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Old 12-22-2016, 03:26 PM   #1
johndallman
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Default [Basic] Skill of the week: Surgery

Surgery is the IQ/VH TL medical skill of physically modifying bodies to treat illness or injury. There are prerequisites of First Aid or (preferably) Physician, and the defaults are First Aid-12, Physician-5, Physiology-8 or Veterinary-5. Physiology and Veterinary have defaults to Surgery. In settings where Esoteric Medicine replaces Physician, it's a prerequisite for Surgery. Most modern surgeons have an optional speciality, and there are more ideas about that below. The skill appeared at GURPS 1e.

There are lots of modifiers, for equipment, physiology, -3 if the working area and equipment are not sterile, -3 for head or chest surgery, and -5 if you don't know what the actual problem is. If you don't have Physician skill, you're at -5 to do anything except "field-expedient" surgery, such as stitching wounds, removing arrowheads, bullets, shrapnel, etc. The rules for surgical implantation of biomods and cyberware have penalties for larger changes (B295). The Surgery rules on B424 have TL modifiers for equipment, anaesthesia and infections, and rolls for stabilising mortal wounds and repairing crippling injuries.

DX-based rolls are sometime required, and High Manual Dexterity and Telekinesis are useful. Healer talent boosts Surgery, like all medical skills, Haemophilia requires its use, as does Forensics for doing an autopsy and in some settings, Hypnotism can substitute for anaesthesia.

On a successful roll, you can carry out a procedure successfully. Failure means that the patient was harmed in some way. Basic has 2d damage for a simple amputation or 3d for other operations, but infection is an obvious possibility. Bio-Tech expands on these rules, but doesn't change much, and gives professional surgeons Diagnosis and Surgery at 14+. It also suggests that full hospital facilities and support staff remove the need to roll for Surgery; as an alternative, you could use the same rule as Piloting for re-rolling critical failures if you have skill 15+, and full hospital facilities certainly give at least +1.

Edit: Here's a link to an optional, harshly realistic, rule that didn't make it into Bio-Tech, but PK uses. It makes Surgery necessary before extra injury from wounds to the vitals can heal.

Surgery is ubiquitous on templates for doctors, surgeons and military medics. Action points out that in campaigns with no magical or ultra-tech healing, and no ambulance service at fight scenes, mortal wounds will usually kill unless you have a surgeon in the party. AtE clarifies medical rules in general for the unusual TL. DF requires Surgery for removing monsters' valuable organs, or dealing with burrowing attacks, and mending zombies; a Gnomish Modular Toolkit will do just as well for surgery as for lockpicking or blacksmith work. High-Tech has historical surgical equipment. Horror has the effects of stress, cinematic neurosurgery, and lobotomy; Madness Dossier has brain hacking with the (Neurosurgery) specialisation, while Infinite Worlds has worse things, from Reich-5, and Locations: Hellgate worse yet. Low-Tech has a lot on Surgery before the development of Physician, with several techniques to buy off penalties, and comprehensive equipment lists; LTC1 adds more detail.

Magic has a Cleansing item which is usable to a non-mage with Surgery 15+, and suggests a school of ritual magic based on this skill; there are several Death Spells which necessitate Surgery on the resulting corpse before you can try to resurrect it. There are example perks, talents, enhancements, wildcard skills and limitations for this skill in the Power-Ups series; Powers: The Weird tells us that the skill appears at TL1, with (Trauma Surgery) at TL0, and has amazing things you can do with it. Psi-Tech has lots of fascinating applications for (Neurosurgery), while Psionic Powers and Psis provide Psychic Surgery. Ultra-Tech has plenty of advanced equipment, and Zombie infections might be staved off with quick and drastic Surgery.

I'm of the opinion that modern dentists use Diagnosis, Physician and Surgery, all with the (Dental) specialisation. Humans on modern diets need dentistry a lot more than any other kind of surgery, which is why there are so many dentists. Giving and monitoring anaesthetic seems to be a Physician task. Suturing seems to come under either Physician or Surgery: I suspect you need Surgery for the more drastic cases. RAW has nothing on DX requirements for Surgery. Having suffered from a dentist who seemed to be Ham-Fisted, I'd suggest that effective DX of 10+ would be demanded by medical schools for surgery training.

There's a case that First Aid should also default to Surgery, at full value or maybe even a bonus for the right specialisation, as discussed in the Physician thread. However, Surgery needs a lot more equipment than First Aid to avoid penalties, which limits the usefulness of this default.

There is also a case in that thread that Surgery at TL6+ should require specialisation, at least in a realistic game. Making it a mandatory optional specialisation, so that there are defaults between the specialisations, would probably be acceptable in anything other than a harshly realistic game centred on surgeons.

One confusing detail is that "General surgery" is a specialisation in modern practice. It is not the "general surgical expertise" from RAW Surgery with no optional specialisation, which is arguably cinematic at TL6+. The list from Wikipedia comes out like this, if you add dental surgery as a branch of Surgery rather than a separate field of medicine:
  • General surgery
    • Cardiothoracic
    • Orthopaedic
    • Paediatric
    • Plastic, reconstructive & aesthetic (includes hands, craniofacial and burn treatment)
    • Trauma
    • Urology
    • Vascular
  • Ear, Nose & Throat
  • Neurosurgery
  • Obstetrics & Gynaecology
  • Ophthalmic (eyes)
  • Podiatric (feet & legs)
  • Dental surgery
    • Orthodontic (aligning teeth)
    • Oral & Maxillofacial
Microsurgery seems to be a technique that can be applied to several specialisations. Craniofacial surgery seems to be shared among Plastic, ENT and Oral & Maxillofacial surgeons.

Now, few games will want this much detail, but double optional specialisation does seem to make sense in GURPS terms. If we have unspecialised Surgery/TL as an IQ/VH skill, someone with Surgery (General (Trauma)) is learning it as an Average skill, and is -2 for General surgery tasks, and -4 for all other fields of Surgery. That makes some sense for military special-operations medics and the like. If we have required optional specialisation for Surgery, it's up to the GM if the top-level specialisations are IQ/VH or IQ/H, and double optional specialisation works again. If we require specialisation from, say, TL6, then the top-level specialisations are IQ/VH, and the second-level specialisations are ordinary optional specialisations.

I've seen this skill used a couple of times by NPCs to save badly wounded PCs, once by a GP who lived close by and got lucky, and once by a emergency room doctor who came out with an ambulance because the gunfire had been audible. A PC became a ghost outside Stalingrad in the Weird War II campaign because he was the only magical healer, but was also Impulsive enough to try an aimed shot against an alert enemy after passing his first death check, and then had to make several more. We didn't have a surgeon, which is something that party could do with, although the ghost is still around to do healing.

After all that, have you done anything notable with this skill in a game?

Last edited by johndallman; 09-06-2017 at 01:00 AM. Reason: Link to optional rule from Bio-Tech playtest
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Old 12-22-2016, 04:07 PM   #2
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Default Re: [Basic] Skill of the week: Surgery

It seems to me that the defaults for Surgery are overly harsh. The default for First Aid is -12, which is more than the penalty you get for complete darkness or not having any tools at all!

Also there is no IQ default at all. Sure, Surgery is a very complicated skill, but there are still some relatively simple procedures that should not be completely impossible to do at IQ default for a talented individual under good conditions. Especially if the one performing the procedure has access to a good step by step guide on how to do it.
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Old 12-22-2016, 04:35 PM   #3
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Default Re: [Basic] Skill of the week: Surgery

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Originally Posted by Andreas View Post
Also there is no IQ default at all. Sure, Surgery is a very complicated skill, but there are still some relatively simple procedures that should not be completely impossible to do at IQ default for a talented individual under good conditions. Especially if the one performing the procedure has access to a good step by step guide on how to do it.
If they are that simple you use Physician or First Aid. I recommend Physician personally, but... I can see the argument being made for using First Aid.
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Old 12-22-2016, 04:47 PM   #4
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Default Re: [Basic] Skill of the week: Surgery

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Originally Posted by evileeyore View Post
If they are that simple you use Physician or First Aid. I recommend Physician personally, but... I can see the argument being made for using First Aid.
That does not seem to fit very well with the descriptions of the skills in the Basic Set. The description of Physician seems to exclude certain kinds of procedure regardless of simplicity and Bio-Tech also lists some procedures as being Surgery.

The case for First Aid seems even weaker than for Physician. It is true that someone skilled in First Aid should be able to improvise many things that don't fall under that skill description, but that is why Surgery defaults to First Aid.
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Old 12-22-2016, 05:49 PM   #5
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Default Re: [Basic] Skill of the week: Surgery

Just want to say that most dentists have no practical knowledge of surgery. Those are oral surgeons, in the U.S.
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Old 12-22-2016, 05:53 PM   #6
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Default Re: [Basic] Skill of the week: Surgery

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Originally Posted by evileeyore View Post
If they are that simple you use Physician or First Aid. I recommend Physician personally, but... I can see the argument being made for using First Aid.
Physician is a very vaguely defined term in Gurps. It's kind of like a god-of-the-gaps, in that whatever isn't Diagnosis or Surgery must be Physician.
Of course that muddies things further if we can't pin down what those other two cover.

Personally, it seems like it should just be Pharmacy/Diagnosis/Surgery maybe all limited by species Physiology-Biochemistry. But that may be "thread crapping" for a thread about canon.
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Old 12-22-2016, 06:18 PM   #7
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Default Re: [Basic] Skill of the week: Surgery

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Originally Posted by Flyndaran View Post
Just want to say that most dentists have no practical knowledge of surgery. Those are oral surgeons, in the U.S.
In terms of the way the word is commonly used in English, that's right. But GURPS defines surgery as treatment of illnesses and injuries by physical manipulation of the body as an object. That's a bit more general.

The standard dental degree, DDS, stands for "doctor of dental surgery." And that reflects the history. In the middle ages, you would go to a barber surgeon to get your hair cut, your teeth pulled, or your boils lanced. And on a battlefield the same sort of practitioners might remove arrows or sew up wounds. The current American specializations are not historically universal.
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Old 12-22-2016, 06:27 PM   #8
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Default Re: [Basic] Skill of the week: Surgery

This deserves a "cinematic" modifier for those cliche events where someone is operating on themselves, or delivering a baby in the middle of an unusual circumstance, or calling a halt to the fraternally protective burglary of a hospital to save someone's life on the spur of the moment.
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Old 12-22-2016, 06:30 PM   #9
Flyndaran
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Default Re: [Basic] Skill of the week: Surgery

True, but most players are using modern American English. And I'm blanking on even seeing Dentistry as a skill in any Gurps book, so at best it's a specialization of Physician and/or Surgery.
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Old 12-22-2016, 06:50 PM   #10
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Default Re: [Basic] Skill of the week: Surgery

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This deserves a "cinematic" modifier for those cliche events where someone is operating on themselves, or delivering a baby in the middle of an unusual circumstance, or calling a halt to the fraternally protective burglary of a hospital to save someone's life on the spur of the moment.
I think the main problems with operating on oneself are pain, flexibility, and fear. Of course why you needs to operate on yourself could negatively impact concentration and coordination by itself.
High Pain Threshold, Flexibility, and Fearlessness should allow for most such semi-realistic situations, along with very high skill of course.
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