Monday, December 05, 2005

Skill Versus Judgment.....
In a comment to this post my neurologist colleague Greg P. posted:
One of my colleagues (also not a surgeon) suggested once that the diagnostic and judgment skills and the technical operating skills of surgeons can many times be independent features of a surgeon. One would always hope that ones own surgeon is good at both, but one can certainly sense that some surgeons are much better at one than the other.
In my opinion, technical skills and judgment are developed separately. Since while one of those qualities can be taught, the other must be learned. The difference being is that the technical aspects of an operation can be learned from a book or other means. The time may come in the near future when a surgical resident can learn and practice a procedure on a simulator multiple times prior to performing it on a live patient. This would allow for the ultimate refinement of technique in an atmosphere of no risk to a live patient.
But would the training be complete? Hardly, in my opinion. But those on the other side of the "surgeon as technician" debate, would differ.
"Surgical judgment", on the other hand, is something that has to be learned, for the most part. I say "for the most part" because the foundation for surgical judgment comes from the knowledge one accumulates from reading textbooks or sitting in lectures. This is the "don't cut the common bile duct or bad things will happen" type stuff that you pick up along the way. This, along with experience, molds one's surgical judgment over time. It forms a feedback loop of sorts, as this Quotation From Training demonstrates:
"Good judgment comes from experience, experience comes from bad judgment"
So you have to learn (sometimes painfully) judgment. You learn from your mistakes. Some good examples of this come from a show that I initially had little nice to say about but I have grown to appreciate: Grey's Anatomy. Dr. Alex Karev gives a patient too much hypertonic saline and it causes complications. At the end, Dr. Shepherd speaks to him about "the first patient I killed". That experience left an indelible mark on him. That's not something that can be taught. Same thing for Izzie's "distance problem" I have said it before operating is easy, surgery is hard.
Now there are some surgeons out there that can acquire skill and judgment more quickly and less painfully than others. Surgery has its' "naturals" like every other profession. Most are "skills" naturals rather than "judgment" naturals.
As for me, while I would like my surgeon to have both good skills and judgment, I would pick the one with good judgment/mediocre skills over one with mediocre judgment/good-great skills because the surgeon with superior judgment recognizes their limitations and will adjust while the "technical wizard" can find themselves in trouble very easily.
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