Boston Med

[SLUser11]

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I know "Boston Med" has been discussed in other forums, but I was just wondering if anyone caught last nights episode, and enjoyed the ridiculous behavior of the two surgical interns that were profiled.

I know that "reality TV" is still just TV, and there was probably some creative editing, but they were dismissive, condescending, arrogant, and 10 other traits that sucked. One guy was way worse than the other, but still it made me wonder if this sort of behavior is condoned in certain prestigious environments.

One of the interns visits a patient's bedside, and sees that a chest tube is still in place that was supposed to be removed.

Intern "This is ridiculous, I was paged by CT surgery 8 hours ago that this was going to be done."

Intern then calls CT surgeon (or possibly even worse a resident from his own program on CT surgery) and chastises them, followed by hanging up and whispering "Worthless!" under his breath.

Intern then threatens that if the chest tube isn't removed soon, "I'll do it myself!!!!"

He then dismisses his senior resident's advice that he not be a huge tool.

He then flops around and struggles with a simple lap appy under step-by-step guidance from his bosses...then acts like he just did a whipple by himself.


How is this behavior possible in a professional environment?

 

[JelloBrain]

I agree that this episode showed totally inappropriate behavior on the part of both the interns portrayed. As it is the public doesn't really understand the rigors of our training, these "real" shows are not helpful in the slightest! At least hospital-based soaps are just that-soaps-and only a fool would believe them to be reality!

The one thing I would like to disagree on, based solely on the Chief Resident's comments, is about the said guy's operative skills. I came away with the impression that the intern aced his first lap-appy and he possessed skills far beyond his year of training. I can't personally comment on his skills as I was never traind to do lap-appys or hernias in the UK, we never did them-open ones were the norm.

 

[SLUser11]

I came away with the impression that the intern aced his first lap-appy and he possessed skills far beyond his year of training.

That was the impression the audience was supposed to get, but that wasn't what I saw. He struggled on one of the simplest cases that exist. Besides, how can you possibly demonstrate skills "far beyond your year of training" on a case like that? The only reason that the staff said that is because she was equally socially awkward and was sort of flirting.

Another great scene: socially inept intern #1 gives socially inept intern #2 advice on how to pick up girls.....it's priceless if you get a chance to see it.

 

[filter07]

I enjoy the show. Clearly the program wanted to show a narrative about young, cocky, brash surgeons in training. There were many instances of "I don't want to sound cocky but..."

The interns acted pretty much like interns I've seen before. There are always a few cocky ones that question their chiefs and attendings, and I think some of that is healthy. The program did have the chief resident on trauma talk about his role in reigning in their egos. Although it is a bit ridiculous to wait all day to have a chest tube pulled, this might reflect the way things are done at the particular hospital rather than poor judgment on the intern. I can imagine overly-protective anal services (CT is usually a prime example) wanting to pull their own tubes.

I don't know how late in the intern year this was, but one thing that impressed me was that the chief allowed the intern to do the case himself. That is probably common at many places, but unfortunately in the university settings where I've been, the intern is either on the floor or holding the camera.

Finally, the show is very surgery and ER heavy. I guess that's what the public finds most interesting. Also, that nurse is getting pretty annoying.

 

[Fah-Q]

I was more offended by the neurosurgery resident who gave the audience the impression that he was "doing" the patient's anterior skull base tumor resection. If you watch closely you'll notice ENT doing the case and he's holding the suction. The fact that he didn't even once mention that this was a combined case with ENT speaks volumes about that guy's character.

 

[JelloBrain]

SLUser11-As I had mentioned in my post, I have not done or even seen a lap appy in the UK, 🙁. The only laparoscopic experience I have is holding the camera for lap-choles, and I wasn't much interested in that at the time. So I'll bow to your opinion.

Filter07-I can't agree more with you on how annoying the nurse is-I guess they needed a pretty face for the camera and she was it!

The thing that I liked was their use of a sheet for the pelvic fracture. I have always done that when training in India due to lack of fancy resources. I was pleasantly surprised that MGH (no less) uses the same easy no-frills solution.

 

[BozoSparky]

I don't think the show tells you much about those hospitals...it's a self selecting group that shows up on TV...

 

[Apollyon]

The fact that he didn't even once mention that this was a combined case with ENT speaks volumes about that guy's character.

Whether it's reality TV or the news, "journalists" are filthy scum, who want effect. "COPS" is a rare exception, because police are a tighter brotherhood than medicine and virtually all other groups. Even for shows like "Blind Date" and "Elimidate", they taped 15 or 18 hours to get material for a 1/2 hour show (15 hours on a blind date? Either you will hate them or you will have sex with them by the end).

I have NO DOUBT that the NSx resident DID state that he'd be working with ENT on the case. However, that's not good TV. We're specialists beyond laymen, so we see these things, whereas they just blow by the average non-medical viewer. The character in question are the producers and editors.

 

[dienekes88]

Even for shows like "Blind Date" and "Elimidate", they taped 15 or 18 hours to get material for a 1/2 hour show (15 hours on a blind date? Either you will hate them or you will have sex with them by the end).

I have NO DOUBT that the NSx resident DID state that he'd be working with ENT on the case. However, that's not good TV.

Agree. I knew a girl who was on a reality competition show. The interviewers, producers, editors, etc. will just ask the same question in different ways over and over again until they get an answer they can use. This is because they're trying to tell a story - e.g. this surgery intern is cocky and brash, this person is reigning him in, etc. - and they'll edit the raw film to pieces to tell it even if it's not true.

 

[SLUser11]

I don't think the show tells you much about those hospitals...it's a self selecting group that shows up on TV...

True enough.

I enjoy the show. Clearly the program wanted to show a narrative about young, cocky, brash surgeons in training. There were many instances of "I don't want to sound cocky but..."

The interns acted pretty much like interns I've seen before. There are always a few cocky ones that question their chiefs and attendings, and I think some of that is healthy....

I don't know how late in the intern year this was, but one thing that impressed me was that the chief allowed the intern to do the case himself. That is probably common at many places, but unfortunately in the university settings where I've been, the intern is either on the floor or holding the camera.

....Also, that nurse is getting pretty annoying.

I also enjoy the show, although it deeply pains me at the same time. I also find the nurse annoying, but I can't be surprised because we all know how nurses are bred in these environments. I also find it ironic that she acts like a weathered know-it-all veteran, then breaks down when she has to do compressions on a kiddo, and admits it was her first time doing that.

As for the intern's behavior, it was straight up unacceptable, and the fact that you don't feel that way reinforces my feelings that this behavior is silently condoned in some academic centers. It seems normal to you because you see it so often.

The guy had a loud, misplaced sense of self-entitlement, and blind arrogance. These are the guys that think they have it all figured out already, and don't think there's much to learn, so they end up hurting patients in the end. On top of that, they are super annoying.

As for the appy, obviously it's more common in some places than others for interns to do that case, but it's defined as "simple laparoscopy" for a reason.

As for the chest tube incident, the problem with that was the interns tone and actions that insinuated that the CT surgeon (or resident) was below him or had to answer to him, and the intern felt he was in a position to reprimand this person.

 

[ESU_MD]

not many CT surgeons I know would even acknowledge an interns opinion.

that guy would have gotten hung up on by me by the end of the first sentence.

 

[Socrates25]

He then flops around and struggles with a simple lap appy under step-by-step guidance from his bosses...then acts like he just did a whipple by himself.

I agree that he was unprofessional in regards to the chest tube but you are grossly exagerrating what happened with the lap appy. The intern clearly says before the case that he's nervous and that he's never done one before. Its not like he said "hell yeah I'm goin to do this bitch solo!" or anything like that.

Once he was in the OR, he did well enough for an intern who's never done one before. The surgical chief was obviously impressed with his skills, and so was the gen surg/trauma attending. They both said in the segment that his skills were pretty good, in fact "beyond" the level normally expected for an intern. I dont remember hearing the guy brag about it after the procedure either.

Considering that both the chief and the attending were with him on the case, I'd defer to their judgment of his skills.

 

[wAyRadikull]

I'm going to side step and ask a really naive question if you don't mind: do interns also wear short white coats? 😕

 

[opr8n]

I'm going to side step and ask a really naive question if you don't mind: do interns also wear short white coats? 😕

they do at some places, like Duke for instance
from what ive heard

 

[alphaholic06]

And Harvard from the looks of this show.

 

[Apollyon]

At Duke, yes. I'd heard that everyone at the Harvards (D-BI, MGH, and B&W) all wear the short coat, from attendings on down.

 

[GTFOOMICT]

I found most of the show putting interns in bad light.

But non-hospital tv viewers find it very entertainig! Ask around.

Pre-meds dig it. Makes every moment seem exciting!

 

[JackADeli]

not many CT surgeons I know would even acknowledge an interns opinion.

that guy would have gotten hung up on by me by the end of the first sentence.

I'm not sure if he was pretending someone was actually on the other line.... All the CT surgeons I know can "defend themselves".... but none would put up with that even if it meant giving an extra dose of plege, scrubbing out, finding the intern (and his chief) and strangling him... and that is only speaking of the fellows. Don't even think about that game with an attending. Good luck to that kid when the CT attending staff sees that video of BDeuche...

The thing that bothered me most... was the abdominal ultrasound comment to the chief resident in front of the patient. There are numerous things that bothered me second.

We spoke of "punitive psychiatry" before in other threads. good luck to residents that, even in jest conduct themselves like that on camera. It can and likely will be used against you.

 

[filter07]

At Duke, yes. I'd heard that everyone at the Harvards (D-BI, MGH, and B&W) all wear the short coat, from attendings on down.

What do the pharmacists, PAs, and NPs wear?

 

[filter07]

As for the intern's behavior, it was straight up unacceptable, and the fact that you don't feel that way reinforces my feelings that this behavior is silently condoned in some academic centers. It seems normal to you because you see it so often.

The guy had a loud, misplaced sense of self-entitlement, and blind arrogance. These are the guys that think they have it all figured out already, and don't think there's much to learn, so they end up hurting patients in the end. On top of that, they are super annoying.

As for the chest tube incident, the problem with that was the interns tone and actions that insinuated that the CT surgeon (or resident) was below him or had to answer to him, and the intern felt he was in a position to reprimand this person.

I also think the behavior was unacceptable, but see it enough, and attribute it to the interns being inexperienced. I think it is common to have an overinflated sense of importance, skill, and judgment when you don't have the benefit of experience and perspective. Teenagers are like this, so are medical students, interns, etc. I think it was telling that the chief resident talked about reigning him in. Maybe academic centers, especially the caliber of B&W, might allow for more cockiness than average, but I think most of that behavior is a reflection of youthful indiscretion rather than institutional mores.

I think you might have questioned the "some of it is healthy" comment. While it is annoying to be second guessed, I think some of that is good. It shows that the interns are thinking, they aren't just blindly following the chiefs' orders, and they feel comfortable enough to speak up when they disagree. If it is excessive, as in the bedside scene and the U/S, it is a problem, but in small doses, it is good.

In the chest tube scene, I would guess that he is talking to another intern or midlevel on the CT service, rather than a resident or fellow. No self respecting senior resident or fellow would let something like that pass without a significant tongue lashing.

 

[Rabbit Hole]

I've never heard of this show. On IMDB it says season 1 episode 1.
I'm wary of "reality" medical shows.. need more reviews.

In the premiere of this eight-part documentary series about the staffs and patients at three Boston hospitals, Maria Troulis is an Oral Maxillofacial surgeon who reconstructs the faces of people who have had traumatic injuries. These include a soldier returning from war, an NFL football player, and in this episode, a police officer shot in the line of duty. ABC cameras are there when the officer and his family arrive at the Mass General ER. Pina Patel is in her fourth and last year of an Emergency Medicine residency. A graduate of Ohio State, she struggles to gain confidence in a training program filled with colleagues toting Harvard degrees. After failing to perform a standard medical procedure and being criticized for her leadership abilities, Pina questions whether she is cut out to go the distance and become an attending. Daniel "Dibar" Dibardino is in a very different place than Pina. He is cocky and self-assured, a surgeon approaching the top of his game after nearly a decade training in the ultra-demanding cardiothoracic program. Even after only two hours of sleep, he talks and walks like he is on rocket fuel as he tries to pull off a tricky double-lung transplant involving two recipients.

 

[SLUser11]

I've never heard of this show. On IMDB it says season 1 episode 1.
I'm wary of "reality" medical shows.. need more reviews.

I'm also wary, as there is always heavy editing.

However, despite all my gripes, I've got it scheduled to record on my DVR, and I know I'll be watching it, so I guess I'm part of the problem......


Here's the intern-in-question's profile, btw. Excellent nickname. He's got an amazing list of pubs, and he's obviously smart and dedicated....just needs to develop some basic social skills and some insight. Too bad the cameras caught him before a good senior resident could straighten him out.....

 

[NJA61479]

I find the interns on the show hilarious. They give the impression that they are in charge and that they make decisions and call the shots. I guess the TV producers didn't want to talk about how their real job is to run errands and check of "to do" boxes. Also as an intern and now as a senior resident I would never pull another services drains, tubes, etc..... ever

 

[JackADeli]

...Also as an intern and now as a senior resident I would never pull another services drains, tubes, etc..... ever

I most certainly would... if it got a rock to the rehab and off my list.😎 The only alternative would be to adivise the "drain service" that their drain was the only thing keeping the patient in the hospital and we would like to transfer care to them for definitive care of the ongoing problem

 

[WentForitandWon]

At Duke, yes. I'd heard that everyone at the Harvards (D-BI, MGH, and B&W) all wear the short coat, from attendings on down.

At D-BI interns wear long coats. At MGH and B&W they wear short coats. Interestingly, the cheifs at BI wear short coats.

 

[Guile]

I'm also wary, as there is always heavy editing.

However, despite all my gripes, I've got it scheduled to record on my DVR, and I know I'll be watching it, so I guess I'm part of the problem......


Here's the intern-in-question's profile, btw. Excellent nickname. He's got an amazing list of pubs, and he's obviously smart and dedicated....just needs to develop some basic social skills and some insight. Too bad the cameras caught him before a good senior resident could straighten him out.....

I love the link at the end of that page: "What is an Appendicitis?"

Regarding reality TV show editing, check out this segment how they can basically make anyone look any way they want. They cut the film here to make it look like a model is flirting with Charlie Brooker.

[YOUTUBE]http://www.youtube.com/watch?v=BBwepkVurCI[/YOUTUBE]

 

[ILikeDrugs]

That surgeon went home to a rather "normal" home, and he came home on a bike. Where are the multi-million dollar mansions? Maybe his Bentley was getting a tune-up at the shop?

 

[GreatSaphenous]

That surgeon went home to a rather "normal" home, and he came home on a bike. Where are the multi-million dollar mansions? Maybe his Bentley was getting a tune-up at the shop?

Its Boston. Like New York and LA, the cost of living goes up dramatically, but reimburment only increases a little. Sad fact is that in large cities, plumbers make as much as some doctors and with better hours.

All for now, go back to your pastrami on rye.
I am the Great Saphenous!!!!

 

[glade]

I know "Boston Med" has been discussed in other forums, but I was just wondering if anyone caught last nights episode, and enjoyed the ridiculous behavior of the two surgical interns that were profiled.

I know that "reality TV" is still just TV, and there was probably some creative editing, but they were dismissive, condescending, arrogant, and 10 other traits that sucked. One guy was way worse than the other, but still it made me wonder if this sort of behavior is condoned in certain prestigious environments.

One of the interns visits a patient's bedside, and sees that a chest tube is still in place that was supposed to be removed.

Intern "This is ridiculous, I was paged by CT surgery 8 hours ago that this was going to be done."

Intern then calls CT surgeon (or possibly even worse a resident from his own program on CT surgery) and chastises them, followed by hanging up and whispering "Worthless!" under his breath.

Intern then threatens that if the chest tube isn't removed soon, "I'll do it myself!!!!"

He then dismisses his senior resident's advice that he not be a huge tool.

He then flops around and struggles with a simple lap appy under step-by-step guidance from his bosses...then acts like he just did a whipple by himself.


How is this behavior possible in a professional environment?

What kind of a worthless douchebag needs to page someone to remove a chest tube? What's he going to do next, page someone next time he needs to urinate so that they can untie his scrubs and hold his weiner? If I got that page, I'd go to the patient and put in additional chest tubes and hang a note on them saying "Merry Christmas, loser. P.S. Follow up the chest x-ray." (Note: nobody lecture me on how this doesn't benefit the patient. I'm well aware of this fact already.)

The gay is strong in that one.

 

[SLUser11]

What kind of a worthless douchebag needs to page someone to remove a chest tube? What's he going to do next, page someone next time he needs to urinate so that they can untie his scrubs and hold his weiner? If I got that page, I'd go to the patient and put in additional chest tubes and hang a note on them saying "Merry Christmas, loser. P.S. Follow up the chest x-ray." (Note: nobody lecture me on how this doesn't benefit the patient. I'm well aware of this fact already.)

The gay is strong in that one.

It seems that his behavior is reinforced, however, because even though we all assume that the CT surgeon tore him a new one after that comment, instead they made him a fast-track CT resident....according to his profile.

 

[glade]

Note: all that means is that they fast-tracked him into a position where he's responsible for removing lots of chest tubes. 👍

 

[Conqueror]

I was more offended by the neurosurgery resident who gave the audience the impression that he was "doing" the patient's anterior skull base tumor resection. If you watch closely you'll notice ENT doing the case and he's holding the suction. The fact that he didn't even once mention that this was a combined case with ENT speaks volumes about that guy's character.

Curry is a fellowship-trained skull base neurosurgery attending. By the description of the tumor it was probably a SNUC or maybe an olfactory groove meningioma, both of which are most definitely cases in which the neurosurgeon does more than hold the suction. The fact that he wasn't actively resecting tumor in the 10 seconds of footage they aired has no bearing on the degree of his involvement in the 4+ hour case as a whole.

 

[VandyMD10]

What kind of a worthless douchebag needs to page someone to remove a chest tube? What's he going to do next, page someone next time he needs to urinate so that they can untie his scrubs and hold his weiner?

At my program, the CT surgeons are very protective of their chest tubes - I wouldn't pull one without explicit instructions to do so from the attending. So yeah, I'd page the CT resident too. I just wouldn't be a d*** about it.

 

[SLUser11]

What did you guys think about tonight's episode? I thought it was very good to show the female trauma surgeon and the social/personal sacrifices that she had to make for her career. Similar situations seem to play out with a lot of the female surgeons I've met over time.

However, when they wheeled in the pulseless blunt trauma, continued compressions, etc for some time without success, and then decided to crack his chest, I threw up in my mouth a little.

 

[JelloBrain]

I couldn't figure out why someone who had a Caesarean section 10 days previously would come to the trauma surgeon instead of going back to the Obstetrician for what sounded like post-op. complications. Is that the norm in USA?

I was also surprised that the ABC team went to Cairo with Bardouche!

Other than that, I have been enjoying Boston Med, living vicariously through it. And I agree about life being tough for female surgeons everywhere.

 

[filter07]

They should have called the show "Boston Surg". Not once did I see someone getting their blood pressure or glucose adjusted. The show is very Surgery-heavy... and rightfully so. The stuff we do is way more awesome.

JelloBrain: it varies at every hospital but sometimes the OB/Gyn team will defer to the acute care surgery team for complications they don't see very often. It's not uncommon for lots of other services to dump their low paying complications to general surgery. A wound washout probably pays little.

 

[Winged Scapula]

JelloBrain: it varies at every hospital but sometimes the OB/Gyn team will defer to the acute care surgery team for complications they don't see very often. It's not uncommon for lots of other services to dump their low paying complications to general surgery. A wound washout probably pays little.

Yep. We would occasionally get consults from Ob for post-op wound infections. These would usually come from residents who had done a year elsewhere and didn't realize that GS was not about to manage their post-op complications.

 

[dynx]

What did you guys think about tonight's episode? I thought it was very good to show the female trauma surgeon and the social/personal sacrifices that she had to make for her career. Similar situations seem to play out with a lot of the female surgeons I've met over time.

However, when they wheeled in the pulseless blunt trauma, continued compressions, etc for some time without success, and then decided to crack his chest, I threw up in my mouth a little.

Eh. Teaching institution. It may be wrong for that patient but its right for the patient that comes in that has a chance. I'd rather have someone who has 1 under thier belt than 0. (I'd prefer 100 but you get the point).

And female surgeons have the same sacrafices male surgeons do. I don't feel bad about self inflicted pain.

 

[Castro Viejo]

However, when they wheeled in the pulseless blunt trauma, continued compressions, etc for some time without success, and then decided to crack his chest, I threw up in my mouth a little.

👍

 

[JelloBrain]

filter07[/B]]
JelloBrain: it varies at every hospital but sometimes the OB/Gyn team will defer to the acute care surgery team for complications they don't see very often. It's not uncommon for lots of other services to dump their low paying complications to general surgery. A wound washout probably pays little.


Yep. We would occasionally get consults from Ob for post-op wound infections. These would usually come from residents who had done a year elsewhere and didn't realize that GS was not about to manage their post-op complications.

Thanks for clarifying that.

PS: I still haven't figured out how to quote multiple messages, the multi-quote button never seems to work for me.

 

[JackADeli]

I couldn't figure out why someone who had a Caesarean section 10 days previously would come to the trauma surgeon instead of going back to the Obstetrician for what sounded like post-op. complications...

Unfortunately...

...it varies at every hospital but sometimes the OB/Gyn team will defer to the acute care surgery team for complications ...It's not uncommon for lots of other services to dump their low paying complications to general surgery...

...We would occasionally get consults from Ob for post-op wound infections...

Post-op wounds are not "low" paying, rather they are often "NO Pay Globals (NPGs)" for the dumpers. Further, some "specialty surgeons" market themselves as a very refined specialty to their patients. Thus, when a complication occurs, the "refined specialty surgeon" will refer to someone that is more skilled in this area....

I remember a csxn patient transfered for wound care after the OB spent 10 days treating the wound by filling it with honey. We washed it out, debrided the necrotic material, wet to dry x24hrs, then put a vac in it... and like magic it healed great!

 

[smq123]

I remember a csxn patient transfered for wound care after the OB spent 10 days treating the wound by filling it with honey. We washed it out, debrided the necrotic material, wet to dry x24hrs, then put a vac in it... and like magic it healed great!

....wait, what?

 

[45408]

I remember a csxn patient transfered for wound care after the OB spent 10 days treating the wound by filling it with honey. We washed it out, debrided the necrotic material, wet to dry x24hrs, then put a vac in it... and like magic it healed great!

Why not VAC it right away?

 

[JackADeli]

Why not VAC it right away?

You could. But, we like to keep a mismanaged wound easily viewable for at least 24hrs before putting an occlusive vac dressing and covering it for 4 days. It gives you a general feel for what the wound base looks like after you cleaned it up and allowed it to settle.

 

[JackADeli]

....wait, what?

Yep, take a internet search... you will find honey in wounds as an old wilderness/pioneer/homeopathetic approach. It does have some data.... Unfortunately, I have seen patients come into the ED with pounds of granulated sugar in their wounds cause they didn't have honey and, "...grandma swore by sweet honey"! I know some wilderness EMTs that also take it a step further and do wet to dry with coca cola.... I have never been able to convince them otherwise.

 

[SLUser11]

I remember a csxn patient transfered for wound care after the OB spent 10 days treating the wound by filling it with honey.

Nice.

Why not VAC it right away?

You typically want to control sepsis prior to placing a wound vac, although a lot of people end up just slapping a "silver sponge" on there and calling it good.

Also, this wound required excisional debridement. Watching it for a little while to make sure no further debridement is needed is a good idea as well.


Is anyone familiar with the literature as far as placing wound vacs on frankly purulent wounds? I can't say that I am, but I've always found it counter-intuitive, since it sort-of turns it into a closed space.

 

[JackADeli]

...Is anyone familiar with the literature as far as placing wound vacs on frankly purulent wounds? I can't say that I am, but I've always found it counter-intuitive, since it sort-of turns it into a closed space.

A few things to consider. The vac by nature is an actively draining wound... though draining into a closed but actively assisting system. Most is industry literature or anecdote.

We have put vacs on frankly purulent wounds. It is counter intuitive and since the attending was nervous, we changed the vac daily for 4 days.... which sort of defeats the purpose and adds great cost. The sponge coming out performs a debridement function similar to wet-to-dry gauze removal. I was always taught to NOT wet the gauze when removing or you lost that debridement benefit of the dressing change. But, back to the purulent vacs... So, we had an attending that had us slap them on unroofed purulent wounds/open purulent incision wounds and daily changes. Well, it eventually happens that a vac is placed for the first time on a purulent wound, just before long weekend, as attending left town, and residents changed rotations..... meaning the daily changes were forgotten. The wound look great at change day 5. After a few experiences like that the chiefs before me and subsequently I as chief, ignored the attending and did standard vac care. If the attending wanted a vac, he/she got a vac with standard of vac care. We were not going to practice expensive voodoo for show to the patient or because we were at a teaching center with attendings too seperated from reality!

Oh, and I always loved the attendings that used active silver type dressings simultaneously with saline wet to dry!!!! Talk about shooting into the foot and paying alot for the bullets.

 

[SLUser11]

A few things to consider. The vac by nature is an actively draining wound... though draining into a closed but actively assisting system. Most is industry literature or anecdote.

We have put vacs on frankly purulent wounds. It is counter intuitive and since the attending was nervous, we changed the vac daily for 4 days.... which sort of defeats the purpose and adds great cost. The sponge coming out performs a debridement function similar to wet-to-dry gauze removal. I was always taught to NOT wet the gauze when removing or you lost that debridement benefit of the dressing change. But, back to the purulent vacs... So, we had an attending that had us slap them on unroofed purulent wounds/open purulent incision wounds and daily changes. Well, it eventually happens that a vac is placed for the first time on a purulent wound, just before long weekend, as attending left town, and residents changed rotations..... meaning the daily changes were forgotten. The wound look great at change day 5. After a few experiences like that the chiefs before me and subsequently I as chief, ignored the attending and did standard vac care. If the attending wanted a vac, he/she got a vac with standard of vac care. We were not going to practice expensive voodoo for show to the patient or because we were at a teaching center with attendings too seperated from reality!

Oh, and I always loved the attendings that used active silver type dressings simultaneously with saline wet to dry!!!! Talk about shooting into the foot and paying alot for the bullets.

The decision to do daily wound vac changes is ridiculous. It really makes me chuckle thinking of some of the voodoo that we do to make our attendings happy. I'm lucky to be surrounded by staff that are relatively evidence-based, but I'm definitely not completely free of these types of requests.

I'm at home, so my ability to do a lit search is limited, but I was unable to find info on wound vacs for purulent wounds. Most papers that popped up on wound vacs used "active infection" as one of their exclusion criteria.

 

[redbeans]

Agreed that the interns on that show are extra Bardouchey. But the problem with douches is they think it's a complement, and accept it as a nickname.

But what do you all think of Dibar? He was my chief resident at Baylor and I think the show portrays him pretty well as an overall good guy, great surgeon.

 

[JackADeli]

...the problem with douches is they think it's a complement, and accept it as a nickname...

Yeh, I was amazed at someone willingly accepting such a derogatory nickname.... I mean, come 5-7 years later, he can fondly look back at how people always thought of him when passing the vinegrette or something! Family must be so proud how he wears the name