“I am a surgeon. It is what I do.”

It is early Sunday morning, traditionally a day of rest for everyone. I am up and about, soon to head to the hospital to amputate a gangrenous finger on the hand of an unfortunate individual with end-stage kidney failure due to diabetes that is poorly controlled. This is not the scenario most people envision when they think of plastic surgery. I am surprised to feel mildly excited, looking forward to surgery. On reflection, I think, this is weird. Am I abnormal? How can I revel in such a sad situation?

I make my living performing surgery, so one could rightly say that I have a vested interest in people getting sick and needing surgery, or simply wanting surgery for some other reason, so that I can make a living. This particular accusation has been leveled at doctors and the entire medical profession by those who believe there is a financial incentive in all that doctors do. Many are advocates of alternative medical therapies. They fail to see the hypocrisy of claiming that traditional doctors have a profit motive as their primary imperative when they profit from their own alternative/non-traditional therapies as well.

Medical practice is not simply caring for simple, common problems.

There has been a strong and largely successful push by advanced practice nurse practitioners (NPs) and physicians assistant (PAs) to practice autonomously as primary care providers. The Florida legislature recently granted advance practice nurse practitioners license to practice independently https://www.usnews.com/news/best-states/florida/articles/2020-03-11/florida-oks-independent-practice-for-nurse-practitioners. That term, “provider”, has replaced the original, which was “physician”. NPs and PAs have now been elevated from their original designation as mid-level providers of care to acknowledge their more limited education and clinical experience, while primary care physicians have been demoted so that they are now lumped in with mid-levels as “providers.” Many patients do not know the difference and commonly refer to NPs and PAs as their “doctor”.

“Absent an effective treatment or vaccine, and knowing that we cannot stay locked down indefinitely, our only hope for dealing with this virus is to turn to the most effective anti-virus agent known to man: a healthy immune system.”

I have no illusions about the Wuhan Virus, aka SARS-CoV-2. It is a dangerous beast to be taken seriously. What does that mean, exactly? When we speak of containment, mitigation, flattening the curve, what are we really referring to?

Let me say up front that it is a terrible thing and too many have died. For them and those they have left behind, we can only offer our prayers and condolences, and a promise to try to do better. With that said, how do we do better? As a physician, admittedly not an expert in public health, an epidemiologist, or an expert on viral pandemics, I have some observations and opinions. Take them from someone who has been in medicine for over 40 years. I am a plastic surgeon, yes, but first and foremost, I am a medical doctor.