Doing and thinking: a view from the operating room
YEARS AGO, when life was perhaps simpler, the medical profession was to a great extent divided into groups of "doers" and "thinkers": surgeons and nonsurgeons. During the past two decades, however, this distinction has become increasingly blurred, and in no specialty has this change been greater than in the field of cardiology. The cardiologist of old relied on his stethoscope and his ability to interpret electrocardiograms and x-rays, but now he may perform cardiac catheterizations or
... zations or angioplasties, insert intra-aortic balloons and pacemakers, or prescribe streptokinase in addition to interpreting echocardiographic and radionuclide studies. To a surgeon looking across the professional scene at his cardiologic colleagues this change elicits mixed feelings. For years cardiologists have accused surgeons, sometimes in jest and sometimes seriously, of being interested only in operating. On the other hand, surgeons now see cardiologists who want to spend all their time in the laboratory doing invasive studies and who openly express their dislike for seeing patients in the office and their pleasure in technical accomplishments. There is nothing wrong with this attitude provided the implications of being a "doer" are recognized. First, "doers" must be appropriately trained. Current cardiology training may be falling short in this regard. Training in technical operating skills, the discipline of the operating room, and the analysis of morbidity and mortality and the discussion of technical errors, which are an essential part of the training of a surgeon, might be incorporated into that of the invasive cardiologist. An active rotation on a surgical service could enable the fellow to learn technical skills and gain a valuable visual knowledge of pathology, which is essential for the surgeon and equally important for cardiologists doing angioplasties and interpreting arteriograms.