DON'T be these Anesthesiologists - advice to residents

[seinfeld]

Thought this would be nice lead in to help those who are graduating and will be taking their first jobs.

For the first time since I joined my group we have employed Locum Docs (planned retirements, long term disability, increased OR footprint all at once) . Now this thread is not a bash against locums but more focused on the type of anesthesiologist you are. This is total opinion but i can tell you what works in my group and what doesn't.

1. Be a physician first - If a cardiologist refers a patient for a vascular workup and indicates the patient is otherwise stable and then the patient comes to the OR, don't go looking for another note by the same cardiologist clearing the patient for surgery. Funniest thing is that the cardiologist did right a note, it was one line "cleared for surgery", somehow that made the new guy feel better about proceeding with the case. As periop physicians we should know when a patient needs to be worked up and should be able to see a patient and decide for ourselves.

2. We make our money by doing cases and working with surgeons - In the private world I have as much stake in keeping the surgeons coming to my hospital as the hospital does. This doesn't mean dick surgeons should walk all over you or be allowed to unprofessional, but any problems with a surgeons patients should be discussed with him on a collegial level. Put surgeons cell phone numbers in your phone and call them with questions. From interviewing a ton of people i have come to learn that our ability to have a real, non confrontational discussion with surgeons is a bit unique.

3. 90 y/o patients are sick, no way around it. Don't go looking to cancel a hip fracture surgery because they have a non active heart condition, or hx of COPD without PFTs. Also PA Caths rarely help you and are an overkill in these patients, makes you look like a weak. Aline are sometimes a good thing, but rarely required. Keep the numberers the same as when they enter and you should be fine.

4. There is a fine line between asking for an opinion of your colleagues and having them decide for you how to do the entire case. I am more than happy to assist you in debating how to proceed, whether to proceed etc but don't start having CRNAs and PACU nursing calling me with any and all concerns.

5. The speed and efficiency of you procedural ability WILL mold your reputation as clinician.

6. Don't be righteous - Practice in a similar manner to the entire group. YOU will look like the idiot if you start telling nursing, surgeons, housekeeping etc that the groups way is wrong. If you have a real concern, bring it to the leadership, bring data and articles. Otherwise you will be deemed to not "fit in".

7. Be careful who you talk bad about until you know what you're talking about. New guy starts bad mouthing one of our best CRNAs. Who do you think we all believe, the guy who we all would trust with our families lives or the new guy?

8. BE able and willing to explain yourself to nursing, surgeons etc. It will be much more confidence in your decision making if you detail to the nurse out loud, what you think the issue is, how you are planning to treat it, what the other potential causes are, and what you might do next. Ie somulent PACU patient, tell the nurse it is likely hypercarbia, you will get an ABG to confirm, if the ABG confirms hypercabia you will place on BIPAP as you don't want the patient to go into acute pain and opiod withdrawl. CT head not needed as this patient was supine and only 31 y/o. If the bipap doesn't work will give small doses of narcan ......



I hope others add some more pearls of wisdom or debate the ones I laid out, either way good luck to the new grads!!!

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[urge]

Thought this would be nice lead in to help those who are graduating and will be taking their first jobs.

For the first time since I joined my group we have employed Locum Docs (planned retirements, long term disability, increased OR footprint all at once) . Now this thread is not a bash against locums but more focused on the type of anesthesiologist you are. This is total opinion but i can tell you what works in my group and what doesn't.

1. Be a physician first - If a cardiologist refers a patient for a vascular workup and indicates the patient is otherwise stable and then the patient comes to the OR, don't go looking for another note by the same cardiologist clearing the patient for surgery. Funniest thing is that the cardiologist did right a note, it was one line "cleared for surgery", somehow that made the new guy feel better about proceeding with the case. As periop physicians we should know when a patient needs to be worked up and should be able to see a patient and decide for ourselves.

2. We make our money by doing cases and working with surgeons - In the private world I have as much stake in keeping the surgeons coming to my hospital as the hospital does. This doesn't mean dick surgeons should walk all over you or be allowed to unprofessional, but any problems with a surgeons patients should be discussed with him on a collegial level. Put surgeons cell phone numbers in your phone and call them with questions. From interviewing a ton of people i have come to learn that our ability to have a real, non confrontational discussion with surgeons is a bit unique.

3. 90 y/o patients are sick, no way around it. Don't go looking to cancel a hip fracture surgery because they have a non active heart condition, or hx of COPD without PFTs. Also PA Caths rarely help you and are an overkill in these patients, makes you look like a weak. Aline are sometimes a good thing, but rarely required. Keep the numberers the same as when they enter and you should be fine.

4. There is a fine line between asking for an opinion of your colleagues and having them decide for you how to do the entire case. I am more than happy to assist you in debating how to proceed, whether to proceed etc but don't start having CRNAs and PACU nursing calling me with any and all concerns.

5. The speed and efficiency of you procedural ability WILL mold your reputation as clinician.

6. Don't be righteous - Practice in a similar manner to the entire group. YOU will look like the idiot if you start telling nursing, surgeons, housekeeping etc that the groups way is wrong. If you have a real concern, bring it to the leadership, bring data and articles. Otherwise you will be deemed to not "fit in".

7. Be careful who you talk bad about until you know what you're talking about. New guy starts bad mouthing one of our best CRNAs. Who do you think we all believe, the guy who we all would trust with our families lives or the new guy?

8. BE able and willing to explain yourself to nursing, surgeons etc. It will be much more confidence in your decision making if you detail to the nurse out loud, what you think the issue is, how you are planning to treat it, what the other potential causes are, and what you might do next. Ie somulent PACU patient, tell the nurse it is likely hypercarbia, you will get an ABG to confirm, if the ABG confirms hypercabia you will place on BIPAP as you don't want the patient to go into acute pain and opiod withdrawl. CT head not needed as this patient was supine and only 31 y/o. If the bipap doesn't work will give small doses of narcan ......



I hope others add some more pearls of wisdom or debate the ones I laid out, either way good luck to the new grads!!!

2 Not the locum. He/she has no skin in the game. Unless everything is perfect there is no point in proceeding. The group should take care of those not quite right patients.

6 There are many ways to skin the cat. Why can't he do what he is best at? For your comfort level? Is that reasonable?

7 Shutting up is always the right approach.

8 You have to explain yourself to nursing? I thought physicians gave orders, not explanations.

Keep in mind every place has a culture, and the new guys is not familiar with it. What matters is were any patients harmed?

 

[aneftp]

If you are hiring locums doc. Just put them on the simple cases. Avoid the headaches. Cysto, eyeballls, breast cases, hernias.

Locums are hired guns. They do what's best for them in the safest way they feel. They aren't there to make money (profit) for your group. You have incentive as a group member to push cases though. Even you said it yourself. There is financial incentive for Yi to do the case. Locums are there to fill a need (labor) and make money for themselves.

I know you meant to do a thread "not to bash locums". But it seems like you are writing the thread as a response to locums your group has hired temporarily to fill a need.

But ask yourself if you were in their shoes (no one knows them or their habits). What would u do in a new environment.

When I did locums back in 2007/2008. All eyes are already on you as the hired gun. Has A hole nureosurgeon always wanting paralysis even when patient has zero twitches. As locums I clearly documented surgeon "requested more paralysis even though informed zero twitches".

Took patients over to pacu on vent.

Inr 2.1. Informed orthopedic doc. Orthopedic doc said to put patient to sleep. 20 minutes later after patient asleep. Orthopedic doc asks nurses what inr was. Sees it as 2.1. Cancels case. Writes note anesthesia failed to informed him. Admin calls me in for putting patient to sleep. I got documentation surgeon informed with inr. Admin feels stupid. Thought they could have an easy fix and blame the locums doc. Said thing is patients family was told anesthesia doc was "new" and failed to inform staff of thin blood.

Morale of story. Locums docs are always under the gun. Practice as safe as possible. They will throw u under the bus if any complications.

 

[Wiscoblue]

It's important to be humble when you go to a new place. It also shows that you are flexible when you are able to adapt to local methods and practices without being critical of locals or rigid about the way you do things. We had a locums guy couple years ago. He wasn't very smart. But he really thought he was better than all of us and he would tell that to the surgeons in an attempt to get them to pressure us to hire him permanently. What a douche. Needless to say, he didn't last. Explains why he is still doing locums all over the state.

 

[urge]

Inr 2.1. Informed orthopedic doc. Orthopedic doc said to put patient to sleep. 20 minutes later after patient asleep. Orthopedic doc asks nurses what inr was. Sees it as 2.1. Cancels case. Writes note anesthesia failed to informed him. Admin calls me in for putting patient to sleep. I got documentation surgeon informed with inr. Admin feels stupid. Thought they could have an easy fix and blame the locums doc. Said thing is patients family was told anesthesia doc was "new" and failed to inform staff of thin blood.

The surgeon is not responsible for looking up his own labs? That's a new one to me.

 

[urge]

8. BE able and willing to explain yourself to nursing, surgeons etc. It will be much more confidence in your decision making if you detail to the nurse out loud, what you think the issue is, how you are planning to treat it, what the other potential causes are, and what you might do next. Ie somulent PACU patient, tell the nurse it is likely hypercarbia, you will get an ABG to confirm, if the ABG confirms hypercabia you will place on BIPAP as you don't want the patient to go into acute pain and opiod withdrawl. CT head not needed as this patient was supine and only 31 y/o. If the bipap doesn't work will give small doses of narcan ......

I would like to hear more details of this. The discourse doesn't add up. Patient got a CT scan because the locum failed to explain opioid narcosis to a pacu nurse?

 

[BuzzPhreed]

I agree with most of what you said here, except I want to clarify my experience with this one.

8. BE able and willing to explain yourself to nursing, surgeons etc. It will be much more confidence in your decision making if you detail to the nurse out loud, what you think the issue is, how you are planning to treat it, what the other potential causes are, and what you might do next. Ie somulent PACU patient, tell the nurse it is likely hypercarbia, you will get an ABG to confirm, if the ABG confirms hypercabia you will place on BIPAP as you don't want the patient to go into acute pain and opiod withdrawl. CT head not needed as this patient was supine and only 31 y/o. If the bipap doesn't work will give small doses of narcan ......

I hear what you're saying here, but I think you meant to say just outline your plan.

In the words of Benjamin Disraeli "don't complain, don't explain" (which is basically what I think you were saying in most of the other ones too).

However I would caution anyone not to overexplain to nurses and other staff what you're doing and why. It can appear weak. And it can invite criticism and second guessing downstream because some will perceive that you are inviting a discussion about what should be done. Just tell them what needs to be done. You don't need to always tell them why. If they're smart, they'll put together why you made a decision. If they're stupid, it won't matter what you say. That is a much stronger way to approach a clinical problem and simultaneously command respect... unless you're actually a clinically weak *****... in which case nothing you say will matter... and you should (as others have said) just keep your mouth shut.

 

[aneftp]

The surgeon is not responsible for looking up his own labs? That's a new one to me.

You'd be surprise how little the surgeons know about their patients. Especially the super busy ones.

 

[urge]

You'd be surprise how little the surgeons know about their patients. Especially the super busy ones.

I know they can be busy, but it is still their responsibility. No way around it.

 

[Ezekiel2517]

Great post, agree with all points. Be able, available, affable, adaptable. All are important.
One thing I'd like to contribute to those starting out (may be obvious but you'd be surprised) - Always have a backup plan. And a backup plan to that backup plan. You will undoubtedly be placed in some tough situations. Situations you've never been in. Don't let yourself get burned.

 

[amyl]

Half of my surgeons know nothing about a patient except what procedure they need....

 

[pgg]

8 You have to explain yourself to nursing? I thought physicians gave orders, not explanations.

It's all in the delivery.

No, you don't owe them an explanation and a lesson. You're not asking for input or permission. But they're human beings with egos of their own, and they're taking care of your patients. If you treat them with officious arrogance or indifference or open disdain ... they pick up on it. Some get passive aggressive, some just get aggressive. No fury like a nurse scorned, and nobody needs that headache.

It's not hard to be amiable with nurses, even as you're telling them what to do. It doesn't take much effort, and it's worth it.

 

[BLADEMDA]

It's all in the delivery.

No, you don't owe them an explanation and a lesson. You're not asking for input or permission. But they're human beings with egos of their own, and they're taking care of your patients. If you treat them with officious arrogance or indifference or open disdain ... they pick up on it. Some get passive aggressive, some just get aggressive. No fury like a nurse scorned, and nobody needs that headache.

It's not hard to be amiable with nurses, even as you're telling them what to do. It doesn't take much effort, and it's worth it.

Wisdom takes experience and it shows with your post.

 

[fakin' the funk]

8. BE able and willing to explain yourself to nursing, surgeons etc. It will be much more confidence in your decision making if you detail to the nurse out loud, what you think the issue is, how you are planning to treat it, what the other potential causes are, and what you might do next. Ie somulent PACU patient, tell the nurse it is likely hypercarbia, you will get an ABG to confirm, if the ABG confirms hypercabia you will place on BIPAP as you don't want the patient to go into acute pain and opiod withdrawl. CT head not needed as this patient was supine and only 31 y/o. If the bipap doesn't work will give small doses of narcan ......

Seinfeld, this is wisdom that comes from your ICU practice. In ICU its so important to get RNs to buy into your plan by explaining and teaching if necessary, because that plan will be played out over hours/days/weeks and because you often are working with a core of the same RNs. But this is a skill/talent that anesthesia residents may not be practicing until they are warming up for oral boards -- IMO that's way too late...

The timeframe is shorter in the PACU but the ability and need to explain to and teach, when and as appropriate, your colleagues and co-workers about why you're doing things is like, doctoring 101. It's professional, it's easy, and it's best for the patient. Urge why you see this as below you (or a sign of weakness?) is beyond me...

 

[nimbus]

It's all in the delivery.

No, you don't owe them an explanation and a lesson. You're not asking for input or permission. But they're human beings with egos of their own, and they're taking care of your patients. If you treat them with officious arrogance or indifference or open disdain ... they pick up on it. Some get passive aggressive, some just get aggressive. No fury like a nurse scorned, and nobody needs that headache.

It's not hard to be amiable with nurses, even as you're telling them what to do. It doesn't take much effort, and it's worth it.

And a little chocolate goes a long way

 

[urge]

Seinfeld, this is wisdom that comes from your ICU practice. In ICU its so important to get RNs to buy into your plan by explaining and teaching if necessary, because that plan will be played out over hours/days/weeks and because you often are working with a core of the same RNs. But this is a skill/talent that anesthesia residents may not be practicing until they are warming up for oral boards -- IMO that's way too late...

The timeframe is shorter in the PACU but the ability and need to explain to and teach, when and as appropriate, your colleagues and co-workers about why you're doing things is like, doctoring 101. It's professional, it's easy, and it's best for the patient. Urge why you see this as below you (or a sign of weakness?) is beyond me...

You don't want to create an atmosphere where the nurse feels that she has to agree with your plan in order to carry it out. That's not the way things work. That's how things get out of control. Orders are orders. They can be given respectfully, or not, but they have to be carried out. The outcome of the patient shouldn't be at the mercy of the nurse agreeing with you or not.

 

[deleted171991]

You don't want to create an atmosphere where the nurse feels that she has to agree with your plan in order to carry it out. That's not the way things work. That's how things get out of control. Orders are orders. They can be given respectfully, or not, but they have to be carried out. The outcome of the patient shouldn't be at the mercy of the nurse agreeing with you or not.

It's not you/us who creates it. It's usually there already, at an institutional level, created by management. Whenever nurses can question your orders and get away with it, your order is not really an order.

On the other hand, one can catch more flies with honey. But I also agree with Buzz that overexplaining, without having been asked to, will make one look weak and unsure.

Unfortunately we live in a world where nurses believe that they are part of a "team", hence you need their blessing, too. Plus they are the "patient advocates" who protect the patient from the big bad doctor, don't you know?

Tl;dr I always explain my thinking to the PACU nurses, in extra 15-30 seconds.

 

[SouthSideSteve]

The surgeon is not responsible for looking up his own labs? That's a new one to me.

It was an orthopod....

 

[deleted171991]

It was an orthopod....

I once had a general surgeon who had a patient lined up for portocath with contrast, with a history of anaphylaxis to it. He had seen the patient in his office before, and still had no idea.

 

[dhb]

Seinfeld you could have made your post shorter: don't suck at your job.
I agree with aneftp though, as a locums you should protect yourself at all times

 

[deleted171991]

My advice to residents is: just be nice to everybody. You will not believe what nice people can get away with.

 

[Shimmy8]

I like to teach medical students while making sure the PACU nurse is within earshot.

 

[G-Man82]

I agree with Seinfeld. It's very important not to forget the fact that we are physicians too. Keep up with the literature, even some of the general medical stuff because those are the patients we treat. If you're at a cancer center, you don't need to turn into an oncologist, but understand the pathophysiology and its anesthetic implications, if for instance you're called to manage the airway of someone with leukostasis, or said patient has a small bowel perf or obstruction.

Also, don't treat numbers. That's a CRNA move. I caught a CRNA giving furosemide because she'd given 5 L of fluid during a big abdominal case and the urine output was low. A-line trace was undulating wickedly. And she gave lasix. The patient was sliced open from xiphoid to pubis in a big whack bowel procedure.

One thing I've noticed some Anesthesiologists, and more so some residents do, as they come through the unit is use the anesthesia excuse: "I'm in anesthesia, so that stuff doesn't matter to me. I'll intubate and done." Doesn't make us look very good.

For the residents, don't forget the fact that you're not a gas jockey paid to put in the tube and turn the dial. There's more to it than that.

 

[michigangirl]

Everytime we make a decision at the bedside, whether anyone else gets it or not, we are internally going through a complex thought process-- the verbal output may just be "let's get a gas" for the guy who is hypertensive and tachycardic and you suspect hypercarbia, but "thinking out loud" with authority is a skill that every trainee should aim to perfect over time. As Fakin' said, it's a priceless skill in the ICU but even in the shorter term situations a little extra time (i.e. seconds) can ensure that your plan is carried out exactly as you wanted-- because the nurse actually understands why it's happening. Seems like there are more and more junior, inexperienced nurses these days which makes it even more important. Thinking out loud with authority also provides a feedback loop to make sure all the data is being transmitted and received accurately.

It's not an ego thing or a power thing. You're not asking for advice. You're making sure that the folks carrying out the plan understand why it is so. It's a good clinical care thing.

 

[BuzzPhreed]

It's not an ego thing or a power thing. You're not asking for advice. You're making sure that the folks carrying out the plan understand why it is so. It's a good clinical care thing.

I think that's basically what I said.

But you don't really and necessarily need to explain, given the specific situation. Especially when time is of the essence. In that regard I could tell you about a (very) recent "leaking" AAA (yeah, that's what the surgeon called it... I've always called them "ruptured"... anyway...) I did solo in the OR while on call over a weekend, and how I basically told the surgeon to STFU at an appropriate and well-deserved point in the case... but that's a story for a later time.

Suffice it to say that the patient (eventually) left the hospital alive and that very same surgeon, in a fit of remorse and in as-much-of-a-tacit-apology-I'll-ever-get, endorsed me a few days later on my linkedin account.

Don't complain, don't explain. Sometimes you just have to act. And explanation is a luxury. And you don't always have time for that. You want an environment where when you say something it happens. That takes time. You want people confident that you know what you're doing. Barring that, you don't want them second guessing you. No matter the circumstances.

 

[Planktonmd]

I think this post is precisely what it claims not to be: "Bashing Locums"
I have nothing but admiration for those able to be "the new guys" every time they have new assignments, if you don't know what I am talking about just remember how you felt when you started your current job and imagine having that feeling all the time.
Imagine being under the microscope all the time.

 

[urge]

You're not asking for advice. You're making sure that the folks carrying out the plan understand why it is so. It's a good clinical care thing.

This is completely necessary if you are not going to be around to follow up. You are thus giving verbal orders.

 

[seinfeld]

Regarding #8 i would say that most of the time when a partner leaves and I have to take over, a nurse comes to me with an issue. Most of the time I am trying to explain to myself, and everyone else, why someone ordered a test/lab , left the patient intubated etc. If the attending took 2 seconds to explain he thoughts to the beside nurse, and a partner, perhaps everyone would have a better sense of what the issues being explored. Also I don't ask for permission via explanation but when i do explain my reasoning I get stuff done quickly and I have found nurses alert you faster when the patient displays signs outside the initial diagnosis. Lastly nurses can be your best friend or worst enemy, treat them like a subordinate and then they will only do and act on what you say. I believe in the Captain Picard not the Captain Kirk way of management.

Although the current locums docs brought about these thoughts, i have seen the same issues in new hires in the past.

I wish i could keep changing the locus assignments throughout the day to ensure they get easy cases, but no such thing exists in our practice. All ASA 1-2 cases are done at our output centers, otherwise healthy patient are only done in the hospital for major procedures. We do try and keep them out of open AAA, and definetly no hearts but otherwise its a sick environment. We do help them a lot in getting patients ready for surgery and often make the "final" call whether to proceed or not, but in general, when they discuss with us first, we support the physicians decisions.

 

[IlDestriero]

You'd be surprise how little the surgeons know about their patients. Especially the super busy ones.

And the not so busy ones.

 

[Mman]

that very same surgeon, in a fit of remorse and in as-much-of-a-tacit-apology-I'll-ever-get, endorsed me a few days later on my linkedin account.

On so many levels....What???

For what purpose do you have a LinkedIn account? Has anybody actually landed a clinical job via this route? I ask because as a recruiter it has never once dawned on me to even consider the possibility of using it.

Also, what is an "endorsement" on your account? Is that the facebook equivalent of being your friend or liking a post?

I will freely admit the only thing I've ever done with an email from linkedin is hit the delete button. Curious as to what role it plays for you.

 

[urge]

Regarding #8 i would say that most of the time when a partner leaves and I have to take over, a nurse comes to me with an issue. Most of the time I am trying to explain to myself, and everyone else, why someone ordered a test/lab , left the patient intubated etc. If the attending took 2 seconds to explain he thoughts to the beside nurse, and a partner, perhaps everyone would have a better sense of what the issues being explored. Also I don't ask for permission via explanation but when i do explain my reasoning I get stuff done quickly and I have found nurses alert you faster when the patient displays signs outside the initial diagnosis. Lastly nurses can be your best friend or worst enemy, treat them like a subordinate and then they will only do and act on what you say. I believe in the Captain Picard not the Captain Kirk way of management.

Although the current locums docs brought about these thoughts, i have seen the same issues in new hires in the past.

I wish i could keep changing the locus assignments throughout the day to ensure they get easy cases, but no such thing exists in our practice. All ASA 1-2 cases are done at our output centers, otherwise healthy patient are only done in the hospital for major procedures. We do try and keep them out of open AAA, and definetly no hearts but otherwise its a sick environment. We do help them a lot in getting patients ready for surgery and often make the "final" call whether to proceed or not, but in general, when they discuss with us first, we support the physicians decisions.

You cannot send them to the out patient center and get one of your regulars to do in patients?

 

[IlDestriero]

I considered doing some week long and local fill in Locums work when I had a lot more free time. One of the things that kept me away was some horror stories about a few really bad rural surgeons where I would have been going and one guy did a week long gig elsewhere and they dropped the sickest train wrecks on him every day. They had a Locums person there all the time apparently. They were the liability shield for the 3 lazy partners in the group.

 

[cockblockandrun]

Good work ethic, being a team player and never leaving the troops (i.e. colleagues) behind is the key to success regardless of if you are a locums or perm guy. I have been doing full time locums since residency and almost of all of my locum gigs I have been offered a permanent contract within 2 weeks of starting. I know my skills and clinical acumen isn't god-like- I get a long with everyone, try to quickly learn the system and integrate myself while delivering a safe anesthetic. As a locums, I always get a suspicious-feeling-out-period but when you go that extra mile to help a colleague put in an art-line for a sick patient while they focus on the airway, or you run up to OB to pop that epidural because the OB guy is in a section... those are things that count.

 

[criticalelement]

I considered doing some week long and local fill in Locums work when I had a lot more free time. One of the things that kept me away was some horror stories about a few really bad rural surgeons where I would have been going and one guy did a week long gig elsewhere and they dropped the sickest train wrecks on him every day. They had a Locums person there all the time apparently. They were the liability blocker for the group.

That is correct. All the cases are "SET UP" cases as a locum. Be very careful. SInce any bad outcome you will be answering for. But you get good quickly.

 

[BuzzPhreed]

For what purpose do you have a LinkedIn account?

You're showing your age.

And youre forgiven for not knowing (or remembering... or caring) that I'm approximately 50% done with my MBA program, and that I have about 3x the number of business contacts on my Linkedin account vs. doctors. And it doesn't hurt to have one place to manage your connections, even the physician ones. But, yes, you're right. It's Facebook for professionals. And I'll take as many "likes" as I can get.

You think I'm going to be turning the vaporizer dial forever? Or even 5 years from now? We'll see.

 

[Ignatius J]

I have found the best advice is the most simple advice. We all have completed residency and should be at least halfway competent in the OR.

Be nice. Be respectful. Be friendly. Be on time. Don't complain. Say 'please' and 'thank you'. Be honest. Admit mistakes. Learn from them. Learn a good joke or two.

If you do the things your mother always told you to do when you get out there, you will be just fine for the long haul.

And if you have a late start and a few extra bucks, buy some donuts and stick them in the nurses' lounge when you get there. Yes, 15 bucks and 10 minutes out of your way can buy you a an inordinate grace period in some hospitals.

 

[Mman]

You're showing your age.

At several years from 40, I'm hoping I haven't got there yet. I just find LinkedIn seems to be for people looking for jobs in business, not in medicine, which is why I find it odd that a surgeon would be recommending you via LinkedIn.

 

[repititionition]

You're showing your age.

And youre forgiven for not knowing (or remembering... or caring) that I'm approximately 50% done with my MBA program, and that I have about 3x the number of business contacts on my Linkedin account vs. doctors. And it doesn't hurt to have one place to manage your connections, even the physician ones. But, yes, you're right. It's Facebook for professionals. And I'll take as many "likes" as I can get.

You think I'm going to be turning the vaporizer dial forever? Or even 5 years from now? We'll see.

Buzz, where are your business interests? Tech? Money-side? Practice advisory? Etc?

 

[asmith1121]

[
QUOTE="BuzzPhreed, post: 16512151, member: 590616"]I agree with most of what you said here, except I want to clarify my experience with this one.



I hear what you're saying here, but I think you meant to say just outline your plan.

In the words of Benjamin Disraeli "don't complain, don't explain" (which is basically what I think you were saying in most of the other ones too).

However I would caution anyone not to overexplain to nurses and other staff what you're doing and why. It can appear weak. And it can invite criticism and second guessing downstream because some will perceive that you are inviting a discussion about what should be done. Just tell them what needs to be done. You don't need to always tell them why. If they're smart, they'll put together why you made a decision. If they're stupid, it won't matter what you say. That is a much stronger way to approach a clinical problem and simultaneously command respect... unless you're actually a clinically weak *****... in which case nothing you say will matter... and you should (as others have said) just keep your mouth shut.[/QUOTE]

I'm a female resident and your last paragraph was something I was thinking about this week. I feel like in the OR and PACU I have a great working relationship with the nurses, I think mostly bc we don't ask them to do anything, except for maybe that warm bag of LR in the OR. In PACU, they ask us to do things, and they grow to respect and trust you. But now I'm in the SICU, and it's so uncomfortable giving orders. I'll put an order in, and I let the nurse know, bc it's not like they're staring at the computer waiting for orders to pop up, I say please, I'm always super nice about it to the pt where I find myself explaining why we are doing whatever it is I need. My rationale being, that I respect them and treat them like part of the team and I'm not just wasting their time w meaningless tests. But is that making me weak? This is of course sub acute situations. There's just so much attitude. I miss the OR, where I can do that myself. Critical care

 

[Machinery]

Good advise OP. However, I have to say with all due respect that anytime an anesthesiologist starts using phrases like "keeping the surgeons coming", "Don't go looking to cancel", or "speed and efficiency", what some people hear is "capitulate to surgeons for the sake of keeping your contract, even if it means proceeding with cases that ought to be canceled, while banging out as many cases as possible, so we can make the most money". I personally do not think that is what you are saying, but a lot of anesthesiologists have exploited those phrases to achieve exactly that, which btw negates your #1 point.

 

[seinfeld]

agree, i am not saying don't ever cancel or delay a case but I am saying is that don't cancel cases because there is not a note from a cardiologist but cancel when the patients history suggests they should have had an evaluation. A patient with a hx of CAD doesn't automatically mean you need a note blessing the patient Also understand the differences between elective, urgent, emergent and time sensitive cases.

 

[epidural man]

Nice thread -

Nice read.

Although I know I'll get hammered for this - but whatever.....I disagree with the "alines are rarely needed". Although this is probably true and msot everything can be done without one - I absolutely love having one - and I personally feel they are often easy to get, have low risk profile - and again, I think are HUGELY useful. I love being able to check a lactate, follow a HBG on a bloody case, and follow pulse pressure and systolic pressure variation. I admit since I have been using the CardioQ, some of the information I would obtain can be gotten (with better data) on the CardioQ - but I like having it. I like data.

 

[Hockeyguy]

My advice to newbies: Keep your head down low and collect the dough! Be friendly and work hard but no-one cares how you did it in residency or anecdotal stories of difficult cases you had. We all have those stories and I assure you know one gives a s hit about yours. We had a guy who said at least four times a day "at the Cleveland Clinic we did X or Y" it drove us all nuts.

 

[nimbus]

agree, i am not saying don't ever cancel or delay a case but I am saying is that don't cancel cases because there is not a note from a cardiologist but cancel when the patients history suggests they should have had an evaluation. A patient with a hx of CAD doesn't automatically mean you need a note blessing the patient Also understand the differences between elective, urgent, emergent and time sensitive cases.

Agreed.

Surgeons don't like complications any more than we do. The good ones know the difference between legit cancellations and BS ones. We have a guy who probably cancels 3-5x as many cases as the average. He is also always proclaiming he gets the sickest patients. The running joke in the OR is that he cancelled an organ harvest because the patient was too sick. Don't be that guy.

 

[fakin' the funk]

The running joke in the OR is that he cancelled an organ harvest because the patient was too sick. Don't be that guy.

Those brain-dead donors are at a really high risk of a bad outcome!

 

[Arch Guillotti]

My advice to newbies: Keep your head down low and collect the dough! Be friendly and work hard but no-one cares how you did it in residency or anecdotal stories of difficult cases you had. We all have those stories and I assure you know one gives a s hit about yours. We had a guy who said at least four times a day "at the Cleveland Clinic we did X or Y" it drove us all nuts.

Yeah but they are second to none