[ ARC forum 2 ]
Show's on in theatre (2)
As an answer to: Re: Show's on in theatre written by Jim at 28 Jan 2003 20:44:47:
> Paul, are you saying that any family physician, or general practioner would be quite well aware of skin expansion techniques?
Methinks you know me a little too much Jim! 
But never mind!
Well, of course, my comments as such relate to the practice of surgery, and GPs who also perform such "minor" surgery are a bit of an endangered species (at least, in the cities), particularly with new regulations about certification of sterilisation procedures and such. But I perhaps digress.
The point is that even completely "non-procedural" GPs have at least been trained in hospitals and know what happens when a skin lesion is removed as I describe - the critical point is in transferring that knowledge into another situation, realising that what works in situation "A" would be appropriate also for situation "F". While you expect doctors to be better "lateral thinkers" than the average Joe, - it doesn't always happen!
> Would you believe that a urologist should have knowledge of these simple techniques also?
They not only know of such techniques - in general, - but use them where it has been documented. Like other fields, "prior practice" is the golden rule.
> We're aware that those who practice in the vast country of China actually employ such techniques, using balloons to expand the preputial opening in order to permit retraction. Since these are published papers, wouldn't they have ready access to them just as we do?
Yes and no. To be honest, China is still considered a primitive society, and therefore not taken seriously. Another (unrelated) example, radial keratotomy, came from Russia and has been embraced - slowly (and just as well) - so that now we see these "Laser refractive surgery" clinics all over the place, but it's been some 20 years or more in the adoption, and re-developed to suit.
The big matter is that in Western medicine, it is assumed that the patient does not want to become involved in the cure if at all possible. Lifestyle modification is just "too hard", pills cannot be taken reliably more often than once a day - and even that is a big ask, whilst less convenient measures - even the use of eye drops as I personally experienced recently - are yet more difficult again.
There is the experience of explaining the steps of a slightly complex procedure - and foreskin stretching as we explain on this forum would have to qualify - and seeing the patient's "eyes glaze over". Surgery by comparison, is entirely passive (hey, it's almost always done with the patient lying down, generally asleep!) - sign the consent form and you've done your bit!
Another attraction was the subject of a discussion yesterday - if the procedure involves (not that circumcisions do, but it's an interesting thought) a new technique involving a $50,000 or more machine, then it has to be even better, doesn't it?
> considering the money angle of which we are acutely aware,
Yes, I do think you are "onto the money" there!
Incidentally - a (different) discussion yesterday with my friendly Urologist, challenged me to realise that the issue of exactly what is or is not Health Department policy on the performance of "non-indicated" circumcisions in Public Hospitals in this state, is nowhere near as clear as I had been informed before. I was chastened, but pointed out that this is counterbalanced by a growing awareness amongst (I gave an example of our General Surgeon) practitioners that they may soon be called to account on the issue of consent.
- No need to worry Jim 1/28/2003 22:08
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