that a surgeon is a person who has a general medical registration (plus other perquisites) and completes five year of training. Without training and accreditation as a surgeon, a medical practitioner cannot claim to be a surgeon.

My interest in this topic came about due to treatment for skin cancers. Several years ago, I visited a dermatologist (a doctor that specialises in skin conditions). I was referred by my General Practitioner (GP). Alarm bells first went off for me when I was in the second waiting room (near the doctor’s consultation/examination room) regarding infection control. The waiting room (a converted hallway) was generally untidy with boxes and other paraphernalia on top of storage cabinets. While I was waiting another patient arrived to have his stitches removed. He sat at the other end of the hallway, on a bed trolley for the procedure. The curtain was not drawn for his privacy! I felt I was intruding so I moved and sat facing the opposite wall.

When I was shown into the consultation room it was a large room with an examination table and other equipment. The space did not look hygienic to me. The examination was for the bridge of my nose. I had asked my GP to do a biopsy, which she did reluctantly. Even though the pathology results were benign my GP was suspicious it was a squamous cell carcinoma (SCC). I also had a small and insignificant brownish patch on one side of my face. The dermatologist was enthusiastic in his diagnosis and told me I had Bowen’s Disease. No signs of this at present!

Right then and there he was going to scratch and scrap and perform laser treatment. He laughingly said, ‘you’re not going to a ball in the next couple of weeks, are you?’ I told him that I would rather wait for treatment once I recovered from my cold (cough, cough)! He then gave me a more detailed explanation of my condition and told me there were three options: laser, excision, liquid nitrogen. I never returned.

I then visited a skin cancer clinic. I had solar damaged skin, solar keratosis with moderate dysplasia. My condition, including my nose, was treated with Imiquimod cream. At the time I was also diagnosed with a Basal Cell Carcinoma (BCC) on my back. At the last minute I got cold feet about having surgery in a room at the skin cancer clinic. This happened after I saw a severe rash on the face of a person I knew who had a BCC removed from the side of her nose (same clinic). I cancelled my appointment. I asked my GP for a referral to a general surgeon. I knew a surgeon who was highly skilled. He had performed major surgery in 2010 on my One & Only (O&O) who had stomach cancer. A complicated operation which was very successful.

The doctor sitting in the chair must have the right qualifications. GP’s can do minor surgery but there are occasions when a trained surgeon is the best option for the best outcome.

My BCC was removed in a private hospital, St Andrew’s Toowoomba. I chose the option of a local anaesthetic. It was one of those occasions when you walk into the theatre and have an opportunity to have a good look around! It was a new theatre, with glass walls and incredible technologically advanced equipment. I knew I had arrived at the right place. Afterwards I was monitored for a time in recovery and was given water, then tea and sandwiches. I had a follow up visit with the surgeon who checked the wound. The stitches dissolved and the wound healed. The operation was a complete success.

In May this year I was diagnosed with three skin cancers that were incised at the same skin cancer clinic (different GP) that I previously visited. I decided to have the three incised at the same time: upper left arm, upper left back and right thigh. I do not know what I was thinking at the time, but the doctor did not recommend, nor did I ask for biopsies!

Five months later I am still receiving treatment for the infected incision on my back! It appears that the internal stitches did not dissolve after the surface ones were removed. I know this because I pulled out one knot of fishing line several months later. Then later in another part of the wound (it had only five stitches) there was a foreign body (a stitch) that was causing trouble. I visited my GP – treat with Bio-Oil! Several months later I phoned the skin cancer clinic and asked for an appointment with the doctor who did the surgery. I was given an appointment with the nurse. A month later back to another GP (mine is on holidays). I am given anti-biotics and cream to apply to the wound.

When a surgeon is not a surgeon this is what happens. My incision is still healing after five months. In my case I had local anaesthetic and incisions in three separate places on my body. There was no offer for a cup of tea or a period of time to sit and rest prior to leaving the clinic. I paid my account and left. When I went back weeks later to have the surface stitches removed the treating doctor did not check my wounds. The stitches were removed by the nurse.

I am currently completing my course of antibiotics. A few months after the incisions I asked for the histopathology report. The wound I have had all the trouble with is a solar keratosis. It could have been treated with Imiquimod cream!

Please Note: I am not a trained medical practitioner and the comments in this article relate to my personal experiences. Anyone who has a skin condition should first see a GP. My preference in the future is to have any surgery done by a qualified surgeon, not a GP who works in skin cancer medicine and performs surgery. Click on the article here by William Verity who looked into cosmetic surgery and skin cancer treatments and the associated risks.

When is a surgeon not a surgeon? Now that you have read this article I think you know the answer!

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