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Are all the horrors of surgery universal or localized? What can we do to change?

Discussion in 'Surgery and Surgical Subspecialties' started by SLUser11, Apr 14, 2007.

  1. SLUser11

    SLUser11 CRS 10+ Year Member

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    I get extremely long-winded in this post, but my main points are that the surgical stereotype is most prevalent in the Northeast, and that there are a lot of programs in other areas of the country, both academic and community, where your experience can be different. It's up to you to decide (and it's also up to you if you want to read my whole post or not).


    I've been on SDN for two years now, and I've noticed a very large population bias, with much less input from students and residents training in the Midwest, with most people who share their experiences being from the East or West coast. I understand that a part of this is the large ## of people training in these areas, but it still raises some issues for me.


    I believe that a lot of our experience in surgery is limited to where we went to med school and where we trained for surgery. Still, since we're extroverts and know-it-alls (myself included), we still convey our limited experience as "the way it is." So, when SDNers come to this forum seeking information, they're told "this is what surgery is like, no exceptions," and it scares a lot of people away from our beloved field of medicine. Anyone who would make such an important decision based on an anonymous internet forum has their own problems, of course….



    There is a small geographic area that is home to supposedly the "best schools in the country," and yet this is area from where I hear stories about:

    1. the most outrageous physician mistakes
    2. the worst student and resident behavior
    3. the biggest violations of work hour regulations
    4. the most deficient ancillary staff
    5. the least autonomous and lowest volume of operative cases
    6. etc, etc, etc.


    However, these stories don't come off as cautionary. Instead, they sound like bragging or stating the surgical norm, with no desires or attempts to fix the problems. I believe everyone should express their opinions here, but I feel that those people who propagate negative stereotypes and facilitate bad behavior are not good for the field. We've cluttered this board with fallacies that impressionable students are accepting as fact. And, as soapbox-y as this sounds, we need to be instruments for change, not facilitators of outdated tradition.



    To start, as a student, it is not necessary to do menial tasks unrelated to education to earn some teaching from the team. As a resident, it is not necessary to work 100+ hours/week, especially when a lot that time is spent doing low-yield work. It is not necessary to train at large big-name academic centers to get a good education and a strong fellowship, and so on.


    Some other things that bother me:

    1. The 80 hour rule- How many times have we heard students and residents alike state that this rule is some wild fantasy and is really non-existent. On SDN, we universally state that we lie on our timecards weekly, and we'd get in trouble with the program if we didn't.

    This isn't true everywhere. There are plenty of programs, both big and small, that try their best to comply with the rules, and many who succeed. I average 80 hours, mostly thanks to night float. Granted, I take calls on my patients from home.....


    2. Operative experience- The stereotype is that you don't operate until you're a senior resident, and you have to go to a VA or county hospital to actually do anything besides assist the attending. Thus, you feel the need to do a fellowship to learn how to operate.

    There are lots of program where you operate from day one until you graduate, with your caseload appropriate for your level (Appys, choles, hernias, etc for juniors, and colons, liver/panc, etc for seniors). In these surgeries, you do the operation, and you're not retracting for an attending. Academic surgeons and private practice guys will both allow you to do this if you find the right place to train.


    I guess my main point, although probably lost in my ranting, is that we should all share experiences and give input, but we shouldn't act like the choices we made and the environment that we're in is the only way to do it. In surgery, there are plenty of choices, and the students should be presented with options instead of being told that the "horrors of surgery" are inevitable.
     
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  3. Tired Pigeon

    Tired Pigeon 7+ Year Member

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    Thanks for your post. I am very interested in surgery, but definitely feel a little put off by all the horror stories. Thanks for a more balanced perspective.:thumbup:
     
  4. PediBoneDoc

    PediBoneDoc 2+ Year Member

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    very well said.

    i am new to these forums and i have noticed that if you don't go with the status quo, people will attack you. so i applaud you bravery for stating something that is more fact than myth.

    i do believe there is a bias of those who submit. many people who are happy with their situation will not complaint or make statements about how happy they are. many people who come from the "hallowed grounds" of a well known academic establishment feel it gives them the information of all other institutions, because they are leading the way. there is also the opinion that because you comment a lot on the forums, the information is more important. ok, i know that is probably me projecting my own thoughts; it is just an observation from being on these and other forums.

    from the side of making resident education better, many institutions are trying to make situations better. program directors are in the process of making education more streamline. so, SLUser11's comments are in my mind dead on. :thumbup::thumbup:
     
  5. lilnoelle

    lilnoelle Moderator Emeritus 7+ Year Member

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    Oh, this is good news to me. I'm currently an M1 at KU Med and very interested in trying to stay in Kansas City if at all possible. I don't know that I want to be a surgeon (I have some time to figure that out) but it is definitely something that really interests me.
    Please tell me more about KU's surgical residency.
     
  6. Tigger14

    Tigger14 Ready to move 7+ Year Member

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    I clumped a bunch of stuff I have previously said into one group, so it looks long, but I did not just type all of this...

    * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
    I'll add a couple more points here. Yes, every job has its ups and downs, and you have to get to know yourself to know what will be the best fit. That part can't be answered by anyone but you.

    Having said that, I am happy with my profession. In terms of a career, surgery is very exciting, and vascular (which is the fellowship to which I am headed) is changing almost daily with new technology. I have done about 150 lap chole's and yes, every one is exciting. There are different reasons... sicker patient, younger person, difficult anatomy, the privilege of operating on someone you know well... it may get old in 10 or 15 or 20 years, but I don't expect that. I work with attendings (not all, but many) who LOVE what they do. Hopefully you will encounter people who fall into this category, because they can really energize/motivate/add perspective to medicine. Part of how I ended up even applying to the program I matched at is that one of my attendings is an alum. I never expected them to take a second look at me, and now I am joining them for two years.

    Personally, medicine is demanding. Yes, there is less personal time, and I have considered quitting and looking for something less time intensive. I have dragged myself home just to wish for more than 12 hours off so I can recharge. This part is more unique to medicine, and anyone going into medicine should be aware of and ready for it (to the extent that you can).

    I could never titrate someone's hctz; that is why I am not in medicine. One of my best friends just could not justify tolerating the typically more abusive training of surgery, and chose medicine. We are both happy with our choices.

    At the end of the day, I still am excited to be in surgery. Not every day is great and not every procedure goes well. Patients and their families add a whole new challenge in some circumstances. Could I do something else? Nope, not with the enjoyment that I have for my career.

    * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

    I am starting a vascular surgery fellowship in July. I agree with several of jubb's points, and add a few.

    1. A lot of people don't like vascular because they are sick patients. I love critical care, but doing a critical care fellowship and ICU coverage usually means a severely diminished operating schedule. Vascular is a great combination of sick patients who need surgery... from you.

    2. Also, most of them do very well. There are jokes around about repeat operations and ultimate amputation, but that is not the rule. In all specialties there are frequent fliers; vascular is no exception.

    3. It is delicate surgery, so your skills will have to be really good... vascular anastomoses do not tolerate rough handedness.

    Having said that, I love endo and open surgery. Once you rotate through and talk to vascular surgeons at your hospital, you will have a better idea about it. Good luck.

    * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

    Perspective of a chief resident

    --------------------------------------------------------------------------------



    I skimmed this thread because there is a request in the resident forums for MD responses. I am by no means the authority, but I will offer my two cents, and comment on the above quote in a minute.

    First, I am a chief surgery resident, going into a vascular surgery fellowship in July. Currently I am post call (and post nap, thank goodness) after an emotionally draining night. The reason I say this is that I have not chosen a cush specialty by most people's standards. All of my attendings encouraged me to consider their specialties because they really enjoy what they do. I chose vascular (which many people hate) in part because of how much fun I saw my attendings have with it. It is not perfect, always fun, or an easy job. It is not always rewarding, but it is a great choice for me.

    I understand where a lot of the pre-meds are now, since I was an excited, energetic, devoted applicant to medical school. I could have been forced into doing something else, even in medicine (PA, RN, etc), but being a physician was all I had wanted since childhood, so here I am.

    Now, what is my experience/advice about previous comments? Here goes:
    1. You're entering a world that despises you and hates you. From the patients that want to sue your ass... This is usually not true. Yes, there are lawyers and greedy patients and families, but the vast majority are not like this. I love most of the patients I care for, and am truly happy to have a chance to assist in their medical care. In fatigue, long hours, and a pre-existing expectation that doctors will be treated like gods, many become jaded. I don't expect or want to be treated like a god, just respected for what I can offer. My emotionally draining night included on hour with a patient whom we thought had a post-op complication who wanted to leave AMA... she was less than insightful or easy, but her family appreciated the time it took to convince her to stay for evaluation. Yes, at 3 am, with 5 other admissions and a trauma coming in, my patience can be frayed, too. However, that is not how things are most nights. The second was a patient who came in with abdominal pain, and her evaluation revealed a high likelihood of mortality. I had the dubious honor of going to her to say... "you need surgery ("what??") and I hope that is the best news I have for you." I told her what our concerns were, including that she may very well not survive the night, despite that she was sitting there chit-chatting with me. Indeed, my worst fears were confirmed at surgery, and she died this morning, about 7 hours after surgery ended. Her family came to me this morning to thank me for being straight forward and honest with the patient and them. Did I enjoy that? No. Did I enjoy operating on someone who was likely to die that day? No. But life sucks sometimes, and those skills will help me later. This family was not going to sue, did not hate their doctors/nurses, and were not difficult to care for. It makes it a lot harder sometimes because it is human nature to be more detached from people with whom you do not empathize.

    2. Your life will be long and hard, filled with endless hours and no vacations and no weekends. This is just not true. Yes, life is hard, but I am off all of this upcoming weekend to go house hunt. I just got back from a cruise to Mexico, and was in Europe last fall. What you do with your vacation and time off is your choice. Yes, a lot of it gets lost in fatigue (I started a thread in the surgery forum about being exhausted), but most of the time, you can do stuff. There may be people who still have this life, and I can't speak to that, but in surgery, even before the 80 hour rules, I got time off.

    3. Sleep will be but a memory to you, and don't even think about taking sick days unless you are three steps from death. Again, this is an overstatement. I needed surgery as a second year, gave two weeks notice, and took my week off. Life went on. On a side note, it was knee surgery, and on returning my first OR day was 4 cholecystectomies in a row. I had to beg the attending to let me assist by the last case because my knee hurt... he did not care that I was gone for a week, or I would have been relegated to the assistant's side of the bed at the beginning of the day. I also needed two procedures this year, and both times my attendings asked if I needed more than the one requested day off. There are humane people here, you just have to look for that.

    4. No one cares about you, not the nurses who give you death stares, not the office assistants who mock you at the water cooler, definitely not the insurance agents who slowly take away your retirement fund, and certainly not your fellow struggling physicians. Again, not my experience. We (the residents in my program) have a very good working relationship with staff at our hospital... so much so that the operators send us crank pages, and nurses call to invite us to dinner/coffee/snacks, whatever. I can only hope (I have heard it is the case) that the people at my new hospital are as nice. One of my closest friends is one of my co-chiefs... both of us were worried about working with another female in surgery, and have gotten along great. We are already planning vacation together next year, because we are going to different places. I will miss her a lot. Most of our residents and attendings have a great relationship, but there are awful people everywhere.

    5. You will most likely die alone, your spouse having left you for someone who wasn't an empty seat, an empty side of the bed, an empty memory of a brief happy moment. Your kids will hate you for never being there, and will tell the divorce courts that you are an uncaring awful parent and suddenly you've got no visit hours and huge amounts of ailmony to pay. I am currently single, but have not lacked for dates. In addition, despite my family being 700 miles away, we see each other a lot. I will see them more when I am 200 miles away, though. It just takes a mutual dedication to nurturing a relationship. My brother is also busy, and we have taken trips together, he came to a meeting at which I presented, we both went to a friends wedding in Canada and he is coming this weekend to house hunt. My vacations are always with friends, so we see each other too. Do I see my friends (outside of residency) every day? No. Do I wish I could? Sure, but with a busy schedule, this has worked fine.

    The bottom line, for me, is this: Medicine is not easy. It is not short, and it is not very forgiving. It is rewarding, though, and I love what I do. I have wanted to quit, have been tired of the abuse in residency, have been tired of the studying (now for board exams) necessary. I hate that I can't exercise like I did before residency. But that will change, and there is some flexibility in how you live your life after training. If you settle for less than a specialty you love (or settle in any job), you will not be happy. Even with something you love, you will not always be happy. Is it worth it? Yes. Have I wondered many times? Yes. Have I been bitter at being deposed multiple times as a resident and knowing the current legal climate? Of course. Could I be as happy at anything else? Nope.

    I also agree with NonTradMed's post above.

    Don't expect any more novel-length posts :)D ), but feel free to ask questions or PM me.
    Hope this helps some of you.

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    I had the same experience as jbean and sml1120. For that matter, I entered surgery thinking I would hate vascular surgery, and that is what I am going to do.

    I assumed that all surgeons were evil, sadistic, inhumane people, and had the opposite experience. Plus, my mother became suddenly ill and died (ironically, of a surgical problem) in the course of the last 2 weeks of my surgery rotation, and they couldn't have been more supportive of the time I needed to spend at her hospital.

    It has been said before, but bears repeating... you should pick something you not only love, but will love at 4 am, when you have had no sleep in 3 years, and the 20th admission is coming in and needing your full attention. If you can do that, you'll be ahead of the game. Hey, instead of 32 page H&P's on that 20th patient, we get to operate!
     
  7. MediCane2006

    MediCane2006 Living the dream Physician 10+ Year Member

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    In response to the OP (and for any impressionable future surgeons who may be reading)...

    I'm a categorical surgical intern at a Northeast academic medical center with a level I trauma center. I have gone over 80 hours a week exactly three times this year, all because we had emergent cases going which I scrubbed in on. I operate a fair amount; I'm on track to finish the year with 75 cases. I have a beautiful apartment, I go to the gym three times a week, and I go out with my friends at least once every weekend. I've been home to Miami twice this year for five days at a time.

    Is it hard work? Sure. I'm chronically exhausted most of the time; I don't have time to study, and there are a lot of days when I'm physically sore from running all over the hospital. My attendings are excellent and I'm learning SO much, but I've been frustrated and even cried a few times when I've gotten yelled at unfairly. There are many, many mornings when I wake up in the wee hours, look out the window at the blustery cold, and can't imagine facing the walk into the hospital. OR time often comes at the expense of floor work piling up. There are quite a few days when my life feels like a particularly outrageous Scrubs episode.

    Is it easy? No, and it shouldn't be. You're learning both a knowledge base and a set of technical skills in a relatively short period of time. (Plus, it's kinda cool do be doing something that not everybody can do). Does it have to be torture? Of course not. I chose to train at a program with a night float system and a group of residents with a "work hard - play hard" attitude, and it fits my personality just fine. For other people, though, an environment with driven, gunner-like personalities might be just what they need to thrive.

    And yes, there are a lot of big Northeast program that fit that model, and just as many old-school surgeons who think that it's the only way to train a surgeon. Hey, they may have a point - many of my attendings and senior residents say they've observed that the night float system and 80-hour work week negatively impact both patient care and resident experience. One attending told me that she finished her intern year with 200 cases. Inevitably, too, the night float and cross-cover systems lead to mistakes simply from lack of familiarity with the patients.

    The bottom line is that right now, surgical residency training is undergoing a transition to a more benign, resident-friendly model (whether the "old guard" likes it or not). How that will affect the quality of residents which we train is debatable (and a topic for another thread). But as a result, there's a spectrum of programs out there ranging from programs that embrace the new model wholeheartedly to those which are still resistant to change. That's why you interview and do second-look visits - to get a feel for the personality of the program and its residents and to find one that fits you.

    And as for the stories about forty-hour calls, dragon-like attendings, and vicious nurses, keep 'em coming. They remind me why I chose this job. :laugh:

    Off to do some "low-yield" tasks...
     
  8. SLUser11

    SLUser11 CRS 10+ Year Member

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    It sounds like you're in one of the more ideal situations available in the Northeast, and yet from reading some of your posts (beep beep beep) it sounds like you still have an attitude problem, and help propagate the surgical stereotype by being mean to residents in other specialties.

    I'm not going to argue with you too much because I don't like to fight with girls, but the last paragraph of yours that I highlighted (I did trim it down) is exactly the wrong attitude, and it kind of proves my point about people in the northeast.
     
  9. Richie Truxillo

    Richie Truxillo Your Scut Monkey Mentor Physician SDN Advisor 10+ Year Member

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    Appreciate you starting this thread. Information like this is invaluable to me since I am drawn to both Urology and General Surgery right now. I immensly enjoyed both rotations and am now trying to set up my "Audition rotations" for this fall.

    I will be getting married this fall to someone who is very supportive of whatever I do. However, it helps to know what I am getting into ahead of time.

    Anyway, enough of this posting on SDN :p I need to get back to studying for step II!
     
  10. MediCane2006

    MediCane2006 Living the dream Physician 10+ Year Member

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    I think so :) at least for me and where I want my career to go. I'm not interested in the hardcore, old-school type of training regimen, and I like to sleep in my own bed most nights. Doesn't mean it's necessarily the right atmostphere for everyone to learn.

    If dealing with stressful, exhausting days by keeping a resolute sense of humor means having a bad attitude then yes. Yes I do.:rolleyes: I'm working on it. It's just...it's just so much fun to make those despicable little fleas cry, though. :laugh:
    (I would argue that you fulfill the surgical stereotype quite nicely yourself, what with that truculent disposition, rigidly-held views, and the stick shoved up a certain bodily orifice. But that would be mean. And I'm really quite a sweet person. No, really).

    That's quite magnanimous of you. Don't let that stop you, though. I promise, I'm not one of those girls who will kick you in the shin with her stiletto and then run away.

    Huh? Look, I'm all for the 80-hour work week. But you can't deny that it decreases the caseload for junior residents that under the old model would operate post-call. Not only that, but if you've worked with a night float system, you know how many transfers of care there are under the cross-cover model. The result is that residents are caring for patients with whom they're not familiar (as evidenced by all those posts in the beep-beep thread complaining about nurses asking the night float guy for the patient's long-term plan of care). Ask any resident who trained under the old system - it's the tradeoff that you make for not having residents in the hospital 120 hours/week. On the flip side, though, the old model resulted iin chronically exhausted residents who were more likely to make mistakes.

    There's no one perfect way to train residents. I think the model we have now is a good one - I certainly don't complain about being able to go home and sleep most nights, and I think I perform better as a result - but to imply that it's free of negative consequences seems a little naive.

    You just insulted this sweet little ol' Southern gal. :mad: Start running now.
     
  11. SLUser11

    SLUser11 CRS 10+ Year Member

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    Joking or not, I bet you really mean that, plus I bet you say it to your co-residents a lot, which is worse. I don't care if you only call IM residents fleas when your joking around, it still makes you sound like a you-know-what, and it propagates a negative surgical stereotype.

    I had to look "truculent" up, and it sounds kind of like you're flirting. I'm married....but still not completely closed to the idea...PM me.

    Anyway, if you knew me in person (or even did a quick post search), you'd see how wrong you are about my disposition. The difference is that I know what's appropriate and inappropriate in a clinical setting. Plus, my jokes are more funny and less mean.


    Had to look "magnanimous" up as well. I agree.

    Great.....thanks for proving my point. You've decided that you know how night float works everywhere, despite your limited experience. My night float system works great, and since I take calls from home on my own patients, the floaters aren't responsible for cross-covering large groups of faceless patients.

    There are plenty of published papers out there, even from Northeast programs like Harvard, where it's shown there's no statistical difference in operative caseloads. Also, you're still proving my point with the "ask any resident" comment.

    There you go flirting again.:thumbup:
     
  12. Apollyon

    Apollyon Screw the GST Physician Lifetime Donor Classifieds Approved 10+ Year Member

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    SCREW IT!
    If you ask the patients who the best doctors are, they will virtually always say the surgeons "because they fixed my problem!" As one of my colleagues said, the cognitive doctors (IM and subspecialists of IM) may diagnose the problem elegantly and brilliantly, but the patients say "they didn't do anything for me, and I still have the disease!"
     
  13. lcoor

    lcoor

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    SLUer...your original post was wonderful BUT since then things have been downhill...

    I normally don't fight with girls either but im gonna make an exception for you...your a complete sociopath. clearly you're either A) too dim-witted to understand the concept of a joke and busting on friends or B) you have such a terrible personality that you don't understand what a joke is.
    I normally am just an occasional reader of this forum but I just had to make an account and tell you how unbelievable you are. If anyone is perpetuating the surgery stereotype its you. your terrible. i give u a D-. you started this completely irrelevant argument for no reason.
    and are you saying your open to cheating on your wife? is that your great joke. and are you aware that truculent isn't a compliment? forget surgery....im going to send you that little orange vocabulary book from middle school (remember those?).
    im sure as soon as you read this you are going to start thinking of some way to zap me back...maybe find something wrong with my spelling or that I forgot to use an apostrophe...im perpetuating the poor grammar stereotype i guess. regardless I am sure it will be lame, so think twice and maybe have someone proofread it to see if it is actually worth sharing.
    medicane don't listen to this chump. he keeps saying your proving his point but he has no point.

    LC
     
  14. TxMed

    TxMed SpottieOttieDopalicious 5+ Year Member

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    i think we have found a winner in the "best first post/most cajones in a first post" combo-category. all of the "best new poster" categories have been extremely competitive this year, but i have to say that lcoor has positioned him/herself nicely. welcome to the board and congratulations on this strong win so early in your SND career.

    -tm
     
  15. MediCane2006

    MediCane2006 Living the dream Physician 10+ Year Member

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    Um. Wow. What TxMed said. :thumbup:

    While looking up all that stuff in the dictionary, did you happen to come across a definition for *sarcasm*? How about *humor*? Okay, that was mean. Sorry.

    Like a what? You can say it. :smuggrin:

    Bless your sweet little heart, darling. That wasn't flirting. I wouldn't dream of flirting with a married man....that would be propagating all those negative Gray's Anatomy stereotypes, after all.

    Your sense of humor has, indeed, been markedly evident throughout this entire discussion.

    I'm afraid I don't quite understand what point it is I'm supposed to be proving. And I'm still quite confused why you're so angry about my saying that both the old and new systems of resident work hours had pro's and con's... If you'd like to debate this, by all means - I think it would be a good discussion and I'd be interested to hear the perspective of some of the more senior residents on the board as well (Kim Cox?).

    But your insistence on denigrating my character, attitude, and professional demeanor when you don't even know me is rapidly reducing this from an intelligent discussion to a silly catfight. Which isn't worth my time. And certainly isn't going to enlighten anyone reading it either.
     
  16. SLUser11

    SLUser11 CRS 10+ Year Member

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    I knew this would happen. I do get a little bored sometimes when SDN is slow, and I have to admit that I added misogyny to my post to ruffle feathers. Not quite sociopathic, but definitely unfair to the ladies of SDN. I apologize for that. I actually love fighting with girls.

    As for "busting on friends," I'd be surprised if Medicane was describing how she teases her best buddy the IM resident. She told a story of how incompetent a fresh IM intern was, and then how she yelled at her for the incompetence, and how the ancillary staff was laughing at how scared the IM intern became......oh, wait, NOW I get it! That is funny.....

    Well, I just looked truculent up in the dictionary today, and I can assure you that it is a compliment. At least the antonyms are, whatever "antonym" means...

    I love that you accuse me of having no sense of humor, then miss blatant sarcasm (like, middle-school-level sarcasm).

    You're actually right....your grammar is bugging the crap out of me. Still, I promise that I won't concentrate on it if you promise to take your panties out of a bunch, and quit getting so worked up over posts in an anonymous internet forum.

    That being said, I hope you come back to SDN and contribute more great zingers. It makes the boards a little more fun. I have to admit that I'm kind of a "last word freak," though, so our arguments might get long winded.


    Medicane, I'm going to reply to you separately since you actually made some good points.......
     
  17. SLUser11

    SLUser11 CRS 10+ Year Member

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    touché . I shouldn't have made the offer....it's just that you looked pretty hot in your avatar. I now realize that is a fish, so I'm going to retract the offer since I don't know the word for fish-philia, and I've maxed out my dictionary time today.


    Thanks for noticing.

    You're proving my point that we are too quick to label our limited experiences as "the way it is," when in fact there is variability and options when it comes to surgical residency. You said, "if you've done night float you'd know x," and "ask any senior resident and they'll say y," when really night float experience and senior resident attitude toward new rules are not universal things.

    As for hearing Dr. Cox's opinion on the issue, I think it's extremely valuable, but I think it's still limited by geography since she trained in the Northeast. One of my original points, before I started chick-bashing, is that the midwest and possibly the central northern areas (MI, MN, etc) are under-represented on this board, leading to a sample bias and a resultingly one-sided perspective on surgical training.

    You're absolutely right, and I apologize. I was picking on you because of your comments in the "beep" thread. I didn't like that you felt it was OK to mouth off to the IM resident and the neurosurg attending like you described, and it made me mad that you thought such behavior was acceptable and also funny. Your comments in this thread were benign.
     
  18. lcoor

    lcoor

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    Apr 18, 2007
    dr cox is my dream woman. if i could id whisk her away on my noble steed to my castle in the clouds. in her honor, no more sarcastic instigatory posts on my part.

    cheerio
    LC
     
  19. blotto geltaco

    blotto geltaco Old-timer 10+ Year Member

    267
    1
    Jun 1, 1999
    USA
    Another special olympics thread. Everyone acts retarded.
     
  20. Winged Scapula

    Winged Scapula Cougariffic! Staff Member Administrator Physician Faculty Lifetime Donor Classifieds Approved 15+ Year Member

    38,062
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    Apr 9, 2000
    hSDN Member
    Which is exactly the reason I refrained from posting on this thread:

    - I trained in the NE at a program which perpetuated the malignant surgery stereotype in many ways

    - although I have friends in residencies in other areas, and can provide anecdotal information about other programs outside of the NE which also conform to the stereotype, they are ANECDOTES and you never really know how something is unless you experience it yourself

    - I never meant for my posts to "perpetuate the surgical stereotype", be seen as "bragging" or represent my experiences as the way surgery is everywhere because I know, even from just reading and talking with others, that it is not

    I would be a bit dubious about any research which states that there is or isn't a difference in case load; its premature. We haven't graduated a Chief year which trained completely under the work-hour restrictions yet. I'd also add that I wouldn't be suprised that, even when the research is done at the right time, there might not be a significant difference in reported cases between pre and post-80 hr residencies. However, this belief stems from the fact that RRC will "ding" a program in which residents have TOO many cases and PERSONAL experience (which by no means represents surgery as a whole, or any other surgical training program) that a program may ask a resident not to report all cases if they are in danger of being "over". Thus, the max number of cases done in the "old days" could have been artifically low. After all, don't we all know that many residents would prefer to deceive (ie, number of hours worked, number of cases done, etc.) ACGME, RRC, etc. rather than give the "wrong" answer and be in trouble?

    At any rate, my past posts were only meant to present my experiences, often in response to others who claimed their experiences were the "way it is". I agree with SLUser that we do need a wider representation here, if only because I'd like to see our community grow and to have more information from users in a wide variety of training programs.
     
  21. MediCane2006

    MediCane2006 Living the dream Physician 10+ Year Member

    5,838
    8,259
    Feb 16, 2004
    Right where I want to be
    Fair enough. I think you misunderstood my point, though. I've talked with the senior residents in my program quite extensively about the benefits and downsides of the current system, and they've unanimously agreed that the one down-side to the night-float model is that you get a cross-cover resident taking care of patients after having received at best a limited sign-out. Now, I in no way am presuming to think that every night float system is identical to ours (sounds like with your system, you take home call on your patients), nor would I dream of suggesting that the opinion of the dozen or so senior residents with whom I've talked represents any sort of national consensus on the matter. Which is precisely why I'd be so eager to hear the thoughts of other senior residents or attendings who trained under the old-fashioned system.

    (As a side-note, I'm not sure if I'd be all that crazy about the home call thing. Doesn't that provide a way for programs to get around the 80 hours since the time during which you take home call isn't technically counted as "work hours"?)

    Er...wouldn't want to "label" or anything, right? Just think it's fair to point out that you accuse me of making blanket statements and generalizations, but you're using a pretty broad brush to paint a lot of the Northeast programs. I interviewed all over the country last year, and found that there was a pretty wide range of program attitudes in each geographic area. You can find malignant, old-school general surgery programs in all corners (and the middle) of the country, and the Northeast is home to quite a few of the more "warm-and-fuzzy" breed of surgical residencies. I wouldn't discount someone's opinion just because of the region where they trained was "labeled" as a traditional bastion of the old-school.

    In re-reading your original post, I think you meant to make the point that we don't hear enough from non-Northeast surgical residents. Which I'm going to assume is true since I don't really have a grasp on where most of y'all are from. In any case, though, I'm not sure why you would think that any one person's experience, as presented on this forum, would be necessarily representative of some kind of homogenous Surgical Residency Experience. When we talk about the nurses, ER staff, or work hours at our program, we're just talking about the way it is at our program. (Kim made this point a little more coherently than I did, probably because Kim didn't just get back from drinking with the OB-GYN interns. I love midweek interdepartmental happy hour).

    I think Kim also makes a fair point in that we haven't had the new system long enough to know what kind of an impact it will have on residency training. Again, as an intern I have no complaints right now - I take overnight call once or twice a month on most rotations and get to sleep seven hours most nights. It's like Surgery Lite compared to what my current chiefs went through. However, as with any new system, I'm sure there are still plenty of wrinkles left to be discovered and ironed out, which was the point of my initial post in this thread. I think that "labelling" the old system as "bad" vs the new system as "great" is simply unrealistic, especially at this early stage in its (and our) development.

    The bottom line is that surgical training is going through a tremendous amount of change right now, as more and more focus is placed on preparing residents for fellowship rather than training well-rounded general surgeons. It's an unsettling - but exciting - prospect to be entering a field that's changing so fast.

    Either you didn't read the post right, or you missed the sarcasm. I'm starting to think, though, that you took the "I'm a surgery intern-fear me" post seriously. Just in case...the "IM resident" who called about the pregnant lady with the prostate was the trauma second-year prank-calling me, in retaliation for a similar call earlier in the week (I "consulted" him to disimpact a patient with a Hartman's who "hadn't had a bowel movement in two weeks, although the ostomy's working fine"). The joke was 100% on me, and yes, I do think that's funny. The neurosurgery consult was called in by the neurosurgery intern, who really is one of my best friends, so I didn't feel the slightest qualm in teasing him mercilessly about losing pulses with a fem-stop on. Trust me, he has a few equally-embarrassing blunders of mine that I hear about on a constant basis.

    If you really, honestly, think that I would tell off a neurosurgery attending ...well, I'm not gonna lie, I'm a little flattered that you think I have cojones that big.

    And blotto....:laugh: sad, but true.
     
  22. drgeeforce

    drgeeforce

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    May 7, 2007
    My funny story/rant was my senior/chief year where the consensus among the residents was at the most hated ER rotation. There was a "board certified" ER doc who we all knew was a lazy mongrel. He would often call for Surgical consults when we all knew the patient didn't need one. He just did that to "CYA" when it got really busy or he didn't want to spend time with the patient getting an H&P himself. One particular memorable case was a 25 female w/ bilateral pelvic pain and back pain NOS.

    He called for an OBG consult within 2 min (electronic med records) of the pt getting an ER bed. The OBG resident told me she asked him for the UHCG level and sexual history, he replied to her he didn't have any. She told him to get both and call her back.

    He called me for a Surgical consult within 7min. His usual consult request... "there's a patient on bed XX for abdominal pain", and hangs up. nothing else
    no name, no medical record number, and he charts "fully discussed w/surgical resident on-call for further workup". So I see the patient, ask her history, examine, and write up my findings.

    Assessment/Plan
    Patient: Ms. X is a healthy, pleasant, race/habitus woman who is 28weeks IUP, her pelvic pains are consistent with uterine ligament stretching as this is her first pregnancy and is unfamiliar with the sensations of pregnancy. Surgical recommendations are as follows: OBG consult, if appropriate, and pre-natal education/Social work f/u. If at any time the patient's S/S worsen, please reconsult. Thank you for allowing me to take care of Ms XX on this consult.

    What I want to write: Look at the patient you lazy, good for nothing bum!

    What the OBG resident wrote (I'm not kidding):

    Assessment/Plan
    This was the worst case of resident abuse to date. This patient clearly is pregnant and a surgical consult was clearly not indicated. A thorough exam to be performed by the ER doctor is recommended for all patients who come in through the ER. Please have all labs and H&Ps ready before any specialty consults. Please have this patient follow-up in OBG clinic on Monday.

    Needless to say she got forced vacation to rethink about her chart fighting and was subjected to "correctional" volunteer clinic time.

    The Board Certified doc? nothing. 1 month later, he received a physician recognition award from the medical staff for fastest ER patient turnaround times and the most number of patients seen in the ER that month. I kid you not!
     

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