Unprepared surgeons?
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Mrs. George had her gallbladder removed earlier this month.
As @bachophile will attest, gallbladder surgery is among the most painful, debilitating, long-recovery surgery. Or, at least it was until it became amenable to laparoscopic surgery. So, rather than spending a week to 10 days in the hospital, you go home that afternoon.
The surgeon who did her surgery said that today's trainees don't know how to take a gallbladder out the "old fashioned way." In fact, they graduate people who have NEVER done it that way. That frightens me. When things go south during laparoscopic surgery, and they certainly can, having someone not know how to handle the complication is not a good thing.
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@Mik said in Unprepared surgeons?:
So even routine lapro procedures can go south in a hurry. Ugh.
You have no idea.
There was one time when I was doing a gyne case, And the surgeon inserted the trocar - that’s the device that’s used to put gas into the abdomen - and when he started inflating with CO2, I heard a bubbling sound come up through the mouth of the patient.
He had inserted the car into the stomach. We had to get a general surgeon to repair the hole in the stomach, and the patient spent three days in the hospital for what should’ve been an outpatient procedure. As far as I know, there was no lawsuit on that one
So, yeah, things can go south.
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hole in the stomach-no biggie, just suture it up
trocar in the aorta or vena cava, thats a whole different kettle of fish. thats when the patient can bleed out even before u have time to open the belly, put a clamp on, scream to high heaven for help.as for what the article says about training, its very multi factorial, and yes includes work limits. i think it also includes residents being a lot less independnet than in the past, because litigation has limited the amount of responsibility on residents and transfered it to attendings. which of course in some sense is a good thing but robs residents of experience of acting independently in the OR. When i was a youngin, i did lot of operations on my own, the night energencies like appendix and incarcerated hernias, with the attending being a phone call away, but still, in the OR i was on my own (with another resident). now, no one has any procedure done in the OR without an attending physically present, which spares the resident the ass puckering feeling of being on your own, which is essential to the learning process. think-learning to fly without ever doing a solo and getting a pilots license. its impossible.
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hole in the stomach-no biggie, just suture it up
trocar in the aorta or vena cava, thats a whole different kettle of fish. thats when the patient can bleed out even before u have time to open the belly, put a clamp on, scream to high heaven for help.as for what the article says about training, its very multi factorial, and yes includes work limits. i think it also includes residents being a lot less independnet than in the past, because litigation has limited the amount of responsibility on residents and transfered it to attendings. which of course in some sense is a good thing but robs residents of experience of acting independently in the OR. When i was a youngin, i did lot of operations on my own, the night energencies like appendix and incarcerated hernias, with the attending being a phone call away, but still, in the OR i was on my own (with another resident). now, no one has any procedure done in the OR without an attending physically present, which spares the resident the ass puckering feeling of being on your own, which is essential to the learning process. think-learning to fly without ever doing a solo and getting a pilots license. its impossible.
@bachophile said in Unprepared surgeons?:
hole in the stomach-no biggie, just suture it up
Yup. Added about 30 minutes to OR time (while we found a general surgeon in the house). But for the patient, an unpleasant event.
Independence is a great thing. As a senior medical student, I spent 3 months doing an anesthesia rotation at the local VA hospital. By the end of the rotation, I was on my own, other than induction. Yeah, the attending was down the hall, but for all the routine stuff (and I was doing heads and chests) I was on my own. As an OB resident, I NEVER saw my attending when called for an epidural. S/he was down the hall, but asleep.
I'll never forget my first day doing OB. I get called for an epidural, so I called the attending.
"Adrian! The lady in room 5 wants an epidural."
(Adrian was from South Africa, so insert accent)
"Well man. Go put it in!"
Didn't see him for 24 hours.
Never happen today.
As a former partner commented, "I had a patient who told me that she wanted to go to a 'teaching hospital.' I politely informed her that it's really a 'learning hospital.'"
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hole in the stomach-no biggie, just suture it up
trocar in the aorta or vena cava, thats a whole different kettle of fish. thats when the patient can bleed out even before u have time to open the belly, put a clamp on, scream to high heaven for help.as for what the article says about training, its very multi factorial, and yes includes work limits. i think it also includes residents being a lot less independnet than in the past, because litigation has limited the amount of responsibility on residents and transfered it to attendings. which of course in some sense is a good thing but robs residents of experience of acting independently in the OR. When i was a youngin, i did lot of operations on my own, the night energencies like appendix and incarcerated hernias, with the attending being a phone call away, but still, in the OR i was on my own (with another resident). now, no one has any procedure done in the OR without an attending physically present, which spares the resident the ass puckering feeling of being on your own, which is essential to the learning process. think-learning to fly without ever doing a solo and getting a pilots license. its impossible.
@bachophile said in Unprepared surgeons?:
hole in the stomach-no biggie, just suture it up
trocar in the aorta or vena cava, thats a whole different kettle of fish. thats when the patient can bleed out even before u have time to open the belly, put a clamp on, scream to high heaven for help.as for what the article says about training, its very multi factorial, and yes includes work limits. i think it also includes residents being a lot less independnet than in the past, because litigation has limited the amount of responsibility on residents and transfered it to attendings. which of course in some sense is a good thing but robs residents of experience of acting independently in the OR. When i was a youngin, i did lot of operations on my own, the night energencies like appendix and incarcerated hernias, with the attending being a phone call away, but still, in the OR i was on my own (with another resident). now, no one has any procedure done in the OR without an attending physically present, which spares the resident the ass puckering feeling of being on your own, which is essential to the learning process. think-learning to fly without ever doing a solo and getting a pilots license. its impossible.
We had Tulane residents. Ortho, Surgery, Medicine, Ob-Gyn and GU. For things like Oral Surgery, Radiology, Pathology etc., we had staff physicians. We were just a meat and potatoes hospital, and referred the neuro and other complicated cases to Confederate (LSUS Med) or Big Charity.
Guys liked and disliked our hospital. Old, creaky, sometimes without the latest tech. But we did a lot of trauma, our OR crew was very good and surgery had some specialty instruments that no other hospital in the area had.
Residents, especially senior residents, functioned much on their own. Especially in the middle of the night, the attending was only called out for the wooly-booger cases. That was a bit different than the big hospitals attached to the medical schools.
Junior residents got stuck with more than their share of ED duty. Didn't matter your specialty, you saw everything from soup to nuts, but at least the junior guys had resident consults to fall back on.
I'd like to think the system turned out some pretty decent docs...
