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DOnut · 03-03-2007, 01:28 PM

Hey guys I have to get your opinion on this. It seems like every time we have a patient come in with some form of facial lac, or fracture, or nose bleed...whatever we are calling a consultant. ENT, Plastics, ect....

I feel like I'm not doing anything. When I was a third and 4th year med student at St. barnabas in the Bronx, I would repair huge facial lacs with subcutaneous sutures myself and think nothing of it. We would splint fractures and send them to ortho clinic...no big deal. Anterior nasal packing...done.

Here, all of the attendings keep saying that patients will sue if they don't like the job we do, so since we're at a university hospital we call the specialist. That's Bull$hit. I went into emergency medicine because I like to do these things....not stay on the phone and watch someone else do my procedure.

Does this happen anywhere else?? What's the deal. My fear is that I will finish residency, go off into a community hospital to work and not know how to do anything but call subspecialists.

Please let me know how this is handled at other places. It's killing me.

DOnut

Dr.McNinja · 03-03-2007, 01:55 PM

At tertiary hospitals it will always likely be done by the specialists, because they are in house, etc.

Once you go into the community you will do it all yourself, because getting them to come in from home will involve more work than just doing it yourself. At least, that is what I have noticed.

basementbeastie · 03-03-2007, 02:43 PM

your frustration is familiar....do your best to take advantage of consultant residents to help you become comfortable with the things you will do on you own soon enough.....

NinerNiner999 · 03-04-2007, 06:32 AM

But, in the example of that huge facial lac that you will have, even in the community it is quicker to call in that specialist, esepcially when you have 20 other patients to see...

GeneralVeers · 03-04-2007, 08:09 AM

You can still learn a lot from the consultants. When they come down to fix the "huge facial lac" pay attention to how they repair it. More than likely they can teach you some special techniques that you can use later on your own. I learned a ton of techniques from our OMFS guys, like nerve blocks, lip repairs, and oral repairs.

EctopicFetus · 03-04-2007, 10:03 AM

Agreed with Veers. I will say this doesnt happen that often in our ED. Much of this has to do with who the attending is. My PD was working with me and I fixed a big lip lac on a mid 20s guy. My fellow residents were like call plastics. So I talked to my PD and he was like no way.. you fix it if you are comfortable. As a student working in some ghetto hospitals I fixed all sorts of stuff. So I stitched the guy and saw him at his suture removal. I was impressed... He has a pretty complex lac that was nonlinear, involved his vermillion border etc.

One of the things I really liked about USC+LAC is their PD Swadron who basically believes EPs should know how to do everything.

DOnut things will get better you prob just worked with one of those super conservative type attendings, we have them too, they have things that we can learn from as well, because some of their caution is not without merit.

DOnut · 03-04-2007, 12:18 PM

You're absolutely right man. I just had a bad day and really needed to vent. Thanks for listening peeps!

I know it gets better and there's a ton to learn from consultants. It just erks me when the consultant is another intern acting as if they didn't graduate at the same time I did.

Ok I'm done now.

D

03-03-2007, 01:28 PM	#1
DOnut Senior Member Status: Attending Join Date: Dec 2001 Location: New Orleans, LA Posts: 492	Defensive Medicine = Annoying as Hell SDN Members don't see this ad. Hey guys I have to get your opinion on this. It seems like every time we have a patient come in with some form of facial lac, or fracture, or nose bleed...whatever we are calling a consultant. ENT, Plastics, ect.... I feel like I'm not doing anything. When I was a third and 4th year med student at St. barnabas in the Bronx, I would repair huge facial lacs with subcutaneous sutures myself and think nothing of it. We would splint fractures and send them to ortho clinic...no big deal. Anterior nasal packing...done. Here, all of the attendings keep saying that patients will sue if they don't like the job we do, so since we're at a university hospital we call the specialist. That's Bull$hit. I went into emergency medicine because I like to do these things....not stay on the phone and watch someone else do my procedure. Does this happen anywhere else?? What's the deal. My fear is that I will finish residency, go off into a community hospital to work and not know how to do anything but call subspecialists. Please let me know how this is handled at other places. It's killing me. DOnut __________________ NYCOM class of 2006 SUNY Upstate EM 2009 Ochsner Medical Center, New Orleans "To find health should be the object of the doctor. Anyone can find disease." - A.T. Still, MD

03-04-2007, 06:32 AM	#4
NinerNiner999 Senior Member Join Date: Nov 2003 Location: Where it's at. Posts: 1,213	But, in the example of that huge facial lac that you will have, even in the community it is quicker to call in that specialist, esepcially when you have 20 other patients to see... __________________ Attending Physician Emergency Medicine Naples, Florida

03-04-2007, 10:03 AM	#6
EctopicFetus Keeping it funky enough Status: Resident Join Date: May 2004 Posts: 8,891	Agreed with Veers. I will say this doesnt happen that often in our ED. Much of this has to do with who the attending is. My PD was working with me and I fixed a big lip lac on a mid 20s guy. My fellow residents were like call plastics. So I talked to my PD and he was like no way.. you fix it if you are comfortable. As a student working in some ghetto hospitals I fixed all sorts of stuff. So I stitched the guy and saw him at his suture removal. I was impressed... He has a pretty complex lac that was nonlinear, involved his vermillion border etc. One of the things I really liked about USC+LAC is their PD Swadron who basically believes EPs should know how to do everything. DOnut things will get better you prob just worked with one of those super conservative type attendings, we have them too, they have things that we can learn from as well, because some of their caution is not without merit. __________________ Unless you are the lead dog the view never changes. University of Arizona Emergency Medicine

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03-03-2007, 01:55 PM	#2
Dr.McNinja Nobel War Prize Winner Status: Resident Join Date: Aug 2006 Posts: 3,538	At tertiary hospitals it will always likely be done by the specialists, because they are in house, etc. Once you go into the community you will do it all yourself, because getting them to come in from home will involve more work than just doing it yourself. At least, that is what I have noticed.

03-03-2007, 02:43 PM	#3
basementbeastie Senior Member Join Date: Oct 2003 Posts: 377	your frustration is familiar....do your best to take advantage of consultant residents to help you become comfortable with the things you will do on you own soon enough.....

03-04-2007, 08:09 AM	#5
GeneralVeers 2K Member Status: Attending Join Date: Mar 2005 Location: Las Vegas Posts: 2,248	You can still learn a lot from the consultants. When they come down to fix the "huge facial lac" pay attention to how they repair it. More than likely they can teach you some special techniques that you can use later on your own. I learned a ton of techniques from our OMFS guys, like nerve blocks, lip repairs, and oral repairs.

03-04-2007, 12:18 PM	#7
DOnut Senior Member Status: Attending Join Date: Dec 2001 Location: New Orleans, LA Posts: 492	You're absolutely right man. I just had a bad day and really needed to vent. Thanks for listening peeps! I know it gets better and there's a ton to learn from consultants. It just erks me when the consultant is another intern acting as if they didn't graduate at the same time I did. Ok I'm done now. D