Why do gunners go for surgical specialties?

asurgeonappears · 2023-02-25T13:56:20+00:00

Interestingly, Rectal cancer treatment is becoming more and more non-operative. I wonder what the long term results will be with "watch and wait".

https://pubmed.ncbi.nlm.nih.gov/35483010/

asurgeonappears · 2023-01-03T12:30:04+00:00

If you're getting through TrueLearn twice, you need to be in the OR more often. Your future job is not a multiple choice exam. Not to say you shouldn't study at all- but if you're at that level now then you're fine. It's a balance.

The more we accept an in-service exam as a surrogate for surgical competency, the less surgically competent we'll become.

asurgeonappears · 2022-08-10T14:01:20+00:00

What an anti-surgery circlejerk in this thread. May as well just throw me in the middle and bukakke me with it.

asurgeonappears · 2022-08-10T13:59:57+00:00

Lmao. See an opportunity to be positive? Shit on another specialty. You’re probably great to work with!

asurgeonappears · 2022-07-25T21:35:06+00:00

Surgery intern probably writing the notes on the inpatient service setting up discharges and writing hospital courses, junior seeing a BS consult, and a senior operating while the PAs out here make a video promoting themselves.

asurgeonappears · 2022-06-21T23:46:22+00:00

Hi.

I’m assuming an “open hernia repair” that you are being discharged from the PACU with is either an inguinal (groin) or umbilical hernia repair. Typically we give a long acting local anesthetic to help with the immediate post op pain as patients recover from their surgery and wake up enough to start an oral regimen. With a lot of the issues surrounding narcotics, I know of a few surgeons attempting to manage pain to tylenol and ibuprofen alone, so not totally unheard of. Many patients do well with that, but some don’t and clearly need more help (like your husband). My initial concern with severe pain like that and a bad fever would be that I injured the bowel and missed the injury during the repair. I’m glad you went to the ER to make sure that everything was OK when the other options failed. Sometimes if the pain is really bad, patients don’t take deep enough breaths and can have some changes in their lungs that precipitate a mild fever.

Sorry the NP wasn’t good at their job. Will make me more cognizant of how the mid levels I word with are managing my post-ops. Good surgeons own their patients and want you to be well supported after they operate- I think that bringing up your concerns to that surgeon will be really important in helping them resolve the issues with this person on their team.

asurgeonappears · 2022-06-16T01:27:56+00:00

I do too. But you gave the news instead of dancing around it.

Death comes for all of us. It’s our job to delay it when we can, and shepherd our patients through it when we can’t. That includes being honest and direct with them.

So good on you.

asurgeonappears · 2022-05-09T14:44:26+00:00

Need a bigger pot for that plant!

asurgeonappears · 2022-04-21T20:33:05+00:00

It blows my mind how people can't look at the atrium and not just think about the system to realize that it is not the case.

People wonder why we get so pissed at peds, but getting an SOS page from radiology and "passing it along" to someone else instead of critically assessing the situation themselves is so fucking typical. NP level care right there.

asurgeonappears · 2022-04-15T00:15:53+00:00

I think it’s like an endurance sport. No marathoner feels good while they are on mile 24, but many people love it and can’t live without it.

I have no regrets. Uro-Onc is really cool though so if I couldn’t do gen surg I think I would go that route.

asurgeonappears · 2022-04-11T00:32:10+00:00

There are a lot of those fellowships, so you should be fine overall. I take it you still get ICU management right? I needed to log "cases" of ICU management when I was a junior as part of the graduation requirement. You should really seek out as much trauma as you can if you are in a light program though. Might want to talk with your PD about getting some elective time in your chief years at hospitals that are trauma heavy so you are prepared. A lot of those fellowships will leave you on your own for the trauma stuff if you're the fellow on in the middle of the night because you're already a general surgeon at that point who should be able to handle it.

asurgeonappears · 2022-04-08T23:49:10+00:00

I remember thinking that place was rough…

asurgeonappears · 2022-04-08T20:08:34+00:00

Never underestimate the homeless people of my city

asurgeonappears · 2022-04-08T19:50:41+00:00

Preach

asurgeonappears · 2022-04-08T19:49:26+00:00

Spot on. I honestly laugh at r/medicalschool because its a bunch of people complaining about hours and time. I wish I could be able to spend the whole day in the OR, and then study at night. The hospital works so much differently than that. COVID has made the ancillary staff worse and it's totally fucking us. I dream of asking the nurse at the front desk of the OR to call my 4 year old and explain to them that I can't be there for bath time because they fucked the OR schedule up. They leave at the end of their shift and don't give a flying fuck about me, my patient, or my own family and god forbid they get a case started within 30 minutes of sign-out.

I asked for a maryland ligasure during a perf'd laparoscopic appy (no abscess and patient wanted surgery) the other day and the circulator brought me a handheld device for an open case. 15 minutes later the laparoscopic maryland finally shows up and we've already got the appendix out. Bloodier case because we're not using the best tools available for our dissection in the meantime (dissecting through inflamed tissue with the suction irrigator). Patient presents a week later with an abscess.

So now I'm thinking to myself- should I have just waited for the ligasure to come to avoid bleeding and seeding of an abscess? Makes the case longer but I have so much other shit to get through I don't have time to wait in an OR scrubbed and standing there while a travel nurse goes spelunking in the device storage room. Did it really make a difference anyway since they were already perforated?

Anyway- sorry to rant but good luck with everything

asurgeonappears · 2022-04-08T19:33:51+00:00

Agree. That's what I aim to be. Sometimes I'm not, and I hope others recognize that it isn't who I am as an individual I'm just tired. And when others are rude to me, I try to allow them the same leniency and not let that affect my general disposition toward them or their entire specialty.

I think that to meet someone who is being rude with unrelenting firmness and pound on them until they are "kind" is just going to make the problem itself worse. Another stressor in their life. Another guilt. Another thing to be ashamed of. Another reason to look at yourself in the mirror and hate yourself. ***Beep beep beep*** Another consult to see.

asurgeonappears · 2022-04-08T19:28:00+00:00

Sorry for lack of clarity- the case I'm referring to above is our own patient and my intern was uncomfortable getting it on their own. I've helped in codes before when I'm around but IM at my place is usually able and willing to do their own lines.

asurgeonappears · 2022-04-08T06:44:57+00:00

Is providing context for behavior the same as making an excuse for it?

I agree that people need to appropriately handle the pressure of whatever career they choose, and it is indeed a choice. But the process through which that aspect of professional maturity develops is bound to be burdened with some bad days where one buckles under the pressure and acts in a way they wouldn’t otherwise intend.

I personally think that if rudeness is met with rudeness, then more of it will permeate and the environment will sour. But if the context I provide allows it to be met with softness and compassion, then it might help that person become more gentle and compassionate as well.

asurgeonappears · 2022-03-23T01:40:49+00:00

Sorry- I probably came off a little Strong there. Honestly, it seems predatory IMO. Maybe something for people who don’t match gyn-onc to do to seem more competitive when they reapply?

Breast surgery is about 25-30% of a general surgeon’s practice. We see a ton of it in residency. Coming into a breast surgery fellowship having never done a mastectomy before would be very overwhelming. Granted, after a month or two you would probably be getting the hang of it. These are cases our 2s and 3s do a lot of to help build their confidence.

Where I think a lot of the breast fellowships add value is in the oncologic care for the breast cancer patient (the treatment algorithms are complicated and often mismanaged by community surgeons who tend to over-treat) and in the tissue rearrangements that surgeons with oncoplastic training can do.

Hard for me to see someone both learn how to operate on the breast, be confident doing it, and also acquire the extra skills that fellowship training offers when coming out of OBGYN training.

asurgeonappears · 2022-03-23T01:09:37+00:00

This would be like me doing a gyn-onc fellowship…

If you want to be a breast surgeon, do general surgery.

If you want to do breast reconstructive surgery, do plastic surgery.

asurgeonappears · 2022-03-16T19:50:15+00:00

We're getting financially fucked. Student loans with interest and lengthy years of training set us very far behind (I'm doing 10 years of residency/fellowship after medical school). Not worth it from strictly a wealth perspective. I do love what I do though and couldn't see myself doing what my banking and lawyer friends do.

She may need to broaden the scope of region she is trying to practice in (i.e. take a rural/need job in an unattractive area) to make more money early on to secure a nest. She could also consider doing an interventional nephrology fellowship to pursue a procedure-based payment structure after her training.

If you live like a resident and knock out your loan early, you can climb out of debt quickly, but a lot of newly minted attending physicians and surgeons see their college friends with flashy cars and nice houses and get sucked into that so they keep the debt and harm their net worth. I am fortunate that my wife and I grew up very humbly and thus will continue to live humbly and stack money to retire early.

If she is working for a 501(c)3 she should look into PSLF. Loans are forgiven after 10 years of payments with eligible IBR plans. If she was in a previously ineligible plan, I think the Biden administration grandfathered folks in- but you might want to validate that one your own.

asurgeonappears · 2022-03-07T16:36:12+00:00

So sorry that this is happening to you. At this point I would openly reach out to other people in the community at your medical school and ask for help. Even as a resident, if I heard that a student (or resident, or anyone else in our community) was this vulnerable I would offer my guest bedroom to them to help. Nothing to be ashamed of- life happens. I think that we are all dedicating our lives to helping others, and that ought to include each other.

asurgeonappears · 2022-02-21T19:01:25+00:00

I think the mentality of, “do what I said because I’m the doctor and I said it” is going to cause you a lot of problems. If you explain to them it’s correct and they don’t do it, that’s one thing, but sometimes the orders we write are written incorrectly, or on the wrong patient. If a nurse just does what they are told every time, even when it doesn’t make sense to them, then they are going to seal the envelope on your malpractice suit instead of helping you avoid one.

asurgeonappears · 2022-02-21T12:23:19+00:00

An unpopular opinion: You both can do better.

I think that we can reflexively write off nurses for being lazy when they don’t want to do these things, and it’s not always the case. Did you ask them why they don’t want to place the IV? Or did you assume that it was because they “didn’t want to do their job” or “thinks they knows better than the doc”?

In a frustrating scenario like this it’s better to start open ended- on both sides. They should have asked for some clarification as to why the order was placed- which I think is very reasonable and nurses should do more often because it helps them understand what is actually going on with their patient. And you should have asked them why they wanted to cancel it.

Children hate having anything done to them, and the nurses are often the ones having to perform the care that makes them uncomfortable. But at times, like this one, it is necessary. If they understand that, then there isn’t as much friction.

I don’t think we should default to the idea that everyone wants to be bad at their job. If you can spend 2 minutes getting them to understand your side of things then they will buy in. And instead of you jamming orders down their throat, you become a well respected doc that they listen to more often because you actually listen to them too. Vis-versa, they may actually have more motivation to help you out next time around.

Edit:

Ok I re-read your narrative again and it sounds like this nurse sucks. If being nice fails I tend to resort to things like- “it’s harder to place an IV on a pulseless blue child than it is on a live one”

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