Domhnall MacAuley: The surgeons who are not doctors

Domhnall MacauleyThe surgeons who are not doctors.

Reading this headline, I expected a story on training healthcare workers as surgical technicians in some under doctored developing country. But no, it was in the UK. I was intrigued.

Medicine is introspective, protective, and doctor centric; self regulating and self directing. Places at medical school are highly prized, access is increasingly competitive and based on academic achievement. We have created a professional fiefdom. But, could others do the job better?

Watching skilled craftsmen is a pleasure. I marvel at cabinet makers, boatbuilders, plasterers, tilers, and plumbers. A job well done looks easy and, if I need a hip placement or knee surgery, I hope that my surgeon has the skills and finesse of the master craftsmen. But, where will my surgeon have learned these skills and were they always “good with their hands?” Unlikely. Being bright at school, they were probably diverted down an academic stream at school—the bookworms and academic nerds separated from those more vocationally skilled. Surgeons will have spent their most formative years with their heads in a book leaving little time left to develop fine movement skills, hand eye coordination and train a plastic brain in neuromuscular coordination. At school and university they had to read, write and recite and progressed by examination rather than apprenticeship. Where was the skills training at a time when skills are learned best?

Working backwards—if you could identify the skills needed for surgery and choose those teenagers with most talent for technical skills, you wouldn’t choose the academics. You would train those with the best manual dexterity; the skilled mechanics, woodworkers, electricians and metal workers. These are the craftsmen (and women) I would like to do my operation.

Domhnall MacAuley is primary care editor, BMJ.