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Eur J Cardiothorac Surg 2006;31:570. doi:10.1016/j.ejcts.2006.12.008
Copyright © 2006, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved
Letters to the Editor |
a Department of Cardiovascular Surgery, Hospital Clínico, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
b Department of Cardiovascular Surgery, Hospital Universitario ‘Marqués de Valdecilla’, Universiy of Cantabria, Santander, Spain
c Deutsches Herzzentrum, Berlin, Germany
Received 8 December 2006; accepted 12 December 2006.
* Corresponding author. Tel.: +34 93 2275749; fax: +34 93 4514760. (Email: cmestres{at}clinic.ub.es).
Key Words: Surgical training • Education • Professional affairs
The kind comments of Molnar regarding our recently published editorial [1], which referred to the paper of Lim and Tsui [2], basically confirm our impression based on the incorporation of the experience of others, the analysis of the literature and our own accumulated combined medical and surgical practices in the vicinity of 100 years. What is clear to us, and most likely to a significant proportion of our colleagues in Cardiothoracic and Vascular Surgery, is that the art and science of surgery cannot be treated like any other shift job. However, current trends in healthcare management identify surgical teaching and learning with unskilled jobs that must be treated on a shift basis. According to Molnar, hospital managers tend to use junior doctors in non-doctoral functions and we agree with him. The point is not only that we have to defend our trainees for the benefit of our patients and the future of our specialty. The point is that the entire surgical community should strongly be opposed to radical changes in the healthcare that tend to convert hospitals into offices, diseases into administrative processes and regard patients as customers for admissions to consume medical services and products. What count only is to cut down the stay at any price, including the in-hospital stay which is equivalent to bullying and mobbing and aim at prosecution of professionals to achieve political and economic objectives to the disadvantage of the financial resources of the institution.
Juniors are the subject of different pressures. The seniors too, at different levels. In terms of professional skills and experience, it is clear that Europe still needs accurate definitions, which are not easy to issue due to the complexity of its political map. The incorporation of new members is making uniformity almost a dream. Regardless of political pressures, we must try to maintain our identity as we are simply different from the others. Neither better nor worse, simply different. It took decades to be at the forefront of creativity and innovation, just based on hard work. Effective work and high performance can only be achieved by motivation and not by simple paper rules.
Molnar has again made the points in his fine description [3]. Evidence-based medicine as it is generally understood is not our goal as surgeons. Evidence is based on hard work. We, the surgeons, know much better than anybody else, how tough it is to work hard. The only evidence we know is that surgical training is a combination of hard work, art, science, judgment and an appropriate transfer of knowledge from one generation to another.
The readers have to appreciate the comments of Molnar, which are presented as simple, clear and educational.
References
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