Asshole doctors: Less common, but still around

I am on a surgery rotation now and one attending I work with is a complete asshole. Now, surgeons are suppose to have a reputation of being assholes, but after a rather benign surgery experience in medical school (the worst I got was just not being acknowledged), I thought it was a thing of the past. For the most part, it is. However, there are still some physicians around who still perfectly fit the arrogant asshole stereotype.

Despite having gone through medical school, I do not know the intricacies of the types of prostheses or the indications for these types of prostheses. When an attending hears that I am not familiar with those types of equipment, they could respond in one of four ways: 1) Teach me the differences, 2) Direct me to someone who could teach me, 3) just tell me what to order, or 4) Sigh, yell at me for not understanding him, ask where I went to med school and why they didn't teach me that particular fact. Guess which one I got today.

At some point in the past, that type of response was the norm. I suppose it was somewhat of an effective way of teaching. It scarred residents enough to force them to remember it. Today, though, with the hospital working more like a system of individuals, each with their own expertise and responsibilities, rather than a boss that (thinks he) knows everything and his underlings. Today, people don't take to kindly to being treated like an underling. The nurses, physician assistants and administrative people who work with this physician just plain don't work as hard or as effectively because this guy is an asshole to everyone. To me, it doesn't really matter. I ignored most of what he said because I'll be leaving this hospital and won't be seeing him ever again. If I were to see him again though (perhaps as a radiologist), I'm not sure I'd go out of my way to make his life any easier (I just might do the opposite, as long as it doesn't harm patient care). If you're arrogant or an asshole in a hospital, it doesn't matter how experienced, educated or well-qualified you are, your co-workers that you depend on will make your life much, much harder.

If your doctor is praying to heal you...

... you haven't got long to live (or you should find another doctor). Time to add to the list of science journals that have little regard for science. Here's a presidential address published in the American Journal of Surgery entitled "Can prayer help surgery." Unfortunately, the answer is "yes" (or more like, "No, but I'll say yes anyway"). Despite the fact that the author acknowledges that there is no scientific evidence that prayer works, he decides to add the old religious line of "What if those results are the will of God?" Really? Hell, I should have just responded to all the tough questions I got from reviewers by saying "It's the will of God. Who are you to question it?" This presidential address makes a mockery of science. The field of surgery is already decades behind the rest of medicine and Dr. Schroeder of St. John Hospital in Detroit (along with the American Journal of Surgery) just sent it back a couple of centuries. (uggh, I'll be working in a Catholic hospital next year, hopefully I don't run into these types)

Once again, I have to say that if any physician claims that their successfully treating a patient was God's doing, they should give up their salary.

Gotta bring back the Jesus surgeon picture. It makes me wonder why a surgery residency is 5 years. It must take that long to not get creeped out by Jesus giving you a shoulder message while helping you with surgery.

(PZ Myers has a better evisceration of the address and Orac discusses how ethically and scientifically inappropriate it is).

Rural Hospitals

I recently did a surgery rotation at an outlying hospital. It was labeled a "rural" hospital, but in reality it is only a 30-minute drive from where I live. It was a great experience. Without residents, I actually felt that I was a useful member of the team and in the OR actually got to do more than hold something that I can't see. The hospital only had something like 30 beds and I expected that any patient requiring more than a minimally complicated procedure would make the 30-minute hop to the giant academic center nearby. To my surprise lots of patients there would rather have their complicated multi-organ bowel surgery at the small 30-bed hospital (with only 4 ICU beds). Their main reasoning was that they felt comfortable in a place with familiar faces, where they knew the staff as friends or families of friends, something that they preferred over a giant maze of a hospital where you're known as a diagnosis or a room number. Also, I quickly figured out that the quality of care was the same (if not better, in some respects) than the giant academic center. True, you couldn't get a transplant or brain surgery, but for most procedures that general surgeons (or orthopedic surgeons) do, they're just as good. What's more is that things happen amazingly fast at this small hospital. There were several patients that came in with suspicious breast lumps and within a week had a partial mastectomy with pathology results in and an oncology appointment made. Scheduling several procedures across four different specialties is pretty much not possible in a large hospital. So, even though there's a lot of "outside hospital" bashing in academic centers, for the most part, they're just as good.

Chainsaws in the OR

Nope, I'm not on orthopedic surgery. I am working with a general surgeon who likes some good old heavy metal and his playlist included this classic by Jackyl.

(best quote: [James Dupree - the lead singer] once had been asked, "How the hell can you play a chainsaw?" to which he responded, "How the hell can you not play a chainsaw?")

Done Surgerizing

As you could probably tell from the frequency of posts in the last 2 months, surgery was not the most leisurely of clinical rotations. But it wasn't too bad. Maybe it is just our school (or just my experience), but the hype over how much work it is and how much pimping is involved is a bit overblown. Yes, it sucks getting up at 4:30 am everyday, but once your there (and awake) most of it isn't "difficult." I rarely got pimped (in fact there was only one time where I may have felt uncomfortable), I was rarely given any scut work and (this may have been a fluke because of some national conferences) I actually had time to read. Still, I quickly decided (after about 4 days) that it's not what I want to do with my life. What I loved about medicine was the opportunity to get a complete mystery and solve it with clues from your history, exam and labs. In surgery (for the most part) that is already done for you. It's a much more get in there and fix the problem kind of job. Don't get me wrong though... most of the surgeries were really cool. There are a lot of clever approaches to fixing otherwise very disabling problems (like making a bladder out of intestines). And there's nothing like cutting apart someone, hacking at bones, chopping up intestines and seeing the person functioning pretty much as normal a few days later. Here are some quick goods and bads:

Goods:
1. Most of the procedures are awesome - something not too many people get to be (somewhat) actively involved in.
2. There actually is thinking involved - surgeons have a lot of thinking on their feet to do when something unexpected happens intraoperatively. It's not just for jocks.
3. Results - for the majority of patients, the surgeries actually work! It's amazing to see the overnight transformation in patients.

Bads:
1. Hours suck - When med students are violating national hour-limit laws, I don't want to know what the residents are doing.
2. Not much to do for the student - unlike medicine where you can follow labs, actively discuss your patient, in surgery the most you get to do is throw a few stitches, hold retractors and get to open your mouth once every half an hour or so. There is a lot of standing around not doing anything, which sucks when you have to get up so early.

Advice:
1. Ask questions, very few people are enough of an asshole to call your question stupid (you'll figure out who those people are and avoid them).
2. Try to do as much as possible, ask (if you actually think you can handle it) if you could do it. This isn't a rotation to be quiet and timid on. You'll have a pretty boring experience if you don't try to actively get involved in whatever the team is doing.
3. Don't kiss ass. This goes for most rotations, but students interested in surgery tend to be the worst. Everyone ends up hating the person (including, I presume, the attending).
4. Don't fret over studying for pimping. Study what is important for your exam, but don't spend hours reading about details of an operation that you'll never think about again. The reputation of pimping is overrated... it is not what you should be worried about.
5. Always have something to read in your pocket. That way you'll read what you need for the day in your downtime, giving you more time to eat and sleep when you get home.
6. Don't volunteer for scut work just because you think it will give you a better grade. It won't and it'll be a complete waste of your time.
7. Have fun. You may never get to experience being in the OR again, so try to make the most of it. This is especially important to remember towards the end, when you're completely burnt out.

Despite the fact that it wasn't too bad... I gotta say, woohoo!! My two (supposedly) most difficult rotations of medical school are behind me. Now I get a relative vacation with 2 weeks of pathology before starting OB/GYN, something I have no interest in, but at least having a baby on the way will somewhat have me caring.


And remember, Jesus is with you... though he'll definitely get yelled at by the scrub nurses

Surgery

In medicine, you barely have enough time for TV. In surgery, you barely have enough time to eat and sleep. Not for me.


Although taking this monster out of someone's neck is pretty cool