Hey, sorry for the necro, I was deployed when this posted.
The more I think about it, the more I'm a fan of having GURPS's only positive default, with First Aid defaulting to Surgery +1, or
maybe +2. But +2 is a
whopper of a bonus in GURPS, so I'm not sure which is more appropriate. This would be to change as little as necessary, leaving the First Aid default to Physician at +0. Stopping hemorrhage is arguably what surgeons do for a
living, and you sure as hell want a surgeon working in your trauma bay...
If you're defaulting First Aid from Surgery, do you really use all of the modifiers for the Surgery skill such as equipment? I don't think you do, but if that is RAW it seems
far too harsh in this instance.
By far the biggest issue I have encountered with non-surgeons (including other physicians... including ER physicians) doing first aid is that they all try to place pressure dressings inappropriately, when what is really needed is for someone to stand there applying direct pressure until the surgeon gets there. (I've made ER residents stand holding direct pressure all the way to the OR to make this point when they screw it up.) I don't think surgeons should need all of their "toys" to default to First Aid- use the First Aid modifiers. When they use the "toys" it's because Fist Aid failed, and they are now
stabilizing a mortal wound per
Basic Set p424.
I have gotten
damned good at working with tiny things elsewhere in my life while studying to be a surgeon. (It's my aging eyes that fail me nowadays, not my hands.) I often find myself teaching students how e.g. to brace their hands and work small. I would argue that High Manual Dexterity might be fairly common among surgeons.
I would disagree that many military medics have Surgery skill, unless you're talking about the Surgery-without-Physician variant. More likely they have very high First Aid skill, but I haven't reviewed the rules to see if they might need Surgery for some reason. My thinking is that putting just one point in Surgery would make them
far too competent at things like removing gallbladders.
But an argument might be made for Surgery (Dental) in the case of SF 18Ds and Navy IDCs and such, since they learn quite a bit of that.
General surgery
used to be the "general surgical expertise" from RAW Surgery with no optional specialization... but no more. For instance the "father of OBGYN" was a general surgeon, and generic surgeons used to do orthopedics before that became specialized- but I'd be shocked if you could still find a practicing one who trained that way. That was long ago. Nowadays "general surgery" sort of means "abdominal surgery including hernias but also trauma including chest and vascular, and some basic head & neck such as thyroids, parotids, and neck dissections (the last for some cancers)." It gets cumbersome, though, since modern "general surgery" is the route to other subspecialties like vascular, cardiothoracic, colorectal, etc. Some of these usually do continue to do general surgery cases- like colorectal, breast, MIS, etc.- but for whatever reason once someone is plastics, vascular or cardiothoracic they tend to stop doing so (and many refuse to even maintain credentials to do so).
If has been said that you need just a
touch of sociopathy to be a decent surgeon, since you are by definition hurting people for a living, albeit in pursuit of a greater good. And surgeons
do have a reputation for being brusk, aggravating, critical, direct, and quick to anger. So maybe there is something to that. (Discussing medical stereotypes is always amusing to laymen.) Kind of hard to put it into game terms, though. Odious Personal Habit (Stereotypical Surgeon), perhaps?
Some points on specialization:
In the U.S. at least, orthopedics and urology are absolutely
not subspecialties of general surgery. I.e. they need to have
black bullets in the OP, down next to neurosurgery. They have their own residency, though the intern year
only is combined with general surgery at most teaching hospitals. But surgery interns generally do essentially zero operating, and thus learn very little of what GURPS calls "Surgery skill" that year- rather, they are learning Physician skill with a surgical specialization. (Bear in mind that general surgery is a six-year residency,
including intern year.) In fact, there are subspecialties (i.e. fellowships) for urology and orthopedics- hand, spine, and sports being the ones that come immediately to mind for the latter. Most of either still do general orthopedics or urology, though.
A few subspecialties of general surgery that need to be on this list include:
Breast
Minimally Invasive (incl. robotic)
Colorectal
Endocrine
Ostensibly, OB/GYN is a surgical specialty, with their own residency like ortho or neurosurgery. I will avoid indulging in my specialty's stereotypical response to that one. :) They also have subspecialties/fellowships, such as Gyn-Oncology, etc.
Interestingly enough, Obstetrics is a fellowship that is available for
Family Practice docs in some places, and such fellows are supposedly qualified to perform caesarean sections! Which gives me just a bit of pause, since I'm a
surgeon and the only emergency c-section I've had to do since graduating residency scared the living hell out of
me. (All went well.) But, getting back on track, this might rate a single point in Surgery (Obstetrical).
Trauma is a general surgical subspecialty, but frankly it's more of a "surgical critical care" fellowship than a surgical fellowship. It should boost Physician (Critical Care) skill much more than Surgery skill. In fact, maybe it only changes Surgery (General Surgery) to Surgery (Traumatology). But there is a lot of talk about changing the model from "trauma" to "emergency surgery", which would still include trauma but also make the fellow a specialist in most other emergent surgical issues such as appendicitis, bowel obstruction, acute cholecystitis, and even
bone fractures, etc. Which would indeed be a bit of a step back in time to non-orthopedists doing some orthopedics. A very few programs are teaching this now, and it might boost Surgery skill a bit more. It looks like the way of the future.
There is also a lot of talk of splitting Vascular and Cardiothoracic into their own residencies, rather than making them a fellowship after a general surgery residency. In such a case they would also need black bullets in the OP.
Quote:
Originally Posted by Andreas
It is rare, but there have been some very impressive feats of people performing surgery on themselves. For example, 1921 the surgeon Evan O'Neill Kane performed an appendectomy on himself.
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Yes,
a number of people have pulled off such stunts. Rogozov is the really famous one, for taking out his own appendix in Antarctica. On the other hand, someone just died trying to do it a couple of years ago. Doing an
appendectomy, fer chrissakes.