Bad Doctor Stories

[TicDouloureux]

My bad doctor story for today:

I'm doing my Anesthesiology elective, and I'm out at one of the community hospitals instead of the main University Hospital. Today they put me in a room where a neurosurgeon was doing a posterior decompression and fusion of C3-C7. He was kinda old - I'd say in his 60s maybe. So 10 minutes into the case, he settles into a chair in the corner of the OR and TAKES A NAP while the residents do the entire case. Right before they fired up the C-arm, someone told me to go hand him a lead apron. So I do, and he takes it and drapes it over himself and mumbles "mmm it's like a blanket" and goes back to sleep. WTF??! And judging from everyone else's reactions, this is a not an unusual occurance.

---

Members don't see this ad.

 

[stormjen]

During my surgery rotation, we were called to put in a femoral line on an ICU patient. This patient was unconscious, so her niece was making medical decisions for her. The niece specifically requested that the surgery attending place the femoral line rather than a resident.

We go to the patient's room - me, the attending, and a resident. The attending closes the door and shuts the blinds on the window. He then proceeds to sit in a chair and play with his PDA while the resident placed the line (making numerous failed attempts, might I add).

 

[Stinger86]

Sure makes me want to be admitted to a hospital sometime soon...

 

[edmadison]

During my surgery rotation, we were called to put in a femoral line on an ICU patient. This patient was unconscious, so her niece was making medical decisions for her. The niece specifically requested that the surgery attending place the femoral line rather than a resident.

We go to the patient's room - me, the attending, and a resident. The attending closes the door and shuts the blinds on the window. He then proceeds to sit in a chair and play with his PDA while the resident placed the line (making numerous failed attempts, might I add).

Wow, if you or the resident did that procedure than you have committed a crime: assault (or battery, depending on your jurisdiction). Hope no one finds out.

Ed

 

[starayamoskva]

Wow, if you or the resident did that procedure than you have committed a crime: assault (or battery, depending on your jurisdiction). Hope no one finds out.

Ed

Depends, did she sign the consent form giving consent to just the staff person or did she sign the standard form giving consent to Dr. Whoever/Resident/assistant?

 

[delchrys]

thank god there are med mal damage caps to protect these responsible, caring pieces of ****.

 

[edmadison]

Depends, did she sign the consent form giving consent to just the staff person or did she sign the standard form giving consent to Dr. Whoever/Resident/assistant?

Doesn't matter. The specific verbal instructions would override the written document. Of course if there was informed consent following the verbal instruction and it was explained that someone other was going to do the procedure that would be ok.

Ed

 

[djalimd]

for god's sake people, its a freakin femoral line!! He aint putting in a swanz or anything.. How do you expect residents to learn?? A fourth yr could put in a femoral.. I don't think this was a big deal..

 

[Janders]

for god's sake people, its a freakin femoral line!! He aint putting in a swanz or anything.. How do you expect residents to learn?? A fourth yr could put in a femoral.. I don't think this was a big deal..

It doesn't matter if the procedure was wiping the patient's bum with double-ply quilted toilet tissue, to go against the decision maker's expressed wishes is an ethical violation.

(not to suggest we are all perfect, or that minor ethical violations really matter in the long run vis-a-vis the infinite universe... but its generally good to keep your ethics intact.)

 

[supercut]

My bad doctor story for today:

I'm doing my Anesthesiology elective, and I'm out at one of the community hospitals instead of the main University Hospital. Today they put me in a room where a neurosurgeon was doing a posterior decompression and fusion of C3-C7. He was kinda old - I'd say in his 60s maybe. So 10 minutes into the case, he settles into a chair in the corner of the OR and TAKES A NAP while the residents do the entire case. Right before they fired up the C-arm, someone told me to go hand him a lead apron. So I do, and he takes it and drapes it over himself and mumbles "mmm it's like a blanket" and goes back to sleep. WTF??! And judging from everyone else's reactions, this is a not an unusual occurance.

So I'm not clear why you consider this bad. You don't say anything about the anything going wrong with the operation. This is the way surgical education should occur...a senior resident should have the opportunity to do the bread and butter cases of their area, from start to finish, without an attending involved, but with the attending around in case there is a problem. THis is done commonly at many programs. Of course, the attending has to trust the senior resident (if the attending didn't trust the residents, they wouldn't be allowed to forge ahead like that). Any resident that is allowed to do that will already have proven him/herself capable.

It is far better to have this situation than for the residents to never have the chance to do an operation alone until they have graduated and started an attending job. You really get good at a skill when you do it with someone less experienced. If the attending is scrubbed, the experience is very different and you really aren't doing the case yourself. And it is critical to learn to do that by the end of your residency.

When the attendings trust the senior residents, they generally grant the residents more autonomy. I never saw an attending scrub an entire case at my med school. For bigger , less common, more complex cases (eg a whipple) they would scrub for the main part (eg taking out the pancreas). But the standard gen surg stuff was done by the residents. The attending was in the building if there was a problem (never saw one take a nap in the OR...but they might have been napping in their offices) The residents there are far, far ahead of my current program, where we almost never get to do anything without the attending micromanaging. That's why I hate my current program.

 

[Mumpu]

The only problem with this case is potential insurance fraud. The attendings bill separately from the residents, and if the OR note said the attending was present for the entire procedure, that's fraud.

No, sleeping in a chair does not count as "present."

 

[TicDouloureux]

Yes, I know that residents often do cases, but usually the attending is either present and alert or off doing something productive - or so I thought - not sawing logs in the corner of the OR. According to the OR staff, he sleeps through pretty much all of his cases every day, then pats everyone on the back and talks about how "we" worked hard today.

Maybe it's because I'm still a starry-eyed idealistic first-half-of-the-year M3, but IMHO if you can't stay awake during the day, then maybe it's time to retire? If I were a patient and found out my surgeon slept through my operation, I'd probably be a bit miffed.

 

[Trichobezoar]

err, maybe he was having a TIA...

My bad doctor story for today:

I'm doing my Anesthesiology elective, and I'm out at one of the community hospitals instead of the main University Hospital. Today they put me in a room where a neurosurgeon was doing a posterior decompression and fusion of C3-C7. He was kinda old - I'd say in his 60s maybe. So 10 minutes into the case, he settles into a chair in the corner of the OR and TAKES A NAP while the residents do the entire case. Right before they fired up the C-arm, someone told me to go hand him a lead apron. So I do, and he takes it and drapes it over himself and mumbles "mmm it's like a blanket" and goes back to sleep. WTF??! And judging from everyone else's reactions, this is a not an unusual occurance.