Confessions of a Dinosaur
When delivering an invited lecture, there are two potential strategies. The first I would categorize as a “preaching to the choir” lecture. For those who did not grow up in a rural environment where that phrase was common, the Urban Dictionary defined this phrase as “trying to convince those who are already convinced.” The second strategy might be to go “against the grain” and offer views that might be contrary to current beliefs held by a group. I have often tended to contrarian views so this talk may be the converse to some views currently held about “trauma surgery, acute care surgery (ACS), and/or surgical critical care.”
As to the title and the use of the word “dinosaur,” I would refer you to the Merriam-Webster definition number three: “one that is impractically large, out of date or obsolete.” This leads me to my first confession: I am a “dinosaur.” In that regard, the trauma surgery I practiced is no longer practical or possible but there may be some kernel of wisdom to be gained from the experience of my generation. While I readily admit to being a “dinosaur,” I would deny being a “troglodyte” defined as “a person characterized by outmoded or reactionary attitudes.” I have had concerns about workforce issues for some time but am not attempting to recreate the past but share thoughts about future directions for the field of trauma and its disciplinary twin “acute care surgery.”
I will briefly discuss four main themes: (1) a brief history of “trauma surgery” from the “dinosaurs” perspective; (2) review my view of the evolution of acute care surgery; (3) discuss issues with training and practice of trauma/ACS; and finally, (4) discuss the possible (theoretical) impact of new payments models on the field.