tag:blogger.com,1999:blog-30499448.post1396725608789385562..comments2024-02-18T13:53:30.168-08:00Comments on Surgeonsblog: The Student PrintsSid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger30125tag:blogger.com,1999:blog-30499448.post-58033086620238219832008-03-16T08:20:00.000-07:002008-03-16T08:20:00.000-07:00Sid, I completely agree. I've been practicing vete...Sid, I completely agree. I've been practicing veterinary medicine as a generalist for eight years now (and fwiw I was a veterinary nurse for many years before I went to veterinary school). I don't fancy myself a particularly brilliant surgeon by any stretch. Anything unusual gets turfed to a surgeon if the owner will go for it, or to a colleague in my own practice who is more interested in surgery if not. But of course there are times when it comes down to me and I have to step up to the plate because otherwise the pet isn't going to get his problem addressed at all. What do I do? I read about the surgery. I watch a training video if possible. I almost always bring reference material into the OR just in case. If possible I scrub in with someone else on a similar surgery beforehand, too. I can't imagine why anyone would ever want to step into an OR unprepared for all possibly predictable occurrences.webhillhttps://www.blogger.com/profile/05938934194973454729noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-6805197220963059422007-10-12T12:00:00.000-07:002007-10-12T12:00:00.000-07:00Any evidence showing that professionalism in Medic...Any evidence showing that professionalism in Medicine is associated with a higher rate of family failure?<BR/><BR/>I don't think so. <BR/><BR/>Julio Mayol<BR/>A surgeon from SpainAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-44390286558378457182007-10-11T01:15:00.000-07:002007-10-11T01:15:00.000-07:00This comment has been removed by the author.SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-69609466058532395282007-10-09T21:09:00.000-07:002007-10-09T21:09:00.000-07:00mj: I woudn't count on orac passing by again to re...mj: I woudn't count on orac passing by again to read followup to his comment. You could go to <A HREF="http://scienceblogs.com/insolence/" REL="nofollow">his blog</A> and contact him more directly.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-51785522725397229752007-10-09T20:58:00.000-07:002007-10-09T20:58:00.000-07:00"My philosophy is that I pay as much attention in ..."My philosophy is that I pay as much attention in proportion to the level of interest that student shows in the material, after first giving a generous evaluation period to see how interested he is. If a student shows a lot of interest, I'll definitely spend a lot more time teaching him. "<BR/><BR/>Orac, this is the ideal situation for both teacher and student! As a 3rd year student, this sort of custom-teaching is highly appreciated. My question is this - in our school we are shuffled around so much that facetime with an attending might be limited to 1/2 day, period. We may work with 25 different attendings in a month (for example, in our ambulatory block) - so there is little time for a "generous evaluation period." What do you recommend in place of that, if your time with the student is so very capped?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-72233358390605944412007-10-06T16:24:00.000-07:002007-10-06T16:24:00.000-07:00This comment has been removed by the author.SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-48953534726501113502007-10-06T14:36:00.000-07:002007-10-06T14:36:00.000-07:00i recently had a comment on my blog strongly conde...i recently had a comment on my blog strongly condemning the so called boot camp type training surgeons go through and i had a eureka moment. we don't work these hours because we want to prove some macho thing. we do it because we have no choice. the patient load, available surgeon ratio is wrong. and it will never get better. there will always be patients needing life saving surgeries in the wee hours and the number of surgeons training up is decreasing (few left willing to put themselves through the training and the lifestyle). so, if you are the surgeon on duty and some patient comes in when you're not nicely rested up, do you help him or get a good night's sleep and compromise his chances? that, in the end, is what it's all about. all the arguments that don't consider patient outcome with available resources (surgeons) should be ignored.<BR/><BR/>and, yes, sid, the south africans did thump the usa team in the rugby world cup. although your right wing (a zimbabwean born radiologist) ran around our star player (habana) to score a try. very very impressive to say the least. i wonder if he has a medical blog.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-23354890487797236682007-10-06T13:57:00.000-07:002007-10-06T13:57:00.000-07:00Wow! What an excellent and interesting post!Throug...Wow! What an excellent and interesting post!<BR/><BR/>Through reading your blog and some others and yes some TV med shows, I have kind of figured that the intensely grueling training that you surgeons endure along with your personal drives, i.e., perfectionism, hyper-vigilance, etc. is like the marine boot camp of the medical field. Really...it does all fall on the surgeon in the OR. (Anesthesiologist too?)<BR/><BR/>I can't truly fathom the awesomeness coupled with responsibility that you as surgeons experience. (Taking Trust Oct 7th still one of my favorites) I would think that the weak/incompetent (for THAT field) SHOULD be weeded out. <BR/><BR/>I don't say that callously BTW, just that if I or a loved one were on the table...I'd want the surgeon with MOXIE!<BR/><BR/>Of all the docs that I have ever worked with or known...the surgeons are the "crankiest" but NOT always-there are exceptions. And there is one surgeon I am thinking of that I NEVER saw lose his cool and the one time I saw he was pi**ed...(in the ER) the pt never knew and in my opinion-maybe he should have. I actually have a funny specimen story about him that ties in with his laid back demeanor..maybe I'll post it sometime.<BR/><BR/>I've said this before..here..but you docs see so many pts, but the pt sees just you and they look to you, they trust you and if surgery...they are trusting you with their very lives. I think every doctor should read your "Good Vibrations" post (Back in Feb?)and take it to heart.<BR/><BR/>The only thing that perplexes/concerns me about the surgical training is the sleep deprivation. On the one hand..you have to be able to suck it up, have the bladder of an elephant, endure the backaches, etc and persevere with excellence, BUT on the other hand there IS the REALITY/CONSEQUENCES of sleep deprivation which could seriously compromise the pt's well being.<BR/><BR/>I haven't read the comments as yet so forgive me if there is any duplication in comment/questions. :)SeaSprayhttps://www.blogger.com/profile/07906503090688697222noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-30415413657778869302007-10-05T13:10:00.000-07:002007-10-05T13:10:00.000-07:00As a student who loved his surgical rotation, seri...As a student who loved his surgical rotation, seriously entertained thoughts of becoming a surgical resident, and pondered long and hard between two different but similar fields (both in the OR and both care for ICU pts) I finally had to look at it a different way.<BR/><BR/>Being as hard on myself as I am and knowing the level of expectation I place on those around me as well as myself I knew I would not be around for my family. To me this is the most important role I have in life. If I failed as a parent and husband because of pursuing a field that demands the most in medical training then I failed everything. Because of this notion I decided to take the other path. <BR/><BR/>I know several students think of surgeons as assholes. Some simply are. Others, based on their personalities and training, demand more from others than people might be accustomed. Is it wrong? Certainly not.MedStudentGod (MSG)https://www.blogger.com/profile/02670042423377931696noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-54626468212758242762007-10-05T13:05:00.000-07:002007-10-05T13:05:00.000-07:00I think it's not just a matter of the knowlege in ...I think it's not just a matter of the knowlege in question.<BR/><BR/>It's about teaching people to develop habbits of professionalism. Sure, if you're a psychiatrist, you may never need to know about vascular supply of the colon to do your job, but you need to have the habbit of coming in every day prepared to do whatever it is you have to do to take care of patients. <BR/><BR/>The principle is not one of the specific knowlege, but of dedication to the profession. I think that the work hours limits are good, but you still need to study, read, a little bit of something, every day. Get a little better, a little smarter every day, otherwise you get left behind.Midwife with a Knifehttps://www.blogger.com/profile/04309579302399381913noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-64437759077837426782007-10-05T12:31:00.000-07:002007-10-05T12:31:00.000-07:00Speaking purely from a patient's perspective, I am...Speaking purely from a patient's perspective, I am not sure who all these mean doctors are. Maybe I've been very lucky to come into contact with doctors who are all very kind and most importantly capable. I know many people, some in my family and some close friends, who have horror stories they love to tell about an aweful surgeon or cruel family doctor. I sometimes wonder if most of these stories have not been exaggerated so they'd have an interesting story to tell while out for lunch with friends. The worst I can say about my experiences with doctors has been that when I've had each of my three kids, they were sick. Not as sick as some babies but still sick enough to be in hospital. Every single time I took one of my newborns to the hospital, I was perceived as the "crazy, overprotective new mother". I insisted and every time I was right. My first had a staph infection on his tummy and my second and third had nasty kidney infections because of kidney reflux. But other than that, doctors I've known have been great. I recently saw a surgeon who was amazing. I was very pleased with the way he explained things to me, took time to answer every one of my questions without making me feel like I was wasting his time and the most amazing thing of all.....I only had to wait a week to see him. I couldn't believe that. The waiting lists around here to see specialists is months and sometimes years long. I am not sure how I got an appointment in only a week (it's not like I was THAT sick) but I did and I appreciate it. Oddly enough, his wife is my son's nephrologist and she's awesome too. I once accidentally called her at home rather than leaving a message at her office (which was my intention) and she wasn't the least bit put off by it. She's been so great for my son that I can actually say I love her.Christinehttps://www.blogger.com/profile/18077413262117490747noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-63204126656408800852007-10-05T10:45:00.000-07:002007-10-05T10:45:00.000-07:00So is this the era of the coddled student?I precep...So is this the era of the coddled student?<BR/>I precept 1st years in my family practice office. I start on time at 8:30. My student was late two weeks in a row and knocked to come in half way through the physical. After the second time I spoke with her after the end of the morning. I suggested promptness. To motivate her I showed her who was on the schedule the following week for a CPX. Fascinating case of "Subjective blindness"...another story...<BR/>anyway, the next week she shows up 1/2 hour into the physical. Knock on the door... I asked her to wait in my office. After the physical I suggested she go home...<BR/>I got a call from the Program Director that afternoon suggesting I not be so hard on her.<BR/>I think I was appropriate. I think she'll have some problems down the road.DDx:dxhttps://www.blogger.com/profile/05744917175160791044noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-86184268655613451092007-10-05T08:36:00.000-07:002007-10-05T08:36:00.000-07:00I think I agree with most of the posters, it's jus...I think I agree with most of the posters, it's just the depth of knowledge that I sometimes find a bit ridiculous.<BR/><BR/>Absolutely if the student knows who he'll be operating on the night before, he should prepare by reviewing the basic overview of the surgery, the relevant anatomy, and know the patient's history, presentation, and physical. That's a no-brainer. <BR/><BR/>As a medical student, you should know the basics at the very least, since we're here to learn the basics of how different specialties practice. Absolutely. If a patient has endometriosis, and you don't even know what endometriosis is, yeah, that's a problem. But nit-picky stuff done not for learning but for making the attending surgeon, with 15 years of experience under his belt, look good at the expense of the medical student who's been on the rotation for two weeks? Absolutely unnecessary.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-92005874296389294302007-10-05T07:38:00.000-07:002007-10-05T07:38:00.000-07:00"I don't know who's blog posting you read, but if ..."I don't know who's blog posting you read, but if the student was not a sub-intern, and was not planning on going into surgery, the attending berating her for not knowing the surgery is ridiculous."<BR/><BR/>I'll agree that if the student was unexpectedly sent to observe the surgery then it was inappropriate to give him crap, but a student who knows he's going to a particular operation and does not even bother to do even a little reading about it deserves to be made to feel at least a little uncomfortable about his lack of preparation.<BR/><BR/>And not criticized about not knowing the basic anatomy in an operation? Please. Did the student not take anatomy as a first year? I've had students who can't even tell me what artery goes to the appendix or the gall bladder--or even what the blood supply to the colon is. Very basic stuff. We're not talking pointing out tiny named nerves that they'll never need to know.<BR/><BR/>My philosophy is that I pay as much attention in proportion to the level of interest that student shows in the material, after first giving a generous evaluation period to see how interested he is. If a student shows a lot of interest, I'll definitely spend a lot more time teaching him. Lackluster students who can't be bothered to read about the basics of basic bread-and-butter operations during their surgery rotation waste my time and don't appreciate my teaching effort anyway.Orachttps://www.blogger.com/profile/01370846202152605202noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-21993719307258022632007-10-04T20:47:00.000-07:002007-10-04T20:47:00.000-07:00Great post, Sid. Isn't it interesting that the sce...Great post, Sid. Isn't it interesting that the scenario you describe (ranting attending, brutal chief, humiliated student, etc.) is a recurrent theme? The blogs confirm that it echoes across all continents and in every medical school. Interestingly, the same social dynamic has been described by generations of physicians including Chekhov, Williams, Selzer, and Groopman. <BR/><BR/>Sure, we’re always amazed when a resident or student shows up unprepared – we love what we do, and our selective memories have long since forgotten the times, years ago, when we reviewed the wrong chapter or forgot what we had just read. It happened then and it happens now. <BR/><BR/>As we ascend the food chain, we physicians remain at high risk of becoming all too full-of-ourselves. My hunch is that today’s students will likely continue the cycle in their own good time unless they understand their own history.Brucehttps://www.blogger.com/profile/13796821092673583519noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-24429985977352925462007-10-04T20:15:00.000-07:002007-10-04T20:15:00.000-07:00Graham's comment got me to write this follow-up--I...Graham's comment got me to write this follow-up--I didn't mention in my other comment to save space. I stand by everything I said, but it really was in the context of residents or "serious" trainees. For med students, the purpose of these rotations is to learn the <EM>basics</EM> (and anatomy is about as basic as you get for surgery, though often pedantic) of a field and see if it's something that interests you (or that you dislike the least...heh). Unless they are gunners who feel called by God to do surgery, it's less about impressing the attending with your encyclopedic anatomical/procedural knowledge than showing seriousness to learn, making the most of one's opportunities, and being part of a team--just like almost all rotations.<BR/><BR/>Developing somewhat of a thick skin is also part of the training. It's <B>way</B> easier if you're older like me, but should a surgeon ask me questions until I don't know any more, then continue, then insult me for not knowing, then continue with even more obscure questions, I'd have no problem firing back, "You can keep asking more detailed questions and watch me guess randomly all afternoon, but I fail to see what that is going to accomplish. I apologize for not knowing the level detail you'd like, but I would actually like to walk out of here at the end of the case having learned something if you wouldn't mind sharing." No problem whatsoever. <BR/><BR/>Not knowing something you know you should have had you only worked a bit harder is different, as is simply drawing a blank on something that you did know and just couldn't recall at that moment. Aside from outright verbal abuse, "shame" that one often reads in med student blogs for not knowing trivia is self-inflicted and usually serves little purpose. Accept that you will make mistakes, learn from them, and move on. That's what training is about.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-39241531652458062752007-10-04T20:06:00.000-07:002007-10-04T20:06:00.000-07:00Here I am in a little village where the doc turnov...Here I am in a little village where the doc turnover is high. The only guy who stays is the one who owns a clinic or most of it. He is rude to Medicare patients -- not to others.<BR/><BR/>The most recent "passing-through" doc saw a former student of mine -- now a grandfather -- who has managed to struggle through an aneurysm deep in his brain: deep enough that they had to go in through his temple, pushing his eye and other things out of the way and removing a big piece of skull temporarily. This man functions through grit and intelligence. He can't make his eyes track to read now, so he listens to books.<BR/><BR/>When the latest passing-through doc saw him, he cheerfully announced that he hadn't bothered to look at his patient's file. PTD was surprised that his patient became angry... But, ya know, seems like the doc could try as hard as the patient.<BR/><BR/>Prairie Marymscriverhttps://www.blogger.com/profile/13567509503405689139noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-89072770110696555302007-10-04T19:29:00.000-07:002007-10-04T19:29:00.000-07:00storkdoc: good comment. And most of my colleagues ...storkdoc: good comment. And most of my colleagues are more conservative than I; I can handle it (although, as I've said, it's real conservatives that ought to be in the streets with pitchforks and torches over what's going on at 1600 Pennsylvania Avenue.) On the other hand, I actually made a couple of Pfannenstiels in my career.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-52179489179571641932007-10-04T18:59:00.000-07:002007-10-04T18:59:00.000-07:00Great post Sid. I always like your posts even thou...Great post Sid. I always like your posts even though I am far more conservative than you.<BR/><BR/>I have never understood why Docs can be arrogant and condescending to their patients. One, they are the source of your income; two you piss 'em off and they tell their friends and a bad reputation gets around quickly; three, have a great bedside manner and you are less likely to get a summons. <BR/><BR/>Graham, I'm an OB/GYN doc on a teaching service. Our students know in advance what cases I'll be doing in the morning and I expect them to have read up on the anatomy. I expect them to have read the H&P (often they were at the pre-op visit). So I expect them to have read up on fibroids, endometriosis, family planning or malpresentation or whatever. I hate it when a student states that they don't know the anatomy because they had it 2 years ago. I don't yell at them, but they do earn some displeasure.<BR/><BR/>And Graham, its not low yield learning in the OR. Even if you don't go into a surgical specialty, you'll be much better able to advise your patients who may ask you about your opinion on having surgery.<BR/><BR/>Finally Sid, the general surgeons always give me a hard time about pfannelstiel incisions.<BR/>Tomorrow I have to do a section on one of our general surgeons whose baby is a double footling breech. Think I should ask her if she wants a midline incision... :-)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-65023752874649993812007-10-04T17:04:00.000-07:002007-10-04T17:04:00.000-07:00Yeah, well, so much for teaching judgment... Surge...Yeah, well, so much for teaching judgment... Surgeon musta come from one of those easy programs...Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-72566620637518806722007-10-04T16:36:00.000-07:002007-10-04T16:36:00.000-07:00I guess now that I've laid out my humility in my p...I guess now that I've laid out my humility in my previous comment I can come to the "defense" of nonsurgeons by saying that in some cases surgery can be done with no positive or negative consequences. <BR/>I saw a patient recently who previously had some pain in roughly the right lower chest area, eventually ended up having a resection of some lung tissue, all for naught. Another came in and said, "Well your problem really was coming from your gallbladder," and since it resolved with some antibiotics, it was not felt that cholecystectomy was necessary.Greg Phttps://www.blogger.com/profile/18422487877167541900noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-887212636449599352007-10-04T15:13:00.000-07:002007-10-04T15:13:00.000-07:00"five miles uphill both ways." Good stuff; I like ..."five miles uphill both ways." Good stuff; I like it. <BR/><BR/>I assume SA creamed the US team? Missed it, and it's hard to find on the sports page over here. <BR/><BR/>Illini? Is that even a name? It looks like a bar-code.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-42767998146101189342007-10-04T14:42:00.000-07:002007-10-04T14:42:00.000-07:00I remember one time in the office explaining what ...I remember one time in the office explaining what neurologist is, and had to answer that no, I don't do surgery. <BR/>The patient responded, "Oh, so if there is a problem, you don't <I><B>do</B></I> anything."<BR/>I think there was a pause on my part, after which I just said, "Uh, yeah" and left it at that.Greg Phttps://www.blogger.com/profile/18422487877167541900noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-79912955955861650482007-10-04T14:05:00.000-07:002007-10-04T14:05:00.000-07:00I think I know whose post you're referring to (I'm...I think I know whose post you're referring to (I'm a new blogger there as well). While you make excellent points, Dr. Schwab, about medical students needing to stay on top of things, especially for surgical cases, I'd tend to side with Graham and say that there are better ways to go about reprimanding students if they happen to be unprepared than flat-out insulting their intelligence. Perhaps that's the student in me, though.<BR/><BR/>So glad to hear, though, that you've avoided these exercises for the most part and seem to have done so proudly. It seems as though this very episode is precisely why the whole of surgery gets the reputation that it has but that there tends to be an isolated bad bunch that spoil it for the rest (not unlike medicine itself).<BR/><BR/>Finally, go Illini.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-59341327379443219472007-10-04T14:00:00.000-07:002007-10-04T14:00:00.000-07:00"Great post. This is the era of the Coddled Doctor..."Great post. This is the era of the Coddled Doctor-in-Training."<BR/><BR/>I guess if it's not five miles uphill, both ways, in the snow, it's being coddled.<BR/><BR/>"Do I come home too late?"<BR/><BR/>If there's anything in this life that's more important to me than medicine, it's family.Anonymousnoreply@blogger.com