A general surgeon is a doctor who assesses conditions of the abdomen and digestive system, hernias, gallbladder problems and some conditions of the skin and the tissues beneath it. Their work begins with deciding whether surgery is needed and includes any necessary procedure and follow-up care. A referral to a surgeon does not necessarily mean you will have an operation.
Recurring abdominal pain, a new lump or a wound that is not healing may be reasons to book a routine appointment. Sudden severe pain, persistent vomiting, loss of consciousness and bleeding are not symptoms that should wait for an appointment. In these situations, emergency medical care should be your first point of contact.
Problems a surgeon assesses
Many organs lie close together in the abdomen. Some conditions involving the stomach, small intestine, colon, rectum and gallbladder fall within general surgery. Because not all abdominal pain is caused by a surgical condition, the doctor first tries to distinguish between possible causes of the symptoms.
For example, recurring pain beneath the right ribs after meals may be related to gallstones. Abdominal bloating, vomiting and inability to pass wind may suggest bowel obstruction, which means the contents of the bowel cannot move through it. These symptoms cannot be used to make a diagnosis at home. An examination and sometimes imaging are needed.
A bulge at the navel, in the groin or at an old surgical scar is another problem a surgeon assesses. It is necessary to establish whether this is a hernia, a growth beneath the skin or another change. Whether the swelling increases when standing, decreases when lying down or causes pain is useful information for the doctor.
Soft tissue problems include fatty lumps beneath the skin, some cysts and collections of pus. A cyst is a small sac containing fluid or other material. A collection of pus is called an abscess. A red, warm and painful swelling should be shown to a doctor rather than squeezed or punctured at home; treatment sometimes requires draining the pus.
A doctor's day-to-day practice may not cover all these areas equally. One aim of the first appointment is to establish whether that doctor can treat the problem or whether another referral is needed.
A routine appointment or emergency care?
For symptoms that have been present for some time without a sudden deterioration, a routine appointment with a family doctor, a physician specialising in internal medicine or a general surgeon may be appropriate. After examining you, the doctor decides how soon further investigations are needed. Symptoms such as blood in the stool, unexplained weight loss and increasing difficulty swallowing also need prompt assessment.
In an emergency, trying to arrange all the tests beforehand wastes time. Emergency care is particularly important in the following situations:
Severe abdominal pain that starts suddenly or worsens rapidly.
Abdominal swelling, repeated vomiting and inability to pass stool or wind.
Vomiting blood, black stools or heavy bleeding accompanied by weakness.
A painful bulge that becomes hard and red and no longer disappears as before.
Abdominal pain with reduced consciousness or fainting.
Increasing abdominal pain with fever should be assessed that day, particularly if the person's general condition is worsening. A telephone conversation or temporary relief after painkillers does not replace an examination. In an emergency, there is no need to wait for every symptom to appear at once.
Why are referrals and previous test results useful?
If another doctor has referred you to a surgeon, the referral may state the question they would like answered. For example, this might be whether a gallstone is causing the pain or whether a swelling in the abdomen needs surgery. The referral is the reason for further assessment, not the treatment decision itself.
It is helpful to bring previous test results, written imaging reports and the images themselves if available. If you have had surgery before, the hospital discharge summary and the report on any tissue removed may also be needed. Whether a test needs to be repeated depends on when it was performed, its quality and its relevance to the current symptoms.
Writing down the names and doses of your medicines makes the appointment easier. Blood-thinning medicines, diabetes treatment, allergies and any problems during previous anaesthesia should be specifically mentioned. Do not stop medication on your own before the appointment. Not every patient needs to fast before an initial consultation; you can check this with the clinic.
How is a decision reached at the first appointment?
The appointment usually begins with a conversation. You may be asked where the pain is, when it started, whether it is related to eating or movement, and about changes in bowel habits, fever and weight loss. The effect of symptoms on everyday life also matters. Pain that disturbs sleep may be assessed differently from discomfort that occurs only when lifting something heavy.
A physical examination follows. This may involve looking at and feeling the abdomen, assessing a bulge while you are standing and examining a wound. The doctor should explain any examination of an intimate area in advance and obtain your consent. You can discuss having a healthcare professional present as a chaperone if you wish.
A CT scan or colonoscopy is not needed at every appointment. A CT scan produces cross-sectional images of the body, while colonoscopy examines the inside of the colon using a flexible instrument with a camera. These tests are chosen to answer a specific clinical question. If the diagnosis is not fully clear at the first visit, a plan for further investigation and follow-up is provided.
When surgery is offered, its purpose, possible alternatives, the implications of waiting and the main risks should be explained. You may also be told what information is still needed and when the decision will be discussed again. By the end of the appointment, the next step should be clear: investigations, observation, medication, another referral or preparation for surgery.