Like bridging it in this sense?

https://en.wikipedia.org/wiki/Brooklyn_Bridge#Culture

I'm not a surgeon myself, but when I was in medical school the program director of our local general surgery residency told me that in terms of hand skills 90% of surgeons are more or less average, 10% are masters, and 10% are horrific. (So basically a bell curve with very thin tails.) He also said the correlation between test scores and surgical hand skills was pretty week.

How much of surgery is based on dexterity vs knowledge/attention-to-detail? I sort of assumed that most operations are basic plumbing (A connects to B) while there are a few specialized domains that require exquisite deftness.

The question is too general. Depends a lot on the kind of surgery you're doing. I guess the answer you're looking for is that anyone could be a surgeon, but not for all kinds of surgery. Also 'basic plumbing' with no room for error is not an easy thing at all.

I'm just relaying what my friend who is studying to become a doctor told me, but by his account there's a wealth of techniques for each procedure or even parts of it, like tying up the dangling bits after kidney removal.

Ultimately it boils down to what a given surgeon practiced in their career.

Most complex or endoscopic surgeries are (dependent on dexterity)

It's more in that if you improperly connect a to b someone dies, and it's not just a snap fit like a pipe. You need to do things like suture two blood vessels together, using pliers (not the technical term), inside a dark box lit up by a tube, while looking at an upside down TV image of what's going on.

It doesn’t have to be upside down; you can just rotate the camera to any angle you like.

That adds up to 110%…

He's a surgeon, not a mathematician.

Lol literal first four words of the comment said he's not a surgeon

He’s a brick layer, not a linguist.

Which must make it the most MD comment I've seen in a long time. It's hilarious!

That's just the normal level of performance people expect of their doctors, 24 hours a day, 8 days a week.

> (So basically a bell curve with very thin tails.)

Is this a concept that exists? I thought "thin tailed" and "fat tailed" were defined by contrast to a normal distribution.

I don't think that "Bell curve" should be interpreted strictly as a Gaussian in this context, but more literally as a curve with a shape resembling a bell.

I'm pretty sure, yes? Cauchy distribution and student-t have fatter tails than a standard normal distribution.

From a doc, it was just a figure of speech. Most docs have no idea what a statistical distribution is.

Kurtosis[0] is a term I came across when dealing with random vibration analysis, but I understand very little if it. The idea of "moments"[1] of various orders to describe a shape of distribution is interesting in general. It sounds analogous to Fourier series, describing a shape/graph with a series of values.

[0]https://en.m.wikipedia.org/wiki/Kurtosis

[1]https://en.m.wikipedia.org/wiki/Moment_(mathematics)

That says exactly the same thing I just said:

> Excess kurtosis, typically compared to a value of 0, characterizes the “tailedness” of a distribution. A univariate normal distribution has an excess kurtosis of 0. Negative excess kurtosis indicates a platykurtic distribution, which doesn’t necessarily have a flat top but produces fewer or less extreme outliers than the normal distribution. For instance, the uniform distribution (ie one that is uniformly finite over some bound and zero elsewhere) is platykurtic. On the other hand, positive excess kurtosis signifies a leptokurtic distribution. The Laplace distribution, for example, has tails that decay more slowly than a Gaussian, resulting in more outliers.

(Emphasis added.)

You can't have a bell curve with thin tails, because a bell curve has standard tails by definition.

I wasn't trying to correct you. Just responding to your comment asking if this is "a concept that exists".

>correlation between test scores and surgical hand skills was pretty week

even if hand skills is orthogonal to test scores, test scores could still be highly correlated with outcomes

It's not just that there are low performers, but that systems aren't always built to send them to do something else quickly.

When my mom need her second urgent brain surgery, one of the nurses, a friend of a friend, warned us that one of the surgeons on staff that night had dreadful results with basically any procedure. and that if we were stuck with him, that refusing the surgery until another one was able to come in. If the floor nurses know, the head on neurology knows, and yet, they were still OK letting them operate.

Any functioning system just has to eject surgeons that get bad outcomes. It's not as if they have to stop practicing medicine, but move to something a little less dangerous.

I agree with the sentiment. The specifics of the implementation are hard.

When it comes to bad doctors, I think a lot of people in the medical field would agree "you know one when you see one." But when you're talking about putting professional restrictions on someone, you need objective criteria.

The naive way, counting up bad outcomes, leads to a system where surgeons are incentivized to decline any case that looks technically difficult or where the patient has lots of preexisting conditions that put them at risk for complications after the surgery. We already see this to a degree in transplant surgery, where outcomes are followed closely to avoid wasting organs.

That said, I think true incompetence is pretty rare. I can't think of a single doctor I 've worked with professionally where I'd be concerned if I found out they were taking care of one of my immediate family.

I want surgeons to decline any case that looks technically difficult. A better surgeon should handle those cases. I want them to decline cases where lots of preexisting conditions that put them at risk for complications after the surgery, too. I'm worried about surgeons who never decline cases, who are eager to cut and maximize profits. We need more malpractice lawsuits so that surgeons become more willing to decline cases.

> I want surgeons to decline any case that looks technically difficult. A better surgeon should handle those cases.

Already happens all the time, although it's at the discretion of the first surgeon. Again, it's difficult to formulate objective criteria for when a surgeon should forward a case on to someone else.

I don't believe that surgeons obviously over operate.

In my career I've seen

- A case where the surgical team declined to operate for endocarditis with congestive heart failure, despite the fact that the society guidelines recommend surgery in that scenario

- A case where the surgical team declined to operate for a spinal cord injury that left a patient paralyzed from the neck down (and dependent on machines to breathe due to the paralysis affecting their diaphragm)

- A case where the surgical team declined to operate on an abscess even after a patient's blood stream infection failed to clear after two weeks of the strongest IV antibiotics

In all the first and third cases, the disease turned terminal after our surgical team declined to operate. In the second example the patient opted to die rather than live the rest of their life on a ventilator and I was left with the responsibility of arranging hospice for the patient.

I'll admit that these are extreme cases, but my point is the patients and family members in those cases likely had a very different view about whether surgeons should decline high risk surgeries as often as they do, let alone more often.

I don’t. I want the surgeon to clearly state their concerns and the risks, but the patient to decide if it’s worth the risk. After all, it’s his/her life.

The problem is we don't exactly have a surplus of surgeons. The choice could be between a below average surgeon and no surgeon.

Part of this is the AMA cartel artificially limiting the supply of residencies.