Ethics quiz/gimme stitches

[RegularNihilist]

The attending responsible for me, gave me a real scolding yesterday. Like I wasn't tired enough, already, she totally jumped on me with accusations that I had low moral standards and now I am in for another talk with the PD due 2 ethical concerns. Why?

Well, I have just started out, didn't learn much about suturing in med school, and frankly I haven't been too fond of my work so far. I can't seem to get the wound edges properly elevated at will, sometimes they just invert, and I haven't really figured out why yet. The attending told me my stitches were perfectly even-spaced and regular, but I would have to take some bigger chunks of tissue, and have the penetration marks more widely spaced to get the desired result.

Now I did as she told me, but on the next two patients I had to suture, I still think the edges were all wrong. So yesterday, I got this patient with a large, simple, sharp cut on her bald head, and as an added bonus, she had dementia, and asked me three times during the procedure whether I was married to the nurse, so I figured I could experiment a little. I started out with really widely spaced needle insertions, so that the simple interrupted sutures were like two whole inches apart. (not kidding) Then, I tapered down gradually, so that I was like just a few millimeters apart on the 12th stitch. The whole thing looked like a pyramid tattoo, lol. Enter attending from hell, who spots my artwork, and starts biatching that my work is unethical, something about using patients as guinea pigs, blah, blah.

I didn't experiment any less last time I sutured a wound, and depressed the edges, and she was watching!!!! Of course we are using patients as guinea pigs, if we weren't, none of us would ever have gotten to suture, and surgeons would have died out? WTF is she on, anyway, starting to talk about ethics and lotsa yadda yadda.

Women...

---

Members don't see this ad.

 

[Celiac Plexus]

The attending responsible for me, gave me a real scolding yesterday. Like I wasn't tired enough, already, she totally jumped on me with accusations that I had low moral standards and now I am in for another talk with the PD due 2 ethical concerns. Why?

Well, I have just started out, didn't learn much about suturing in med school, and frankly I haven't been too fond of my work so far. I can't seem to get the wound edges properly elevated at will, sometimes they just invert, and I haven't really figured out why yet. The attending told me my stitches were perfectly even-spaced and regular, but I would have to take some bigger chunks of tissue, and have the penetration marks more widely spaced to get the desired result.

Now I did as she told me, but on the next two patients I had to suture, I still think the edges were all wrong. So yesterday, I got this patient with a large, simple, sharp cut on her bald head, and as an added bonus, she had dementia, and asked me three times during the procedure whether I was married to the nurse, so I figured I could experiment a little. I started out with really widely spaced needle insertions, so that the simple interrupted sutures were like two whole inches apart. (not kidding) Then, I tapered down gradually, so that I was like just a few millimeters apart on the 12th stitch. The whole thing looked like a pyramid tattoo, lol. Enter attending from hell, who spots my artwork, and starts biatching that my work is unethical, something about using patients as guinea pigs, blah, blah.

I didn't experiment any less last time I sutured a wound, and depressed the edges, and she was watching!!!! Of course we are using patients as guinea pigs, if we weren't, none of us would ever have gotten to suture, and surgeons would have died out? WTF is she on, anyway, starting to talk about ethics and lotsa yadda yadda.

Women...

This has to be a misguided attempt at humor. Otherwise you are so very wrong, on so many levels.

 

[JackADeli]

...Of course we are using patients as guinea pigs, if we weren't, none of us would ever have gotten to suture, and surgeons would have died out? WTF is she on, anyway, starting to talk about ethics and lotsa yadda yadda.

Women...

This has to be a misguided attempt at humor. Otherwise you are so very wrong, on so many levels.

I'm guessing your interpretation is correct.... If not, I suspect the lack of insight will result in a very interesting visit with the PD.

For the pre-meds and remedial med-students, we do NOT experiment on patients in the course of providing regular/standard surgical care..... If one approaches a basic surgical task with the knowledge they are incompetent and proceeds to EXPERIMENT on the patient before them, one is at great risk of expulsion from training and/or loss of licensure. There is a difference bewteen PRACTICE and EXPERIMENTATION....

 

[RegularNihilist]

I'm guessing your interpretation is correct.... If not, I If one approaches a basic surgical task with the knowledge they are incompetent and proceeds to EXPERIMENT on the patient before them, one is at great risk of expulsion from training and/or loss of licensure. There is a difference bewteen PRACTICE and EXPERIMENTATION....

You are getting worked up over semantics. I have practiced on pork chops and pieces of wet suits. Everybody starts suturing at one point.

How widely do you think my sutures should be allowed to be like, before it is considered "experimentation" in your black and white world?

This is the same attending that let a fresh medical student suture a drunk person without hardly any training beforehand one week ago. Frankly, I was surprised she reacted at all, hearing her mentioning ethics just makes me want to spell out loud: "hypocrite."

I have done wounds with wide-sutures before, and wounds that were really closely stitched.

How come those wounds weren't unethical? Huh?

How come my stitches get any more unethical by the fact that this woman was a vegetable?

Is it possible for you guys to use any logic at all, or was majoring in some history BS a substitute for those capabilities where you are at?

 

[JackADeli]

...I haven't been too fond of my work so far. ...I haven't really figured out why yet...

...as an added bonus, she had dementia,
...so I figured I could experiment...
...The whole thing looked like a pyramid tattoo, lol...
...Of course we are using patients as guinea pigs...
...starting to talk about ethics and lotsa yadda yadda.
Women...

You are getting worked up over semantics.

How widely do you think my sutures should be allowed to be like, before it is considered "experimentation" in your black and white world?

...hearing her mentioning ethics just makes me want to spell out loud: "hypocrite."

...How come those wounds weren't unethical? Huh?

How come my stitches get any more unethical by the fact that this woman was a vegetable?

Is it possible for you guys to use any logic at all, or was majoring in some history BS a substitute for those capabilities where you are at?

I will leave this matter with a few points....
1. My perception on your post was unrelated to the patient's dementia. I do NOT believe I at any point even referenced her dementia as a factor in your clinical actions. Your commentary on the dementia and subsequently her being "a vegetable" will help you greatly in your future discussions.
2. YOU write of "practice" on pork chops and your plan to "experiment" on your patient... YOU presented your approach and intent to experiment on this matter.... enough said.
3. I think we have used some logic and it was missed. Thus, I concur with your attending that maybe you will receive a better understanding from your meeting with the PD.

best wishes,
JAD

 

[Procyon]

For the pre-meds and remedial med-students, we do NOT experiment on patients in the course of providing regular/standard surgical care..... If one approaches a basic surgical task with the knowledge they are incompetent and proceeds to EXPERIMENT on the patient before them, one is at great risk of expulsion from training and/or loss of licensure. There is a difference bewteen PRACTICE and EXPERIMENTATION....

This is a dumb question, I'm sure, but since I'm a pre-med I hope that's allowed. How do physicians in training practice the basic stuff like suturing?

 

[Pir8DeacDoc]

These days everything is pretty much learned in a very supervised manner. You practice in suturing labs as a medical student and then as you do clerkships you are allowed to throw a few stitches here or there on patients with close oversight. When you have mastered that then you are given more and more liberty. There is generally oversight and tutorial if you aren't sure what type of stitching to perform or exactly what the attending wants. Once you progress the attending will generally leave the room when it's closing time (depending on their sphincter tone).

I can't speak for everyone but I take great pride in making sure the pt gets the very best operation I can offer and am more than willing to ask the attending if I am uncomfortable. In my mind learning and excellent care don't have to be mutually exclusive.

 

[maxheadroom]

I think the attending's big objection (along with mine) is the varying technique on a patient (especially a helpless, demented patient). Try different techniques on different patients -- as a Plastic Surgeon I try different variations all of the time.

 

[SouthernSurgeon]

I have done wounds with wide-sutures before, and wounds that were really closely stitched.

How come those wounds weren't unethical? Huh?

Do you think that your pyramid sutures were the best work you were capable of on that particular patient and their wound?

 

[ESU_MD]

dont you wish you just stapled it?

 

[JackADeli]

dont you wish you just stapled it?

But, that would not have satisfied the curiousity and wonder that an experiment does.... It also would have forced a more consistent approximation.... again, no cool pyramid like tatoo appearance at the end... though closure would be shiny but require staple removal from "vegetable" at some point....

 

[RegularNihilist]

Do you think that your pyramid sutures were the best work you were capable of on that particular patient and their wound?

No.

The best work would have been if I had used the narrower sutures all the way. No doubt.

However, I didn't think it was necessary to remove the wide stitches. I was gonna put some steri strips on it, but then the attending came, cut my sutures away, did the job over again, even the sutures that were nice looking and regular, probably because she is a woman, and irrational when she gets upset.

dont you wish you just stapled it?

Do you put staples on a scalp wound when epicranius is cut through and the galea is exposed? Some monster staples. Hey, I am asking, I ain't no hot shot surgeon.

 

[SouthernSurgeon]

No.

The best work would have been if I had used the narrower sutures all the way. No doubt.

Then there's the answer to your "ethics quiz" - for whatever reason, you chose to give a patient care that you knew to be inferior.

 

[RegularNihilist]

Then there's the answer to your "ethics quiz" - for whatever reason, you chose to give a patient care that you knew to be inferior.

If I had known what sutures were right, I'd never attempted a 'pyramid.' I found out. That is different. I didn't ask about the ethics concerning correcting a suboptimal suture retrospectively, vs getting maybe a 5min break.

 

[LucidSplash]

If I had known what sutures were right, I'd never attempted a 'pyramid.' I found out. That is different. I didn't ask about the ethics concerning correcting a suboptimal suture retrospectively, vs getting maybe a 5min break.

So out of curiosity, at the risk of appearing to mirror your somewhat argumentative posture, what sort of nihilism do you subscribe to? At some points it seems as though you are asking an ethics question but that you subscribe to moral nihilism, based on your responses.

 

[thedrjojo]

...probably because she is a woman, and irrational when she gets upset.

I'm surprised with all the quoting and arguments going on here, that he hasn't been called out for his repeated sexism.

It seems to me you came here not to get your question answered, but instead to get an affirmation of what you believed was unfair treatment, but since no one has agreed with you thus far, you are getting defensive. Part of it goes with how you presented the situation to us. Focusing on the patient being demented, calling it an experiment, and calling attention to the fact that you made a "cool pyramid appearance" does not bode well to your case that it was not an ethical issue.

Most other people have addressed why it was indeed unethical to have done what you did, and I think you probably do know this too.

 

[RegularNihilist]

I'm surprised with all the quoting and arguments going on here, that he hasn't been called out for his repeated sexism.

I suppose this can be attributed to the high IQ of SDNers, and their exposure to statistic differences in gender conduct, without necessarily implying that one sex is better than the other, under all circumstances. Some of us actually do like women, especially when they are helpful, e.g. cleaning, ironing, doing the dishes, and give head (yes it DOES happen, I have it on tape).

It seems to me you came here not to get your question answered, but instead to get an affirmation of what you believed was unfair treatment, but since no one has agreed with you thus far, you are getting defensive.

Correct.

Part of it goes with how you presented the situation to us. Focusing on the patient being demented, calling it an experiment, and calling attention to the fact that you made a "cool pyramid appearance" does not bode well to your case that it was not an ethical issue.

So pyramids are unethical, now?

Most other people have addressed why it was indeed unethical to have done what you did, and I think you probably do know this too.

I do know that other people addressed it. I just don't think their arguments are very thought-out. Bad stitching gets any better if the woman is less defenseless, like a lezdom-karate-freak on crystal meth?

 

[LucidSplash]

I'm surprised with all the quoting and arguments going on here, that he hasn't been called out for his repeated sexism.

Personally, I saw it as the low-hanging fruit offered on the Troll Tree and if I really feel that compelled to respond to a troll, I try to avoid the most obvious snare.

 

[RegularNihilist]

Personally, I saw it as the low-hanging fruit offered on the Troll Tree and if I really feel that compelled to respond to a troll, I try to avoid the most obvious snare.

Personally, I'd find it more fruitful, if you would get arrested for throwing out troll-allegations as a substitute for actual arguments. Glad I don't feel compelled to defend myself on every point, huh?

 

[JackADeli]

...as an added bonus, she had dementia,
...so I figured I could experiment...
...The whole thing looked like a pyramid tattoo, lol...
...Of course we are using patients as guinea pigs...
...starting to talk about ethics and lotsa yadda yadda.
Women...

...Some of us actually do like women, especially when they are helpful, e.g. cleaning, ironing, doing the dishes, and give head (yes it DOES happen, I have it on tape)....
...Bad stitching gets any better if the woman is less defenseless, like a lezdom-karate-freak on crystal meth?

This probably belongs in the lounge based on the material I have seen in past relocated and/or closed threads....

 

[Winged Scapula]

I will not close it yet, but users should be advised that offensive content is a violation of the SDN Terms of Service and will result in the thread being closed and/or moved. Professional, appropriate and non-offensive discussion should be the goal.

And thank you to the number of users, almost all male, who found the comments in the thread above offensive and reported it. I am proud to have you as my colleagues.

 

[Moonglow]

Come on WS, the poster is a regular nihilist.

 

[RegularNihilist]

It would have been way more honest to give me a warning and an additional infraction, saying you hate me, and it's personal.

Look up on Salman Rushdie for his comments about adhering to vaguely defined terms of offensiveness as a normative guideline for behavior and opinion.

Look up some epistemology, and stop pretending to know the motivation behind my posting here.

On to some nicer news. I got to suture again. It went really well. I talked to my attending again. It did not go so well. God, I hate attendings.

 

[45408]

Personally, I'd find it more fruitful, if you would get arrested for throwing out troll-allegations as a substitute for actual arguments. Glad I don't feel compelled to defend myself on every point, huh?

No, it's just that some of us get pretty good at spotting the trolls. I'm sure your next attempt will be more subtle.

 

[SouthernSurgeon]

No, it's just that some of us get pretty good at spotting the trolls. I'm sure your next attempt will be more subtle.

But sometimes if you take the obvious bait and run with it, you can get them to cross over the line and get themselves banned...

 

[Dissonance]

This dude is trying to be the next Mysterioso, but oh so failing miserably.
Kudos though, I did enjoy your story.

 

[LucidSplash]

But sometimes if you take the obvious bait and run with it, you can get them to cross over the line and get themselves banned...

Or even PM you profanities.

 

[SouthernSurgeon]

Or even PM you profanities.

awesome