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typical hours/day of surgical residencies
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A fairly general question as the answer will depend on the setting, the patient census, the program and the resident's level of training.
However, with programs being required to abide by the 80 hour workweek, you will see less variation among programs, provided programs are enforcing the regulations.
In general, interns and lower level residents come in earlier to pre-round, although some programs/rotations/Chiefs do not require pre-rounding or have done away with it to reduce work hours. I have come in as early as 4:00 am and as late as 7:00 am (on rotations with no pre-rounding, no OR cases that day and on weekends). The latest I have stayed when not on call was 2:30am (for a 21 hour day) and the latest I have stayed post-call was 10:00 pm (for a 42 hour "day").
Generally I am now working 12-13.5 hour days and go home post-call after 30 hours on. I come in 1 day on the weekend for rounds, if not on call and can stay anywhere from 2 hours to 7 hours, depending on patient census, attending arrival time and attending familiarity with the patients.
I think you will have trouble finding a consensus on work hours amongst the different specialties. NS and Gen Surg are reputed to work more hours than ORL but again this is very program dependent.
However, with programs being required to abide by the 80 hour workweek, you will see less variation among programs, provided programs are enforcing the regulations.
In general, interns and lower level residents come in earlier to pre-round, although some programs/rotations/Chiefs do not require pre-rounding or have done away with it to reduce work hours. I have come in as early as 4:00 am and as late as 7:00 am (on rotations with no pre-rounding, no OR cases that day and on weekends). The latest I have stayed when not on call was 2:30am (for a 21 hour day) and the latest I have stayed post-call was 10:00 pm (for a 42 hour "day").
Generally I am now working 12-13.5 hour days and go home post-call after 30 hours on. I come in 1 day on the weekend for rounds, if not on call and can stay anywhere from 2 hours to 7 hours, depending on patient census, attending arrival time and attending familiarity with the patients.
I think you will have trouble finding a consensus on work hours amongst the different specialties. NS and Gen Surg are reputed to work more hours than ORL but again this is very program dependent.
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its funny how the surgical forum has the most number of posts about work hrs!
if u arent willing to work ur ass off and forget life elsewhere then dont do a surgical residency!
the 80 hr work week will help but many times u will have to work more than that as an attending where no work hr rules apply
if u arent willing to work ur ass off and forget life elsewhere then dont do a surgical residency!
the 80 hr work week will help but many times u will have to work more than that as an attending where no work hr rules apply
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There's been some talk at my program about what the long-term sequelae of the work-hours limits will be. Lots of our politically active attendings believe that there will be some sort of legislation that will affect hours that an attending/staff physician can work. They're not wild about the idea, but they have a hard time explaining to people that it's a good thing for their residents to go home once their hit 30 hours, but that it's OK for the attending to continue operating, taking care of ICU patients, etc. Granted, their work tends to allow for more down-time during their on call periods, but they forsee a time when their hours will be limited, also.
The big worry is how this will affect small town docs (really small town). I know an FP who works in the middle of nowhere up in Montana. He and his partner alternate days of taking call. He says that in the summer (tourist/trauma season) that he'll easily have to be up three days to keep up with the patient load. In his situation, it's not a question of greed but of necessity. He's not sure how they'd comply with similar rules. Just a thought . . .
The big worry is how this will affect small town docs (really small town). I know an FP who works in the middle of nowhere up in Montana. He and his partner alternate days of taking call. He says that in the summer (tourist/trauma season) that he'll easily have to be up three days to keep up with the patient load. In his situation, it's not a question of greed but of necessity. He's not sure how they'd comply with similar rules. Just a thought . . .
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apma,
I'm quite aware that there's no current movement to impose restrictions upon faculty/staff physicians. Some form of work hours restrictions for faculty/staff physicians is the natural next step of the current movement; it was discussed at the ACS meeting last year in one of the symposia.
I'm quite aware that there's no current movement to impose restrictions upon faculty/staff physicians. Some form of work hours restrictions for faculty/staff physicians is the natural next step of the current movement; it was discussed at the ACS meeting last year in one of the symposia.
I average around 90-96 hours per week and have irregular call.
Isn't this exceeding the 80-hour rule (I'm presuming you're a resident)?
90>80, very good.
This is the difference between real life and planned guidelines.
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Yeah, but you've got to realize that those excessive 10-15 hours per week that neutropeniaboy is working add up over the course of a month and year. So if he's working approximately 10-15 more hours per week than he should be, that adds up to 40-60 more hours per month that he wouldn't have to be working if the 80-hour rule was properly enforced. Meaning that he's basically working more than an additional 2 full days than he should be. Add these extra days up over the course of a year and you'll see how excessive it becomes (2 days x 12 = 24 days). Meaning he's working almost an extra month over the course of the year just because the 80-hour rule isn't being enforced.
I'm glad you've tightened up those loose ends. I was wondering where all my time went.
The "80-hour" rule, as I've been told, is an average of 80 hours per week. Anyway, when you have a small residency program, it's impossible to do that go-home-by-noon-post-call days or average no less than q4 calls.
The rules are just silly. Silly. Made up by politicians pressured by the public. It's damaging to patients and detracts from training.
The "80-hour" rule, as I've been told, is an average of 80 hours per week. Anyway, when you have a small residency program, it's impossible to do that go-home-by-noon-post-call days or average no less than q4 calls.
The rules are just silly. Silly. Made up by politicians pressured by the public. It's damaging to patients and detracts from training.
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I wholeheartedly agree that this arbitrary 80-hour limit is silly. One of the problems that I'm already seeing is that the newer residents see the limit as a panacea and use it as a crutch and excuse to get out of "scut" work.
I've had a new intern say that they couldn't come learn how to put in a central line at 9 a.m. because they had "only" gotten 2 hours of sleep on call the night before. So what. They're going home at noon. One of the other new interns has complained to me that they are getting too many of the discharge summaries and he only thinks that he should do the summaries on the patients that he has operated on. Yeah, like a lot of those hernias, infusaports, and lap choles even get admitted.
Surgery has always had a hierarchy. You get to ascend that order by showing that you can master the more mundane things. Sure, I can do those discharge summaries faster and more efficiently, but that's because I did hundreds of them as a junior resident. And most importantly, I never complained. As I see it, if the intern feels too busy to do this, I can see to it that they have more time on their hands by taking all of the cases. The staff and the senior residents let the junior residents do more when they are willing to show that they are part of the team not just looking for a way out of work.
Ahhhh....done venting.
I've had a new intern say that they couldn't come learn how to put in a central line at 9 a.m. because they had "only" gotten 2 hours of sleep on call the night before. So what. They're going home at noon. One of the other new interns has complained to me that they are getting too many of the discharge summaries and he only thinks that he should do the summaries on the patients that he has operated on. Yeah, like a lot of those hernias, infusaports, and lap choles even get admitted.
Surgery has always had a hierarchy. You get to ascend that order by showing that you can master the more mundane things. Sure, I can do those discharge summaries faster and more efficiently, but that's because I did hundreds of them as a junior resident. And most importantly, I never complained. As I see it, if the intern feels too busy to do this, I can see to it that they have more time on their hands by taking all of the cases. The staff and the senior residents let the junior residents do more when they are willing to show that they are part of the team not just looking for a way out of work.
Ahhhh....done venting.
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I think it goes both ways. Don't just take. Teach your interns! Don't beat them into a pulp.
To address Apma's comments:
I agree that there really won't be many surgeons out there that will want anyone to tell them how many hours that they can work, since they are essentially where the buck stops with all patient care. No matter what happens due to the resident, the staff is ultimately responsible. This means that if there is no one around to pick up the slack, there is an ethical duty that supercedes any arbitrary guidelines for work hours.
However, this is where my agreement with Apma ends. From what I understand, the main reason that the ACGME picked up the ball and ran with the issue of resident work hours is that there was essentially the threat of federally enforced guidelines created by congress. When that spectre appeared, it was evident to the ACGME that unless they wanted the resident work hours to be dictated by a bunch of lawyers in congress rather than physicians that have some insight into how the system really works, they would have to take the lead.
Regarding the appropriateness of the new guidelines:
Some of the guidelines are really dumb when applied to surgical residencies, such as the "no new patient contact after 6:00a.m." rule. In my community program, we have several staff, all of which are private surgeons, on each service. They are all extremely busy clinically, so when a couple are in the OR, the others are in clinic working up patients, often without residents. With our new night float rotation as PGY3's & 4's, the home by noon issue only applies to the interns. Strictly enforced, that would mean that outpatient cases that weren't worked up by the resident couldn't be performed by the post-call resident. This would be extremely unfortunate, as these are fantastic learning opportunities for the junior residents that would be wasted if they are robbed of a full day per week of operating. I think that it also means that they can't even go to clinic the morning post-call and work up new patients--they can only see their follow-ups.
These guidelines were made by non-surgeons, made to protect the post-call residents from getting crushed the morning after from admitting a lot of medical or peds patients. I think that it is totally inappropriate when applied to surgical programs. I mean, how many hernias do you have to work up in the clinic to know that they can be repaired? How many cancer patient referrals who need ports need to be done in clinic to know that you can put them in? Why isn't performing a brief interview of the patient in preoperative holding and getting an idea of what's been going on for them adequate to allow them to do a morning case post-call, and thus reap the rewards of the surgical teaching of which they would otherwise be deprived. As a manual skill and as a practice of intraoperative decision-making, it is inherently different than getting another pneumonia patient, of whom the IM residents have seen a thousand, admitted and fully worked up.
I think that we should stage a coup!!! Who's with me?
I agree that there really won't be many surgeons out there that will want anyone to tell them how many hours that they can work, since they are essentially where the buck stops with all patient care. No matter what happens due to the resident, the staff is ultimately responsible. This means that if there is no one around to pick up the slack, there is an ethical duty that supercedes any arbitrary guidelines for work hours.
However, this is where my agreement with Apma ends. From what I understand, the main reason that the ACGME picked up the ball and ran with the issue of resident work hours is that there was essentially the threat of federally enforced guidelines created by congress. When that spectre appeared, it was evident to the ACGME that unless they wanted the resident work hours to be dictated by a bunch of lawyers in congress rather than physicians that have some insight into how the system really works, they would have to take the lead.
Regarding the appropriateness of the new guidelines:
Some of the guidelines are really dumb when applied to surgical residencies, such as the "no new patient contact after 6:00a.m." rule. In my community program, we have several staff, all of which are private surgeons, on each service. They are all extremely busy clinically, so when a couple are in the OR, the others are in clinic working up patients, often without residents. With our new night float rotation as PGY3's & 4's, the home by noon issue only applies to the interns. Strictly enforced, that would mean that outpatient cases that weren't worked up by the resident couldn't be performed by the post-call resident. This would be extremely unfortunate, as these are fantastic learning opportunities for the junior residents that would be wasted if they are robbed of a full day per week of operating. I think that it also means that they can't even go to clinic the morning post-call and work up new patients--they can only see their follow-ups.
These guidelines were made by non-surgeons, made to protect the post-call residents from getting crushed the morning after from admitting a lot of medical or peds patients. I think that it is totally inappropriate when applied to surgical programs. I mean, how many hernias do you have to work up in the clinic to know that they can be repaired? How many cancer patient referrals who need ports need to be done in clinic to know that you can put them in? Why isn't performing a brief interview of the patient in preoperative holding and getting an idea of what's been going on for them adequate to allow them to do a morning case post-call, and thus reap the rewards of the surgical teaching of which they would otherwise be deprived. As a manual skill and as a practice of intraoperative decision-making, it is inherently different than getting another pneumonia patient, of whom the IM residents have seen a thousand, admitted and fully worked up.
I think that we should stage a coup!!! Who's with me?
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This is one of the most disruptive clauses in the new rules for training for the lower level residents. IF say you're on call on Sunday & Thursday on a Q4 schedule, you have 40% of the working week you are barred from operating on the AM post call. Some nights you may be up all night, but some you may get a number of hours of sleep depending on your rotation. This is one of those areas that just needs some common sense exemptions by the ACGME, ie. the realization that not all call nights are created equal
I forgot one of my main criticisms of Apma's statement in my post.
As I said, it was only with the threat of federal legislation that the ACGME moved to limit resident work hours.
Regarding staff physicians, it is very possible that there may be federal mandates that strongly push staff to limit hours, however impractical it may be. And the government does have a lot of clout with which to do this, if and when they see fit. It is the federal government that is control of Medicare and Medicaid reimbursements. It is ultimately the government that controls the HCFA. With the threat of limitations on reimbursement or forced limitations of hospital privileges, they could make it economically in the best interest of the doctors to try to limit their hours. I agree with Apma that it probably won't be the AMA who initiates any move like this, at least without evidence of ongoing legislation in congress, which very well may happen in our careers. Heck, if we can't even get the support for tort reform from the Senate, what makes us think that they would allow us to "put our patients at risk" by working too many hours in a week?
As I said, it was only with the threat of federal legislation that the ACGME moved to limit resident work hours.
Regarding staff physicians, it is very possible that there may be federal mandates that strongly push staff to limit hours, however impractical it may be. And the government does have a lot of clout with which to do this, if and when they see fit. It is the federal government that is control of Medicare and Medicaid reimbursements. It is ultimately the government that controls the HCFA. With the threat of limitations on reimbursement or forced limitations of hospital privileges, they could make it economically in the best interest of the doctors to try to limit their hours. I agree with Apma that it probably won't be the AMA who initiates any move like this, at least without evidence of ongoing legislation in congress, which very well may happen in our careers. Heck, if we can't even get the support for tort reform from the Senate, what makes us think that they would allow us to "put our patients at risk" by working too many hours in a week?
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Some of my thoughts:
1) There's going to be a clash between upper level residents and interns for a few years. Chief Residents must enforce the 80 hours, but it's the 4th and 3rd years who will push these rules to the limit and expect interns to "break" them as well.
The main problem I see is that today's Interns are expected to do the same work as previous interns yet in 25-30% less time. Sorry... it' just can't happen. Mid Residents need to get it through their skulls that times have changed. Interns just don't have the same amount of time to do all the "scut" as they did. Plus, interns are getting pressure from Chiefs, Program Directors, and Chairmen to be 80-hour compliant.
2) I think all residents generally agree that the new hours are a plus. I know many nurses have commented on how "nice" the residents are now... and it has to do with increased amount of sleep.
1) There's going to be a clash between upper level residents and interns for a few years. Chief Residents must enforce the 80 hours, but it's the 4th and 3rd years who will push these rules to the limit and expect interns to "break" them as well.
The main problem I see is that today's Interns are expected to do the same work as previous interns yet in 25-30% less time. Sorry... it' just can't happen. Mid Residents need to get it through their skulls that times have changed. Interns just don't have the same amount of time to do all the "scut" as they did. Plus, interns are getting pressure from Chiefs, Program Directors, and Chairmen to be 80-hour compliant.
2) I think all residents generally agree that the new hours are a plus. I know many nurses have commented on how "nice" the residents are now... and it has to do with increased amount of sleep.
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that's the problem with the new rules.
too many pansies and beauty queens wanna play with the big boys.
what a shame!
a generation of wimps will this produce. No good will they be after dark
--Yoda PGY-5 Surgical Jedi
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Maybe it's just me, but I'd much rather be tucked away in my warm bed at night or be spending more time with my friends and family rather than spending 100+ hours in a hospital patching up an anonymous drugged up low-life at 3:00 AM just so that I can be considered "dedicated" and "one of the team" by some residents that most likely won't be a part of my life once I finish my residency in 5 years.
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If that's the way you think about your patients maybe you shouldn't consider surgery🙄 . Pathology or general radiology is more fitting for you.
I've worked as an emt for over 2 years already and never looked at anyone that way.
Yeah, that is what I think of *those* types of patients. Besides, how many hours per week do you work as an EMT and what would they know about actually taking care of patients once they give them a ride to the hospital?
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OK, if you aren't willing to patch up the HepC+ crack head at 3 AM, what are you willing to do? Are you willing to get out of your warm bed to place a Swan on a patient who is septic? What if the patient is full-blown AIDS and septic with VRE?
AS, who will take care of patients when it's inconvenient for you? Surgical patients require PHYSICIAN care 24 hours per day, not just 8-4:30 Monday through Friday. I agree with the previous posts; you should go Rads or Path where you can work 45 hours per week as a resident and bitch about your three calls per month. You won't survive a surgical internship.
AS, who will take care of patients when it's inconvenient for you? Surgical patients require PHYSICIAN care 24 hours per day, not just 8-4:30 Monday through Friday. I agree with the previous posts; you should go Rads or Path where you can work 45 hours per week as a resident and bitch about your three calls per month. You won't survive a surgical internship.
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I normally work 24-40 hours per week, but for almost 2 months last summer I was putting in 110 hour weeks. Working longer hours didn't change my perception of the patients I treated. The fact that I'm tired doesn't change the situation for the patient.
And yes, I do have experience taking care of patients after I "give them a ride to the hospital." I spent almost 6 months working as an er tech. I was called in to cover the night shift on very short notice many times. Just because I had a long week and was tired didn't cause me to view my patients any differently. Most of these "anonymous drugged up low-lives at 3:00am🙄 " didn't choose to be in the situation they are in. Not everyone has ideal circumstances and therefore not everyone is perfect. Face it, in surgery or emergency medicine, the majority of your pts aren't going to be chearleaders with appy's and little old ladies with lap choles. If you are unable to realize the fact that EVERYONE needs high quality care at all hours of the day and night, general surgery isn't for you. There are many other fields that would fit you much better and compenstate you just as well or better. From my work experience and from the surgeons who I've worked with, it takes more dedication to your patients than you are demonstrating. By describing a patient as a "low-life," you clearly exhibited that surgery does not fit you.
H
HiFi
Hydrocarbon boy,
you don't need to defend yourself or your skills to some ignorant tool on an anonymous forum.
I'd love to see AS walk 3 flights of stairs and assess some unconscious 300 lb woman, with no history. No lab. No X Ray, and no attending holding his hand.
Then make a presumptive diagnosis, formulate a plan of treatment, and more importantly, carry her down 3 flights of stairs, load her into the rig and navigate the mean streets to get her to the hospital.
Most real physicians respect the very tough job that EMT's and paramedics do.
I disagree that AS should do path or rads.
With his attitude, I think he should pick a nonmedical career.
Postal worker sounds about right to me.
I can just hear this whiner getting called at 3 AM for various complaints : "I NEED MY SLEEP. I'm not going to see that patient, I worked 79 hours already this week, and if I go put in that line, I'll be over the limit."
Dumbest premed, keep up the good work. Your experience in the real world will be invaluable. I think AS lost the point of your post. The fact that you see and treat as many patients as you do, in all sorts of circumstances, and still have compassion ( even for the dregs of humanity ) says a lot. I know a lot of guys get burned out and jaded and bitter.
What does it say, when an MS4 that's never actually done anything is already bitter and a prick. God, I'd hate to be that guy's upper level, provided he can con his way into a resdency
Yeah whatever, in little over a year I'll be starting out as a surgeon and you'll still be what for the *rest* of your career...just a regular internist that comes a dime a dozen? Go back to talking about what you should do for your patients without actually doing anything (well except for dispensing drugs like a glorified pharmacist).
Normally, I don't voice my opinion on these futile arguments. However, I have a question for AS.... I am wondering how you will enjoy moving around the country every couple of years or so? I wonder this because often times it is the "dime a dozen" internists who refer their choles and appys to you (often times making their referrals at night, and managing the patient until your consult in the AM) and how you will be able to support a practice after you've thoroughly alienated all of the ER attending, GP's, and IM docs in your general area. After a while, the referrals will invariably go to someone else, or you will only get the wound management referrals of the "3 AM crack head" that you so lovingly refer to. In my experience, the relationships that you form with the other medical staff in your region WILL make or break your fledging practice, a point you may wish to consider before making judgements upon the other people with whom you will (ostensibly) one day work.
When you're the best and working at an academic center, patients ask for you by name and even want to be operated on by you since they want the best working on them or their loved ones. There is no shortage of outstanding surgeons who have an unpleasant personality but still maintain a bountiful operating schedule. Being a nice guy has never been a requirement for a prosperous career in academic surgery.
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AS, I'm not ragging on you but find this interesting because I have always thought that there are many people in medicine, who while appear hard-assed and arrogant on the surface, really do crave the ego-stroking of being held in prestige by the public and (more so) being needed by patients. Interesting.
There are a lot of obstacles that stand in the process of obtaining a career in academic surgery, the basics including research, technical mastery, professional connections, etc. While,
being miserable isn't a requirement to such a career, either.
Just because one thinks very highly of themselves and is not a "nice guy" does not automatically mean they are "miserable" on the inside. I think it is one of those things insecure people like to believe about abrasive people to make themselves feel better...kind of how average looking/fat/unsuccessful people like to think supermodels and very successful people are really "unhappy" on the inside. Sure it may be the case at times, but for the most part it is a myth perpetuated to make the average person feel better about their place in life. Who is not to say that really nice people are actually insecure and have no confidence and therefore compensate by going around treating people very nicely so that they can be liked by others and feel accepted?
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my 2 cents worth: Mediicine is always in crisis in one form or another, so now its the 80 hour work week, and getting everything done plus OR time in that time frame. All right Im still learning the ropes and trying to get efficient and smart about things. What I am finding hwoever is a new problem, a lack of feedback. I dont mind being chastised by higher ups for screw ups, but when I get the cold shoulder and my mistakes are fixed behind my back, thats not cool. Interns cant learn without feedback.
H
HiFi
Interesting that you have a full sense of accomplishment, considering you have never done anything.
Make the speach in 6 years and maybe I'll listen.
FYI, I'm not an internist.
You are so inexperienced, it is becoming quite funny reading your posts about how great you are (going to be)
I'll bet in real life, you are a great retractor holder
Keep up the great work , God
Originally posted by ArrogantSurgeon
Yeah whatever, in little over a year I'll be starting out as a surgeon and you'll still be what for the *rest* of your career...just a regular internist that comes a dime a dozen?
Some might say the same of "surgeons," particularly those that don't distinguish themselves in any aspect of "surgery."
Personally, I think you should not be so bold. It would be interesting to be a fly on the wall when you encounter your first dilemma on day one -- that inevitable "Gee, I don't know what to do here."
Go back to talking about what you should do for your patients without actually doing anything (well except for dispensing drugs like a glorified pharmacist). [/QUOTE]
It will be interesting to throw that back at you when that day comes when your patients have long surpassed their surgical issues and remain on your list with only medical problems. How long before you break down and just pray that you can transfer your patient to a medical service because you just don't know how to take care of their medical problems that you may have created as a result of that wonderful surgery you performed on them.
Don't be so quick to dismiss your medical colleagues; they'll save your ass more than once.
Yeah whatever, in little over a year I'll be starting out as a surgeon and you'll still be what for the *rest* of your career...just a regular internist that comes a dime a dozen?
Some might say the same of "surgeons," particularly those that don't distinguish themselves in any aspect of "surgery."
Personally, I think you should not be so bold. It would be interesting to be a fly on the wall when you encounter your first dilemma on day one -- that inevitable "Gee, I don't know what to do here."
Go back to talking about what you should do for your patients without actually doing anything (well except for dispensing drugs like a glorified pharmacist).
[/QUOTE] It will be interesting to throw that back at you when that day comes when your patients have long surpassed their surgical issues and remain on your list with only medical problems. How long before you break down and just pray that you can transfer your patient to a medical service because you just don't know how to take care of their medical problems that you may have created as a result of that wonderful surgery you performed on them.
Don't be so quick to dismiss your medical colleagues; they'll save your ass more than once.
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To all of you who have bleeding hearts for the low-life, drugged-up, crack-headed scumbags who come into the ED at 3am riddled with bullet holes in dire need of "quality care," GIVE ME A BREAK!!! You think arrogant surgeon doesn't have the "dedication to his patients" to make it through a surgical residency?!!?! Go drink some hippy tea with Ralph Nader. A surgical residency is no place for dandies and liberal whiners!
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AS, since you consider all late night trauma victims to be low-lifes, how are you going to learn to take care of the daytime accidental shooting victim if you're not willing to treat those that arrive after-hours? How do you ration care or decide which trauma victims are of high enough social status to warrant your expert care? Or do you consider all gunshot victims to be scumbags that should be allowed to bleed out in the ED?
Socioeconomic status should not be a factor in the decision tree when treating patients. Sure, no one likes providing their services without compensation, but that should be the last thing on your mind when a critically injured patient comes crashing through the trauma bay doors.
Who knows when the next multiple GSW patient will be worthy of saving? Will you have the skills to save them when the need arises since you've been so stingy with your expertise? I'll bet that Ronald Reagan was glad that the GW trauma surgeons were very well versed in the treatment of penetrating chest trauma when he arrived in 1981 with a bullet through his great vessels.
Socioeconomic status should not be a factor in the decision tree when treating patients. Sure, no one likes providing their services without compensation, but that should be the last thing on your mind when a critically injured patient comes crashing through the trauma bay doors.
Who knows when the next multiple GSW patient will be worthy of saving? Will you have the skills to save them when the need arises since you've been so stingy with your expertise? I'll bet that Ronald Reagan was glad that the GW trauma surgeons were very well versed in the treatment of penetrating chest trauma when he arrived in 1981 with a bullet through his great vessels.
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oops
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Which is exactly why academic institutions continue to attract pathologic personalities. And we wonder how docs get so cynical and bitchy: they are carefully taught.
Paper thin psychology you're sporting there. Doesn't take a shrink to see how inadequate you are.
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Totally owned!
arrogance in surgery, thinking that you are better than everyone, will eventually catch up with you. I have learnt this personally. There is always a patient who will come in and you will be stumped as to what the problem is or how to handle it. It is much better to have an open mind and keep all possibilities on the table, including information from our medical colleges. Arrogance in surgery is a psychiatric way of coping with the knowledge that you know your inadequate, one of the coping mechanisms.
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Users are reminded that personal insults and attacks directed toward other users are not tolerated in this forum. Further such behavior will result in administrative action against those involved.
Please keep it civil.
Please keep it civil.
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Before this thread was derailed by one individual trying to fashion himself into a walking cliche, it was quite interesting, in a time capsule sort of way.
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No offense to surgeons but they are amongst the least intelligent people in medicine. Internists are much smarter and need far more intellectual and critical thinking skills than surgeons who do very little other than perform surgery in the OR once consulted. No real thinking or assessment of patients and coming up with DDX is required in a low intelligence field like surgery. Who would want to live a sorry life of 110+ hours a week of slave work aka surgery??!!
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Cool story bro.
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