What does a general surgeon do?

Most people know what an orthopedic surgeon does, or a neurosurgeon, or a cardiac surgeon. But what about a general surgeon?

General surgeons are often the physicians you meet when your appendix needs to be removed, or your gall bladder is causing intense pain and a trip to the emergency department reveals the solution is surgery.

General surgeons “treat the body from head to toe,” according to Lawrence Novak, MD, FACS, a general surgeon who has been at Cape Cod Hospital for 25 years. The only clinical areas general surgeons do not attend to are neurology/neurosurgery, orthopedic and cardiac issues, he said.

Most people are confused with the term ‘general surgery,’ agreed Mark Loewen, MD, FACS, a general surgeon who has practiced at Cape Cod Hospital (CCH) for 18 years.

“Times have changed. Thirty years ago, general surgeons had been doing chest and vascular, as well as thyroid and breast surgery. Today at Cape Cod Hospital, similar to other community hospitals across the country, general surgeons do mostly abdominal and soft tissue surgery, in addition to covering trauma cases. It is a specialty like all other specialties. We do office procedures, elective surgery, and emergency surgeries.”

What They Treat

According to the American College of Surgeons, general surgeons have specialized knowledge and experience in diagnosis, preoperative and postoperative management, including management of complications in the following types of surgeries:

• Alimentary tract (digestive tract).
• Abdomen.
• Breast, skin and soft tissue.
• Surgical oncology, primarily of gastrointestinal tract cancers as well as skin and soft tissue cancers, including screening, surveillance, surgical adjunctive therapy, rehabilitation and follow-up.
• Comprehensive management of trauma, including admitting patients with blunt or penetrating injuries who sometimes need operative intervention, often helping to manage the whole patient when there are several specialists involved to manage each of the injuries that often include musculoskeletal and head injuries. They have responsibility for all phases of care of the injured patient.
• Care of critically ill patients with underlying surgical conditions in the emergency room, intensive care and trauma/burn units.
• Head and neck, including trauma, vascular (blood vessels), endocrine, congenital and oncologic (related to cancer) disorders, particularly tumors of the skin, salivary glands, thyroid, parathyroid and oral cavity.

When Not in the OR

When Drs. Loewen and Novak aren’t in the operating room doing surgery, they make rounds seeing inpatients at Cape Cod Hospital who are recovering from surgery or awaiting surgery, and meeting with surgical residents to discuss patients. They also evaluate patients in the emergency department who may need surgery. On office days, they may be seeing patients for potential elective surgery, follow-up after surgery, or doing surgical procedures.

Both surgeons said they do procedures in their offices.

“I remove a lot of skin cancers in the office including basal cell, squamous cell and some melanomas,” said Dr. Novak. “Other procedures include biopsies of moles, surgical excisions, lipoma removal and treatment of serious wound infections. I also try to educate patients about the prevention of future skin cancers because the skin cancers we see now are from exposure to the sun five to 30 years ago.”

Dr. Loewen and Dr. Novak also treat hemorrhoid disease in the office.

“I can look inside the anus with a scope to evaluate internal hemorrhoids, and sometimes do banding to treat the hemorrhoid,” Dr. Loewen said.

Their schedules also include being on call for the emergency department to evaluate patients who may need surgery, and they are also integral members of the trauma team.

“When we are on call as a general surgeon, our focus isn’t only on acute-care surgery but on trauma care as well,” he said. “All the general surgeons participate in the Level III trauma center program at Cape Cod Hospital.”

Jeffrey Siegert, MD, FACS is the trauma director at CCH and Mark Zapata, MD is assistant director of the program.

“When we are on call, we are required to be at bedside of a Trauma-one (highest level of critically injured) patient within 30 minutes, and we are dedicated to being there,” Dr. Loewen said.

Additional Support

Mid-level providers, also known as physician assistants (PAs) and nurse practitioners (NPs), are also a big part of the general surgery department, said Dr. Loewen. “They are full-time members of our team and do a great job.”

Cape Cod Hospital has become a satellite teaching hospital for several off-Cape institutions over the past 40 years, according to Dr. Novak. Currently, there are four surgical residents from Boston Medical Center affiliated with Boston University School of Medicine in rotation, he said.

“Additionally, through our partnership with Lahey Hospital & Medical Center (in Burlington, MA), Cape Cod Hospital trains two general surgery residents for a total of six general surgical residents. They are trained to perform breast surgery, intestinal surgery, colorectal surgery, vascular surgery, thoracic surgery and learn multiple other facets of surgical care. Cape Cod Hospital also trains medical students from UMASS Medical School in general surgery, OB/GYN, and other subspecialties.”

Cape Cod Healthcare has doubled the number of general surgeons on staff, from eight to 16 in the past 25 years, according to Dr. Novak. “General surgery is alive and well on Cape Cod, with board certified, competent surgeons who live and work here.”