Рафинированность, т. е. вырванность из жизни – основной недостаток всех учебников по хирургии, их трудно долго читать. Но это понятно – учебник следует писать формализованным языком, а не стихами.

Формализация изложения позволяет поместить на страницу учебника максимум полезной информации – наивысшего мастерства в этом направлении достигли англоязычные учебники.

А вот даже лучшие российские учебники страдают существенным недостатком – византийской витиеватостью. Порой видишь, что написано в книге много, а нужную информацию в ней не скоро сыщешь…

В то же время византийская витиеватость – вовсе не ругательное определение, она служит корнем всяческих «этюдов» и «очерков» отечественных мастеров хирургии, которые читаются взахлёб.

Печально, что абсолютное большинство так называемых «монографий» по различным разделам хирургии, изданных ранее в СССР, являли собой самое ленивое переложение кандидатских или докторских диссертаций, возможно, даже очень хороших диссертаций.

Вот после долгого пережёвывания я пришёл к выводу о необходимости попытки сотворить главу «ХИРУРГИ И ДРУГИЕ ЛИЦА В НАШЕЙ ХИРУРГИЧЕСКОЙ ПРАКТИКЕ»… В ней можно разместить все «обертоны» нашей ежедневной хирургической жизни, что должно облегчить чтение моих «писем».

Мне кажется, что прилагаемая ниже публикация американского хирурга, который, несмотря на своё имя (Паша Заверуха), ни черта не знает по-русски, подтверждает высказанную мной точку зрения.

Мои «рафинированные» русские друзья, не серчайте на английский текст – я не работаю под Льва Николаевича, просто дел много сейчас много.

World Journal of Surgery Official Journal of the International Society of Surgery © Société Internationale de Chirurgie 2005 – 10.1007/s00268-005-1116-4 Twenty-one Commandments for the New Surgeon in Little Town Surgical Center I have been a rural surgeon for nearly 27 years and have made a few observations watching about two dozen docs come and go in various specialties. Here are some things to consider: 1). You need to get accepted in the community—both by the patients and the docs. Take the referring docs out for lunch or bring a deli lunch to their office, a gift at Christmas, and talk to them socially and professionally; let them know what your special interests in surgery are or what you can do to help them with problem patients; ask their advice and input on patients and get medical consults on unassigned surgical patients, even if you know how to take care of the problem of fluid overload or hypertension etc., always keep them in the loop on their patients with follow-up letters, op notes, and thank you notes; and NEVER disparage their care even when it is off the mark by your standards. 2). Always talk up their great care to the patients they send you and send them back for follow-up when the surgery problems are resolved. 3). Attend the non-surgical CME and meetings in the local hospital and participate. 4). Present some CME for them. Be nice to all the hospital personnel also. They can be your best advertisements if they like what they see of you at the hospital. 5). Be soft and friendly and not biting or sarcastic. 6). Keep your office staff happy with birthday presents, and flowers on secretaries’ day. 7). Give your patients all the time they need to talk to you and listen to what they say. If they don’t need surgery just yet, tell them so, even when your schedule is empty. The word in the community will be that you don’t operate when unnecessary and they will come back to you for everything in the future. 8). Be very supportive with the families when their loved ones are in great need. 9). Write some key word notes in your office chart to remind you to ask about their trip to Hawaii or their kid in college, or whatever they mention to you at your last visit. 10). Don’t get into controversy or in-house battles for the first 10 years in a new place. 11). Don’t do Whipple’s in a little hospital. You can’t afford the fallout of high-risk surgery in rural hospitals. 12). Hold hands and touch your patients. Stand by their side, hold their hand, and talk to them as they go under anesthesia. Be there when they wake up. 13). Communicate to inform and allay their fears. 14). See them back in the post-op period sooner and more often than you think they need. 15). Give them a very detailed talk as they leave the hospital about everything to expect at home post-op for instance, pain control, GI function, fatigue, bad dreams, loss of appetite, depression, 6 weeks of not being back to normal, when to shower, when to drive, when to have gentle sex, etc.. They will love you for knowing all this and warning them and reassuring them its OK. 16). Do some volunteer work. Join the fish and game club. Get your wife involved. 17). Don’t drink in public beyond a glass of wine at dinner and never on call. 18). Join the EMS director in giving some talks to the medics and volunteer EMTs on prehospital trauma. They have a vast network in the community. 19). Talk to the Rotary, Kiwanis, Elks, and Soroptomists about the latest and greatest surgery, such as like a laparoscopic gallbaldder surgery. Use slideshows and bring instruments for them to see. 20). Any new surgical partnership is potentially problematic as it necessitates an adjustment of two super-surgical egos. Don’t let this become a competitive fight between you and your partner. Talk to him. Let him know your feelings and needs and don’t let it get hostile. You both need a partner that is a “brother”. You can be each other’s best supporter. Assist each other in cases that don’t even need assisting or even give you payment for an assist. The OR table is a great place to bond your brotherhood. Do favors. Tell him you will take the crummy cases or the Medicaid cases off his hands. Take his call when he’s had a rough night or on his anniversary or Christmas or when he has a cold, and don’t look for any payback. It will come in due time. 21). Everything you do or say in a small town will be known by everyone very quickly. You need to be above reproach in the community—a saint. And if you really do all this it will become a comfortable way of life. Enjoy it and success will find you