General Surgery is "the coolest Lego brick".

This idea came to me while watching a very interesting National Geographic television show. Entitled “One Strange Rock” it is hosted by the Hollywood star Will Smith and talks about how life on Earth started, how living beings are all connected, how the planet Earth made life possible, how we are connected to the environment, and how this is crucial for being the humans we are. It is really a must see. But, in what way can this tv show make us think about general surgery and its role in medical practice?

A newborn originates from a living cell. This means humans cannot create but only transmit life. Only nature can create life from unliving matter. This is what happened millions of years ago when there were no living cells on Earth. For creating a life there are some crucial elements. One of these is carbon. In the fourth episode of “One Strange Rock” it is said that “everything in our body has carbon” and “carbon is the ultimate building block”. Carbon is the most important element in our body, all our molecules have carbon, our DNA is full of carbon. Why is carbon so important? Because “it can connect with other elements in almost infinite ways to generate all the different molecules needed to create a living cell.” Carbon can do everything. Carbon must be everywhere. In a certain way, General Surgery is the “carbon” of medical practice. There cannot be a hospital without a surgeon. There cannot be an emergency department without a surgeon. There cannot be an operation room working without a surgeon available. General Surgery is everywhere in worldwide hospitals. Will Smith says two very interesting sentences. “Carbon is like the coolest Lego brick you can imagine”. “If carbon was one of those blocks, it would be the one we would all fight over because you can snap it together just about any way you like”. General Surgery is also the “coolest Lego brick” of medicine because surgeons can do many different operations, can solve many complications, and can help many other doctors performing several and different operations. Let us keep this.

So, why is this untrue in daily medical practice in the Portuguese National Health Service? Why does it look like General Surgery is not the "coolest Lego brick"? Why are some specializations seen as minor and others as top ones? Why being able to do a lot of things is seen as a minor feature? Nowadays, it seems that knowing less and doing just one thing is the best. In the present day, all doctors try to be (super)specialists in just one operation, in just one disease, in just one technique. Doctors do not even care about other procedures or techniques. This is also true among surgeons who are constantly trying to limit themselves in skills. As Prof Dr. Martin Walz said, “a surgeon can have a hobby, but he must know how to do everything”. This is the amazing feature of General Surgery that makes it fantastic, crucial, paramount, and not boring. General Surgery must be seen as the “coolest brick” of medicine because the general surgeon is one of the most versatile doctors. However, this fact cannot be a justification to use the surgeon to do all tasks other doctors do not like or want to do, even if that task falls inside these doctor's specialization scope. If medical society keeps pushing the general surgeon to the limit, using the essential element he is to do tasks a doctor from that specific area should do, one day "the coolest Lego brick” will not be available anymore. All doctors from different areas must work together, and each one of them must do their specific job, not running away from it saying a surgeon will do it. If they do not like the area they choose, that is not the general surgeons’ fault. The most common sentence heard in Portuguese Hospitals is: “This patient is not mine”. All doctors have the duty to assist and work with colleagues aiming at offering the best diagnosis and treatment possible. Unfortunately, the so-called multidisciplinarity does not leave the paper in many daily situations. This has to change…

Another interesting idea from the National Geographic tv show “One Strange Rock” came in the fifth episode about survival. The main feature of life that keeps it going is variety and diversity. “It is a good thing that life comes in a variety pack, but variety comes from diversity.” Without diversity, life would be exterminated. So, Will Smith presents us with this idea: “Clones have a problem. If every individual is exactly the same, one disease, one catastrophe could wipe them all, so you gotta mix it up a little.” From Nature, we understand that being exactly equal or doing exactly in the same way, is not good for species survival. Different characteristics and different ways of doing the same thing give life the ability to adapt and survive. In surgery (and in medicine) I believe this is also true. Different ways of doing the same thing can give us the ability of learning, evolve, and opens the path for doing it better in the future. Machines do it always in the same way and with the same outcome the majority of the times. However, machines cannot do it better unless humans change the protocol of production. If we get stuck in a protocol or standardization, we will achieve a good outcome, but we will be unable to evolve to a better one. Thinking “out of the box” is crucial for being better as it is crucial in life.

Also learning and doing different surgical procedures give the surgeon versatility and the ability to adapt to difficult situations. Skills gained in a particular procedure can be of very good help in a different one. Our life experience comes from learning and from doing different things. I can travel my entire life and several times a month to the same destination, but that will not make me an experienced traveler. Doing different procedures with different surgeons gives the surgeon the necessary background for being an experienced and skilled one. Imagine a surgeon who would only treat peptic ulcers. What would he be doing in the present day? Imagine a surgeon who only performs abdominal surgery in major trauma patients. In which Portuguese hospital would he be working? Imagine a surgeon who only performs colorectal cancer surgery in the future where genetics suddenly erases colorectal cancer. Imagine a surgeon who only performs bariatric surgery in the future where a pill starts treating obesity. What are they going to do? A general surgeon must be versatile and diverse in procedures he can do. This is why General Surgery is the “coolest Lego brick” of medicine. We must keep doing different procedures and treating different diseases for making General Surgery great again.

Learn and do the most you can. Do different things and learn from them. Apply all the experience you gained yesterday and change the future days for the better. “Think out of the box” and keep in mind that being a General Surgeon is the coolest.

Dr. Carlos Eduardo Costa Almeida

General Surgeon

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