(This post was previously published on KevinMD.com.)
Some doctors love to do procedures. Stitching, skin biopsies, removal of ingrown toenails—you name it, they’ll do it, and then they’ll ask for more. In fact, I used to have a senior partner who actually told me he preferred doing procedures more than any other type of visit. When I asked him why he enjoyed procedures so intensely, he shrugged and said, “Because I don’t have to think too much.”
I, on the other hand, have never gone out of my way to do procedures. For years, I regarded my aversion to procedures as a character flaw. I watched my classmates and fellow residents compete for the next laceration repair and wondered what was wrong with me. Why didn’t I like procedures? Wasn’t it the doctor’s sacred right to hold the scalpel? Shouldn’t I be honored and thrilled to do this? And shouldn’t I be clamoring for more opportunities to break human skin?
As a family physician, disliking procedures is a major drawback not only because it makes me feel like less of a doctor, but because it decreases my earning potential. Let’s face it—medical procedures are lucrative. In today’s world, medical tasks that require manual dexterity are still reimbursed at better rates than those that require mental deliberation. Part of the reason specialists earn more than primary care doctors is because specialists, for the most part, do more procedures.
With this in mind, I recently sat down to examine the reasons for my dislike of procedures. Here are the possibilities I considered.
Simple squeamishness. I’ve ruled this out almost completely, since I could never have made it through medical school and residency if this were the case. I saw plenty of blood and guts during my training, and although the scenes might have been malodorous or graphic, I never passed out or fainted.
Leftover trauma from the days of surgical training. It’s possible I have PTSD from my experiences in operating rooms during my training, when surgical attendings yelled or snapped at me for contaminating the surgical field. After two or three such experiences, I learned to keep my gloved hands to myself, unless explicitly directed where to place them. To this day I don’t like being around sterile fields, sterile gloves, or sterile instruments.
Not wanting to cause the patient any discomfort. Rationally, I know that sometimes doctors “have to hurt in order to help,” and it’s impossible to avoid ALL discomfort. But if there’s the slightest grunt or grimace from the patient, I will start to sweat. Some people might say that this is a different type of squeamishness, and I can’t argue with them.
Last of all, and probably most important…
Lack of time. Another major reason for my aversion to procedures is the knowledge that any hope of staying on schedule has just evaporated.
Because procedures take time.
And I’m slow.
And clumsy.
This baffles me, because in other situations, my fingers have amazing dexterity. I can play the piano. I can type 90 words a minute. I can crochet, and do needlework, and pick up a single grain of rice with a pair of wooden chopsticks. But put a pair of surgical gloves on me, and I might as well be wearing oven mitts.
The advent of skin adhesives like Dermabond (Super-Glue for the skin, used for closing simple lacerations) was a godsend for me. Instead of having to struggle with drapes and sterile instruments for half an hour, all I had to do was whip out a tube of Dermabond, hold the edges of the wound together, and glue them closed. Voila! Good as new in two minutes. The only downside? Sometimes I glued my own gloves together.
Having completed my analysis, I’m not sure I’m any closer to a solution to my sticky “stitch”uation. I still don’t relish the thought of a patient walking into the office with a laceration. The good thing about family medicine, though, is that practitioners can tailor their practices as they like. Procedure-averse doctors, like me, can choose to leave the stitching to their more hands-on colleagues. That is, if we’re willing to take a pay cut.
And for some, that may be the most difficult procedure of all.
