General Surgery is far from being “General”

Dr. KWONG Wing Hang

Honorary Consultant in General Surgery

Specialist in General Surgery

General Surgery is one of the surgical specialties. Being a Specialist in General Surgery, I think it is fitting for me to say that “a title does matter”. This “specialist” title embarrassed me many times.

When I was still working in the public healthcare sector, one day a patient came to see me with a referral letter from his gastroenterologist.

“Hi, Doc. I would like to see an upper gastrointestinal surgeon, but…” the patient said with surprise.  

“I can help you. Please let me see your referral letter.” I said.

“But the signage says ‘General Surgery’, and I have stomach cancer. It is surely not a ‘general’ thing, and I need to consult an upper gastrointestinal surgeon for surgery.” the patient said hesitatingly.

“Well, I understand. Let me put it this way: we general surgeons deal with the stomach, small bowel, liver, gall bladder, pancreas, endocrine glands, etc. In fact, I am specialised in upper…”

“That means you do everything and are not specialised in anything, are you?” the patient asked with frowning.

I put effort on explaining the difference between general surgery and other specialties before consultation. At last he nodded as if he understood, though rather unconvincingly. After the consultation and explanation of the procedure required, the patient said to me with utmost sincerity before leaving, “You are still young, Doc. Better get a specialty qualification quick, then you can do the big surgery I suppose...”

Now working at a private hospital, I came across a lot of patients, enquiring of endoscopy examination at the Outpatient Department or Endoscopy Centre. Our staff will ask, “Either gastroenterologist or general surgeon will do oesophagogastroduodenoscopy or colonoscopy. Which one do you want?” The answer is usually the former.

I have been a general surgeon for 21 years. Whenever my patients and friends ask me about how “general” my specialty is, I just feel amused and simply laugh it off. For most people, the word “general” seems to mean “average” or even “mediocre”, or it implies that my specialty is not comprehensive. In Chinese translation, General Surgery sounds like simple and bored. 

So what is General Surgery anyway? First of all, General Surgery is one of surgical specialties. It ranks the same as ENT, urology, neurology, cardiothoracic surgery, plastic and reconstructive surgery, paediatric surgery, etc. The scope of General Surgery is wide and comprehensive, as it covers the head and neck, esophagus, stomach and bowel, liver, gall bladder, pancreas, breasts, blood vessels, endocrine glands and trauma as well.

Under the current training system in Hong Kong, medical graduates interested in General Surgery must take 2 years of basic surgical training first. They are then required to rotate different subspecialties such as hepatobiliary, pancreatic, endocrine, head and neck, lower GI, esophagus, stomach and vascular surgery before passing specialty examination.

With the fast advance in medicine, no doctor can do every single procedure in general surgery. Apart from some common procedures, a general surgeon often specialises in 1 or 2 subspecialties. However, the College of Surgeons of Hong Kong only allows our title as Specialist in General Surgery.  Subspecialties title is not allowed in Hong Kong. At last you may have heard of “haemorrhoid centre” or “breast care centre”. Actually, they all are run by general surgeons.