A question about my new profession

[alsp99]

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This may seem like a silly question to ask once u've already matched but i was curious about what is acceptable during down time in the OR (i.e. during a case and nothin is goin on) - is it ok to be on the internet, read a book (and god forbid a book a non-medical book)?...don't want to hear a million posts about how this is a shallow question etc. i think its safe to say we all consider patient care top priority but quite frankly noone spends every single minute of their life thinkin about patients i guess i am curious what proper OR etiquette is....

 

[doc05]

In private practice settings, anesthesia is under fairly intense pressure to move things along. Downtime between cases means lost revenue. Some attendings will be on the internet/reading/etc during downtime if it's unavoidable.

As a resident though, you'd better be on your toes. You'll get hell from your attendings, not to mention the surgery attendings, if you're sitting around surfing the net.

 

[alsp99]

i guess i meant during routine cases when nothing is goin on....in between cases i'm sure the pressures are intense to get things moving

 

[VentdependenT]

You will not be doing a crossword puzzle during your cases as a resident.

 

[chillindrdude]

at least not at Rush! 😉

 

[VentdependenT]

I'll be too busy flippen out to concentrate on the mickey mouse x-word puzzle.

 

[alsp99]

yes but that being said i 've at times seen anesthesia residents reading their miller or benumoff or whatever during cases and please dont tell me that it has anything to do with the quality of the residents/residency program etc. i have no patience for ppl who in their late 20s and 30s are still childish and insecure enough to point out that their residency program is better than someone elses (like half of the posts on this board unfortunately)....just want to get an idea of what it's like in the OR - am transferring into anesthesia from another specialty and my experience in the OR is limited....

 

[Skip Intro]

yes but that being said i 've at times seen anesthesia residents reading their miller or benumoff or whatever during cases and please dont tell me that it has anything to do with the quality of the residents/residency program etc. i have no patience for ppl who in their late 20s and 30s are still childish and insecure enough to point out that their residency program is better than someone elses (like half of the posts on this board unfortunately)....just want to get an idea of what it's like in the OR - am transferring into anesthesia from another specialty and my experience in the OR is limited....

Ummm... if you are referring to VentdependenT's exchange with chillindrdude, I think the point was not about the "quality of the resident/residency program" or that his "residency program is better than someone elses (like half of the posts on this board unfortunately)" but instead that Vent is at a real workhorse program that keeps the resident quite busy. Furthermore, I don't think anyone cares too much about the quality of the residency program that each of us is in/soon to be in. We're all working toward the same goal and, if one is in a board-eligible program, that's all that really matters. Certainly, far fewer than 50% of all the posts extol one program over another. Except for the review threads, I don't think there are many at all. Even then, it's just opinions.

Likewise, every program is a little bit different in what they specifically have to offer because they are at different hospitals with different people in different locations. But, the RRC pretty much mandates what is required training. If you're in a program, you're going to get that training whether you like it or not. A good fit for me may not be a good fit for you, and vice versa. Personally, the only program I really care about is the one I matched in. So, don't blow a gasket, dude. 🙂

As far as reading in the OR... personally, I've heard mixed things about this depending on the attending. Guess I'll just have to wait and see in July 2006 what the specifics are with whichever preceptor I'm paired with during my first few months.

-Skip

 

[chillindrdude]

jeez...i was just jokin around...hence the 😉

 

[alsp99]

wasn't referring to his comment but was trying to avoid what seems like the inevitable discussion of residency program quality....really still don't have an idea of what exactly each day of the next 3 years of my life involves - as a medical student u see the interesting stuff but u dont see the dull moments and would be cool to hear from some of the residents what their lives are like......

 

[MAC10]

wasn't referring to his comment but was trying to avoid what seems like the inevitable discussion of residency program quality....really still don't have an idea of what exactly each day of the next 3 years of my life involves - as a medical student u see the interesting stuff but u dont see the dull moments and would be cool to hear from some of the residents what their lives are like......

Show up to WORK and im sure you will be fine. Read fiction and surf the net on your own time. That one of the perks about being an anesthesia resident, the ones at my (and a lot o other) program only work 60-70 hrs a week. Compare that to your General surg friends who are over 80 and that gives you at least a 10-20 hr/week head start on the short story reading.

btw, in the OR I think you have to spend your minutes thinking about the patinent becasue things can change fast. Im not sure that during my training i would even feel comfortable NOT being vigilant and whipping out a novel.

 

[seattledoc]

at our residency, the policy is "no reading or computer if a patient is in the room", the exception being looking up labs, info... and reading as it pertains to the case at hand.
There are days when I'm lucky to just get the vitals down on the chart due to rapid turnover, sick patients, etc. Then there are other days where I'm looking at hours and hours of unchanged BP's and HR's. I read anesthesia text or articles as it relates to the patient. I've never done any computer work but have seen other residents do it. I've also seen attendings reading Time or Newsweek. I've never done it as it's not worth the ass-chewing you might get from the anesthesia attd or the surgeon for that matter.

 

[Skip Intro]

I've also seen attendings reading Time or Newsweek. I've never done it as it's not worth the ass-chewing you might get from the anesthesia attd or the surgeon for that matter.

I think this is dangerous because if something does happen your mind is likely to be elsewhere, like deeply engrossed in the politics of North Korea or how that Eddie Bauer mock turtleneck is going to look on you. If you are reading, simple things like a request to reposition the patient may slip past you if you're not "tuned in". Surgeons don't always bark these requests out, but even the nicest ones start to get pissed if you don't hear them the second time they ask. I had an attending one time put the issue rhetorically to me: "What are you getting paid to do? Read a magazine and do crossword puzzles or take care of the patient? What do you think that patient would think if he/she knew you were looking at Time while you had them asleep on the table? How would you defend yourself if the surgeon recalled to the jury in court that you had your laptop out and were playing Solitaire?"

-Skip

 

[joshmir]

i think the op was also interested in what happens out there as opposed to just what people think is the right thing to do, right?

at my private practice TY hospital, the attendings read magazines and newspapers quite frequently during cases

 

[jetproppilot]

My father was an airline pilot for TWA for 37 years, his last ten years spent flying 747s to London Heathrow from LAX. Taxiing and takeoff are busy times in the cockpit, as are the ascent to whatever the cruising altitude is. But after leveling off and getting everything settled, theres hours of not too much going on. I saw my dad do crosswords many times while at cruise altitude on flights. (when I was a kid, I was allowed in the cockpit to chill with the old man..cool, huh? Doesnt happen anymore thanks to the terrorists).
Then theres descent and landing, which are busy times.
I'm sure you see the analogy.
I know alot of departments don't allow reading in the OR, but I personally think its OK if done discretely and at appropriate times.

 

[ThatManVan]

No, your father ain't reading on TWA cockpits thanks to them going bankrupt not because of terrorists. Anyways.. transoceanic captains have it the easiest they have a nice bed to go to soon as they reach cruise altitude, they got a relief pilot to take over while captain snores for 10 hours making 250/hr.anyways.. I lost my train of thought.lol

My father was an airline pilot for TWA for 37 years, his last ten years spent flying 747s to London Heathrow from LAX. Taxiing and takeoff are busy times in the cockpit, as are the ascent to whatever the cruising altitude is. But after leveling off and getting everything settled, theres hours of not too much going on. I saw my dad do crosswords many times while at cruise altitude on flights. (when I was a kid, I was allowed in the cockpit to chill with the old man..cool, huh? Doesnt happen anymore thanks to the terrorists).
Then theres descent and landing, which are busy times.
I'm sure you see the analogy.
I know alot of departments don't allow reading in the OR, but I personally think its OK if done discretely and at appropriate times.

 

[powermd]

I think this is dangerous because if something does happen your mind is likely to be elsewhere, like deeply engrossed in the politics of North Korea or how that Eddie Bauer mock turtleneck is going to look on you. If you are reading, simple things like a request to reposition the patient may slip past you if you're not "tuned in". Surgeons don't always bark these requests out, but even the nicest ones start to get pissed if you don't hear them the second time they ask. I had an attending one time put the issue rhetorically to me: "What are you getting paid to do? Read a magazine and do crossword puzzles or take care of the patient? What do you think that patient would think if he/she knew you were looking at Time while you had them asleep on the table? How would you defend yourself if the surgeon recalled to the jury in court that you had your laptop out and were playing Solitaire?"

-Skip

The mantra of anesthesiology is "vigilance." I would argue that vigilance is best served by keeping mentally sharp. You probably shouldn't be listening to headphones, or watching a movie, but reading or doing a cross-word puzzle is probably beneficial to the patient if it keeps you sharp.

 

[jwk]

The last two issues of the APSF Newsletter have dealt with this very issue. The one camp believes there should be absolutely no reading or any other activity that would divert your attention from the patient. The other view is that in longer cases especially, it may actually help you stay more alert by having something (anything) to do besides chart "railroad-track" vital signs q5min.

Patient issues aside, like it or not, perception plays a large part in this as well. Having a newspaper opened up in front of your face doesn't look too good. Likewise surfing the internet (a new one on me - we don't have that capability in our OR's) probably doesn't look that great either, especially if the rest of the OR staff can see what you're surfing. 😉 Glancing at a journal article or a crossword doesn't look as bad, although keep in mind that there are many, anesthesiologists or not, that would consider even this to be totally unacceptable.

The other thing to at least keep in the back of your mind are the medico-legal issues involved. IF something happens to your patient while you have been buried in reading material or online, you're screwed. That "perception is everything" concept will certainly hurt you. There have been many long-standing jokes and criticisms of anesthesia personnel reading the paper and doing crosswords. You can bet that the surgeons, and especially the nursing staff, will have taken notice of your usual habits, and if there is any question as to blame when an incident does arise, I guarantee that little subject will appear in someone's deposition.

 

[CambieMD]

If I were an attorney I would want the jury to know that the anesthesia guy/girl was reading Time during the case in question. There are cases where a patient was sent home from the ER and died a fews days later. What they died from may not be remotely related to the cause of death but the family usually grabs on to the fact that grannie was sent home two days before she died. The connection is easy in the mind of most. Grannie sent home and she died, negligent doc. Reading mag distracted doc. That is my two cents.

I suppose common sense should be used.

CambieMD

 

[canjosh]

No, your father ain't reading on TWA cockpits thanks to them going bankrupt not because of terrorists. Anyways.. transoceanic captains have it the easiest they have a nice bed to go to soon as they reach cruise altitude, they got a relief pilot to take over while captain snores for 10 hours making 250/hr.anyways.. I lost my train of thought.lol

He was saying that visitors aren't allowed on the flight deck anymore...that's because of terrorism. And no, they don't sleep for 10 hours while the relief pilot flies.