Which doctor should I see?

I am quite frequently asked by patients and parents which particular specialists they should see for their health issues.

This confusion is understandable with so many medical specialists out there available to render their services to patients.

Medical specialisation is just like any other professional and knowledge specialisations.

With the advent of new technologies and discoveries of many new scientific knowledges, the old scientific disciplines become loaded with information and the consequent extensive services related to them.

One of the reasons of specialisation and sub-specialisation is the pragmatic need to distribute work load and manpower to ensure that knowledge distributions and services rendered are effectively and efficiently maintained to meet the demand of modern standards.

Medical specialisation follows the same need. Most modern hospitals will have basic medical specialists to cover most of the health needs of  a community.

These are basic specialists and specialisations in any modern community hospital;

General Surgeon - General Surgery

Orthopaedic Surgeon - Bone and Muscles Diseases

Ophthalmologist - Eye Diseases

ENT Surgeon - Ear, Nose and Throat diseases

Physician - (Adult) Medicine 

Paediatrician - (Children) Medicine

Obstetrician and Gynaecologist - Obstetrics and Gynaecology 

Anaesthetist - Anaesthetic/Anaesthesia

However, in a bigger tertiary centres and teaching hospitals, the above basic specialisations will be further subdivided into many more sub specialisations, eg;

General Surgery will be further subdivided into;

Hepatobiliary Surgery

Upper Gastrointestinal Surgery

Colorectal Surgery

Breast and Endocrine Surgery

Vascular Surgery

One can see that the process of specialisation/subspecialisations do follow a certain kind of boundaries based on organ systems. This is not a strict rule. Sometimes, due to human resource allocation and logistics,  these specialisations do cross those boundaries.

For some familiar with surgical disciplines, you will notice that Plastic Surgery and Neurosurgery are not classified here. These 2 disciplines have carved out of General Surgery and exist on their own as independant Surgical specialisations but mainly within tertiary referral centres rather than community hospitals.

Patients confusion about the above specialisations can be easily cleared by a good discussion with their primary care doctors who will usually write a referral letter to the appropriate specialists. Then in turn, the specialists may refer to the appropriate sub-specialists if the patients health issues mandate so.

Should the Appendix be removed as well

Quite often a surgeon is faced with a decision making dilemma during laparotomy for any surgical indications whether to remove the appendix at the same time.

There is no one answer to all patients.

If the appendix appears inflammed, then it has to be removed.This is quite often the case since the incidence of Appendicitis of various degrees are very common in humans. It is said that the annual incidence of Appendicitis in any community is 0.002%.....ie.2 people in every 1000 will suffer Appendicitis sometimes in their lives.

Sometimes,Appendicitis is so mild that it can mimick as nonspecific stomach aches or even mild gastroenteritis.

Patients who have undergone any form of laparotomy and laparoscopy should ask their surgeons whether the appendix is removed as well if they are not already informed.

The picture above shows a large loop of small bowels and an inflammed appendix forming the contents of a large Right Inguinal Hernia. The appendix was removed by standard Open Appendectomy technique and the bowels were reduced into the abdominal cavity before the large hernia defect is repaired with a prosthetic mesh.

Open Cholecystectomy for Gangrenous gallbladder

Although the gold standard for the removal of diseased gallbladder(especially gallstones-related cholecystitis) is Laparoscopic Cholecystectomy, I always tell patients that the chance of successfully completing the operation laparoscopically is only 90%, there is always about 10% chance of converting to open surgery.



The more severe the inflammation, the higher the chance of converting to open surgery.



The above patient suffered from Gangrenous Cholecystitis which failed laparoscopic attempt and had to be converted to open operation.

Unzipping the trapped skin

parents have to teach their boys how to zip their kids pants carefully especially the children who have not worn any under garment just yet...



sometimes, the zip can catch the penile skin than can be removed only by a minor surgical procedure that required general anaesthesia

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