As one of the first surgeons who hands-on performed pancreaticoduodenectomy in China in the middle of last century, with ceaseless clinical practice, I have evidenced various problematic events and never-ending back and force surgical procedures changes during the development, yet more profoundly, the flourishing stage that general surgery has entered gradually.

Undoubtedly, with the mushroom updating of contemporary scientific technologies, surgery has been making great progresses, involving modernized management modes, constantly optimized instruments and equipments, renewed medical concepts, and accordingly improved general surgical skills. I have actually witnessed the benefits brought by changes technological progress for the patients. For example, the rapid and vigorous raise of minimally invasive and robotic surgery has provided the patients with benefits of fast recovery and pain alleviation. In China, exceptional high incidence of HBV carriers (7.18% of whole population), and related large number of liver cirrhosis and liver cancer patients has become a significant burden for the medical and social cost. The latest approaches for liver function assessment, advanced operative skills, and improved post-op care techniques have offered the safer recovery and cure. The development of liver transplantation, including cadaveric and living donor liver transplantation, has carved out a novel way of treating the end-stage liver diseases and saved many lives.

However, there have also been defects and regrets during the surgery progress, which might exist both in the Eastern and Western countries. I would like to address my arguments as follows.

1.Significant reduction of the time and opportunities of contacting with patients

With the advent of information age, we are equipped with the ability of acquiring assorted information with high speed and efficacy, enabling us to obtain and update our medical knowledge more conveniently. The widespread application of computers and networks in clinical surgery has provided convenient access to information, but may also considerably reduce the opportunities and time of a surgeon to be in touch with, meeting, talking with the patients and inquire the disease history directly from patients. Compared with the conventional surgery experts, our young surgeons tend to have less time to come into contact personally with patients in the wards and less opportunities for finding out themselves the information of the diseases, carefully performing physical examination, checking the temperature, doing various tests, and more importantly thinking of the diseases. They usually finish the above-mentioned information acquisition by means of computers and outpatients notes, and give medical orders wherever convenient. I would naturally be worried about the inevitable changes in the nature and characteristics of medical care led by this tendency.

Actually, medical care is not only a simple treatment on patients with medicine and operative techniques, but also one kind of humanism, psychological, or even emotional communication. When accepting mechanical surgical treatment, patients usually need enough chance and time of face-to-face communication with surgeons, especially with those young surgeons who wondering around the wards, to know the present situation, treatment outcome, recovery process, and to express their worries as psychological consolation. I believe in the irreplaceable significance of emotional communication as a dispensable important element of surgical treatment. As the ancient Chinese said, doctors need to have “parental love for the patients”. That is to say, as for a doctor, whichever stage the medical care has developed into, it is crucial to effectively communicate with patients in a charitable, sympathetic, responsible, and patient manner. On current environment in China, owing to continuously improvement of living standard and education background, patients may take different routes to get a basic understanding of their own disease, which may be biased or incomplete. They hope to and should have a conversation and exchange their opinions with doctors in such a situation; this is much more than a kind of simple and quick communication on a media platform of computer. I hope a surgeon, running after the rapid development of modernized technology, would not ignore the importance of this aspect.

2.Diagnosis based on the symptoms and signs of the patients decreased by rapid development of adjuvant examinations

The progresses in laboratory tests, endoscope techniques, especially medical imaging, make surgical diseases easier to be notified and diagnosed. At the present, surgeons usually diagnose disease largely depend on the imaging technologies (ultrasound, CT, MRI, PET, angiography or percutaneous radiography). However, these practices have a likelihood of weakening the efforts of a doctor for gathering patient’s information as a first-line inspector. I have noticed more and more young surgeons ignore the acquisition of detailed medical history, attach little importance to the bedside physical examinations, and serious thinking and analysis using their own brain, which have resulted in misdiagnosis and treatment errors. They have relied on too much of those adjuvant examinations for the medical practice which give me an uncomfortable feeling of making the medicine too simplified and not state-of-the-art performance. This tendency might not accordance with the quintessence of medical care and direction of the development.

The general practice that diagnosis and treatment are performed relying on adjuvant examinations is the immediate reason for the overuse of adjuvant examinations. Some patients have been asked to accept complete tests such as CT, MRI and PET before a clear understanding of general conditions is obtained. This probably gives rise to a waste of medical care resources that may be partly responsible for the high medical cost. The overuse of adjuvant examinations also eventuates in excessive dependence on those methods and ignorance of reflection and analysis and consequently simplistic explanation and treatment for the complicated disease occurring in human body.

3.Medical behaviors affected by commercial and economics factors

Under a background of medical costs increasing year after year, the effect of health insurance companies and pharmaceutical enterprises on medical practice in hospitals has been a matter-of-course. In the hospitals in the Western countries and major cities in China, surgical patients’ duration of hospital stay is getting shorter and shorter. Hospital stay with high efficiency should be certainly advocated, but if the patient accept the surgery at the same day of admission, his/her residents and attending doctors have very limited time for preoperative reassessment of the disease and finding out whether there has been progression of the disease during the waiting time after the outpatients. In that way, a coarse, arbitrary, and blind behavioral style might evolve out of the diagnostic and treatment process, and to some extent, the medical quality is affected adversely. By the same token, in consideration of postoperative observation and rehabilitation, it is not always an advantage that patients discharge from the hospital shortly after surgeries, especially for those major cases. I would believe this is a defect caused by modern medicine.

As regards the medication used in clinical practice, which is yield to or affected by some pharmaceutical enterprises, it is of more damage to the benefits of patients. Unfortunately, these cases are not isolate and rare.

4.Misleading in surgical researches

Conventionally, the researches conducted by surgeons should basically be related to the unsolved questions or pathophysiological phenomenon found in clinical practice, and the results would be possibly benefit to the clinic by solving problems and clearing up doubts. But on account of the speeding up everything in the practice, attentive and careful bedside medical care are becoming less and less. And for the professional promotion and a position in professional associations, many young surgeons spend their time doing researches that have nothing to do with clinical medicine, publishing papers and then getting their goals achieved. This fast-paced production has actually led real clinical research in general surgery astray. In recent years, the appearance and development of translational medicine are intended to fill the gap. Now lots of people are beating the drum for translational medicine, however, frankly speaking, its eventual effect is still unclear. In the past half-century, I have witness the ebb and flow of many medical campaigns, some of which were end up with nothing. What we should actually do is something simple, direct, and fundamental: assess the clinical status ourselves, comprehensively analyze the diseases in combination with adjuvant examinations, and concentrate on preoperative and postoperative treatment; devoting ourselves to discover the questions and mysteries of surgery, designing the researches and settling difficult and complicated cases, should be the matters we surgeons pay close attention to.