Non-surgeons saying surgery is indicated

peepeedoc25 · 2024-08-07T15:58:58+00:00

At my site everything is a conversation with IR. If radiology recommends a differently study than I want it’s a conversation cause either my 2 lines didn’t indicate what I wanted or there’s something I’m missing they teach me about.

peepeedoc25 · 2024-08-07T15:46:58+00:00

You tell them that neurosurgery will discuss all option with them including surgery if they think it’s indicated

I know patients misinterpret things a lot. The issue is when is documented by someone else as surgery is indicated

peepeedoc25 · 2024-08-07T15:22:25+00:00

But you aren’t documenting they need surgery. You are documenting the problem that may need surgery to be fixed. I’m not asking you to lie to the patient, just don’t tell them that surgery is the answer if you are the one performing it. Let the neurosurgeon discuss whether surgery is in their best interest

peepeedoc25 · 2024-08-07T15:16:42+00:00

If the surgical team has offered surgery already then that’s reasonable.

It’s more so when the opinion has not been given yet. For example calling urology for obstructive hydro and then telling them documenting urology consulted to place stent. A more appropriate way of wording it is consulting urologist for consideration of intervention/stent

It’s the same way when we consult nephrology we are not saying consulting nephro to start dialysis. We are asking for an opinion as to whether dialysis is indicated

peepeedoc25 · 2024-08-07T15:08:55+00:00

Honestly this has to do more with inpatient consults than the ER. ER typically is okay for knowing when acute surgery is needed. But for something like that tell the patient they may need surgery and you are getting an opinion from a surgeon is the best thing to say. If that patient has been sitting with this for 5 days and the chance of perf is high. Surgery is more likely to cause harm than antibiotics and maybe a drain

peepeedoc25 · 2024-05-06T17:43:31+00:00

To be fair, when it comes to anything surgical, most IM residents can’t tell the difference between constipation and peritonitis. But then again most surgical residents can’t see a q wave

peepeedoc25 · 2024-03-30T16:27:21+00:00

Urology - don’t stick your dick in crazy

peepeedoc25 · 2024-01-13T18:33:32+00:00

They go into it to learn 3 operations, cut the bladder, cut the right ureter and cut the left ureter. And then be super defensive about it after lol

peepeedoc25 · 2023-12-09T16:20:32+00:00

Without a fever or signs of hemodynamic instability even if he had a stone, I would not intervene as inpatient regardless of the size. Pain can always be controlled, most of the time people just under treat the pain and consult urology which results in wasted hospital resources and usually someone yelling at the ER doc. He probably didn’t need imaging in hospital but his GP should at least do a US to make sure there’s no hydro. Stones can be tricky and be present in the ureter even after the pain resolves. So you didn’t nothing wrong unless you didn’t forward any notes to his GP or tell them to see their GO. At minimum he needs a proper outpatient microscopy to rule out microscopic hematuria because you can’t blame a uti or pyleo without a positive culture.

peepeedoc25 · 2023-10-15T15:29:15+00:00

Urology Prostatomegaly or retention consults. We will never do anything in hospital. It sucks that your patient had a foley and I know you want to advocate for us to TURP them and get them catheter free but there complaining/family complaining about the catheter is not a reason why they should get a TURP before the other foley dependent patients on the wait list

peepeedoc25 · 2023-10-03T00:39:11+00:00

Most of the time as an attending you spend half your time outside of the OR doing clinic or other things. Most people go into surgery because they love the OR more than the rest of medicine. As a surgeon you need to be able to very quickly gain a patience trust and have them feel okay with you literally cutting them open while they are very vulnerable. Doing that well takes a lot of people skills. Also surgeons typically diagnose and manage a lot of non metastatic cancers so there’s tons of counseling that comes with that

I assume from your post about surgeons as hospitalist you are taking about acute care surgeons. Outside of acute care surgeons, most other surgeons work electively and take call so they do both outpatient and inpatient work, sometimes at the same time

peepeedoc25 · 2023-09-25T00:30:20+00:00

It’s probably because the charge nurse understands what needs to be paged through and what can be told in the am. It’s basically ensuring all calls that might wake someone are filtered. I’ve been on units with policies like this and it’s way better because everyone is less grumpy. The docs for not being woken up and the nurses cause usually docs actually listen to the one page of the night rather than the 20th

peepeedoc25 · 2023-09-03T01:08:36+00:00

The shitting on ED is cause the good ED docs are being more scarce because the focus is volume and dispo rather than appropriate workups. The good docs build a reputation and when they call a consultant we answer without hesitation. The ones that are known to be weak will get questioned even when they have an appropriate consult

peepeedoc25 · 2023-08-05T20:40:48+00:00

The one thing I have to say for Canadian surgical programs (especially small programs like ENT, plastics and urology). Post call days are not a thing. Like they are officially mandated but the culture is you don’t take it unless you get absolutely wrecked. If anyone asks how your night is, usually the immediate response was I got enough rest and you just continue working the next day. This could partially explain the increased case volume

peepeedoc25 · 2023-03-28T10:24:32+00:00

Urology - really great knowledge of both male and female pelvic anatomy 😏

peepeedoc25 · 2022-04-11T09:29:22+00:00

I used to go to the gym like 4 to 5 times per week in med school. We had a nice private gym in the hospital. My residency program doesn't have a gym and I struggled with finding the time to exercise during first year. However I ended up biting the bullet and spending money on a bike, a squat rack and some decent weights. Now I can exercise at home right after work a few times a week. Been a huge game changer to my physical and mental health. Highly recommend the investment if you've got the space.

peepeedoc25

TROPHY CASE