“I could teach a monkey how to operate” or so some people say. This cliché has been around for years. Recently, I saw it on an MD social media website, and someone said it in a comment on one of my blogs. A while ago, I used it in a tweet trying to entice people to read my blog on the perils of allowing residents to dictate operative notes. And then I thought about it.

I will admit that many procedures we do are simple. I have taught physician assistants to perform such tasks as closing a wound, excising small skin lesions, draining abscesses, inserting central venous catheters and the like. PAs who work in cardiac surgery can harvest veins and perform other more advanced procedures. When I was teaching residents, I taught them just about all types of operations, from the most basic to the most complex.

But a Medline search has failed to produce even one paper showing that a monkey has successfully been taught to operate even on another monkey.

Questions. If a monkey could be taught to operate, would she know on whom and when to operate? Would that monkey know when to ask for help or abandon a procedure?

Let me give you an example. Thanks to the ever increasing use of CT scans and ultrasounds, I have been asked to see a number of patients who have gallstones and abdominal pain. This may surprise some primary care doctors, but many of these patients do not need surgery because their pain is not due to the gallstones. A recent study with an almost 30-year follow-up confirms this.

Sometimes we get the question, “Is that tumor resectable?” In other words, Can you take it out?” My answer is usually, “Everything is resectable (see hemicorporectomy), but will the patient survive the operation?” That is the real question.

I don’t think you want a monkey to make that decision, and I don't want to think about the monkey's dictation.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages 800 page views per day, and he has over 4700 followers on Twitter.