I always stand guard against over-generalisations and over-simplifications but sometimes there is no choice but to succumb to the banalities of common literature. A surgeon is a medical doctor who specialises in doing operations (as the British say) or operating theatre procedures (as the Americans call it) while a Physician on the other hand specialises in prescribing drugs and everything else other than “cutting to effect a cure”. There are overlaps of coarse: Surgeons also prescribe medications and Physicians also do some surgical procedures. The subject of my essay however is not about the qualifications and job descriptions of the two but in the juxtaposition of personality traits that continues to pique the interest of any individual who finds themselves picking lilies, thorns and roses in the rich field that is the medical profession.
Scientific work has been done to better understand these differences. A few come to mind. Rene Warschkow et al did a comparative cross-sectional study on personality traits in Internists (the American term for Specialist Physicians) and Surgeons in Switzerland using the Frieburg Personality Inverntory and published some interesting findings. In general, Surgeons viewed themselves as having excessive achievement orientation and extraversion (talkative, energetic, enthusiastic and assertive) while their counterparts, the Physicians, admitted to having decreased aggressiveness. In the study Surgeons had the stereotype of being less inhibited, more excitable, aggressive and strained while Physicians on the other hand were almost balanced and had the stereotype of having highly developed social orientation. McCulloch et al also published interesting findings on tolerance of uncertainty, extroversion, neuroticism and attitudes to randomised controlled trials (how a doctor accepts the new science) among one thousand (1 000) Surgeons and Physicians who were mailed questionnaires and replied. Surgeons were found to be more extroverted (the talkative doctors) and less neurotic while also being more intolerant of uncertainty. However, no difference was found in the attitudes regarding clinical trials.
On the 27th of September 2013, at the International Conference on Residency Education, Dr Joseph M. Drosdeck of Wexner Medical Centre Ohio made a very fascinating presentation on his findings in a study he did on 68 Surgical participants and 124 non-Surgical participants on the Five Factor Model (also known as the Big Five Inventory Survey). I have to admit this single work of science – the Big Five Inventory Survey – has been the single most powerful driving force behing this nifty essay. Drosdeck compared five aspects of personality:
1. Extraversion (explained above)
2. Agreeableness (sympathetic, kind, mature, caring and affectionate – both hostility and indifference)
3. Conscientiousness (organised, thorough, diligent and planful). Good impluse control also falls under this category.
4. Emotional Stability (Neuroticism) – calm in the face of adversity. Low scores were associated with Anxiety, Depression and self – consciousness.
5. Openness to Experience (Intellectual, creative, artistic – Conventional andConservative) OR
Preference to familiarity
I found Drosdeck’s conclusions very fascinating. He concluded that there are indeed inherent personality differences between Surgical and non-Surgical specialties AND personality traits change during medical training. This is exactly what we ALL have known: Surgeons are born but can be made. Physicans are born but can be made. Now that I have the warm embracing cushion of fact allow me to embellish and indulge.
I know a real Surgeon. I have met him. He has a very deep voice and he loves his drink. Legend has it he once vomitted into an open abdomen while operating. He was called to an emegerncy (even though he was not on call) while lubricating and because he is a real Surgeon he responded. The patient survived, made a full recovery and the Surgeon is still a real Surgeon. I remember a particular day. I was seated somewhere in a plain dark corner while the Surgeon introduced us the meek medical students to Surgery. He said and this I remember clearly for it was during one of those few moments I actually paid attention during a lecture, “A Surgeon has eyes of an eagle, the heart of a lion, hands of a baby……”. He must have said more but I blanked out as usual. He is a politician, loves authority, thinks he’s the greatest Surgeon on earth, thinks being a Surgeon is the greatest call on earth and believes, “God’s greatest gift to mankind is a functioning anus.” He has childish tendencies. I remember one day in theatre we had a very interesting case and my other boss, the other real Surgeon, decided to grace the theatre with his presence. In came in the real Surgeon late, takes one look at the other real Surgeon and sulks his way through one of the best acts of thievery I have ever seen. I believe a Surgeon has to be a very good thief. He has to break into a home, take what he came for and leave everything as close as it was before he broke in. He has to go in, grab, fix and get the hell out of there before he gets caught. Before he gets caught by the Creator.
I know a real Physician. I have met him. He talks well, dresses well, walks fast and praises everyone….at the appointed time. He is eloquent. When he talks you have no choice but to listen. He makes sure you know that he knows what he is talking about. He smells good too. The nurses talk about him as if he invented soap. I heard one say, “He smells of water”. Not ‘like water’. OF water. He too loves authority though he seems to shun it. He is soft. Soft-spoken and very very verbose. He loves euphemisms. AIDS is not in his vocabulary but it certainly is what he knows best. It is ‘retroviraemia’. He can recite all the latest guidelines but never calls Diabetes ‘high blood sugar’ unless talking to a patient. It is ‘glycaemia’. He can do a full examination in under ten minutes and come up with ten different diagnoses. He knows all the drugs: their names, uses, dosages and everything about them that you do not want to know. He thinks “Surgeons just like cutting and nothing else”. He thinks they are not intelligent. He is very gentle. Even his handwriting is gentle and delicate.
A doctor is either a Surgeon or a Physician. Paediatricians, Radiologists, Psychiatrists, Anaesthetists, Oncologists, Gynaecologists, Haematologists, General Practitioners and the works. Every doctor is either a Physician or a Surgeon………….or a Pathologist. Now those people are different and special. They have their own category. I know a Pathologist.