Morning rounds abdomenal exam

[bobbyseal]

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I'm starting to notice something that kind of bothers me on my morning rounds. First, I do my heart and lung exam (albeit in a half assed manner through the gown) which isn't a big deal. However, when I get the abdomen, I want to see the incision and feel how the pt's pain is. Why is it that pts just lay there while I'm struggling to get the gown up to see the belly? I mean, just lift your fat ass off the bed so I can get the stupid gown up. They just seem so content to feel the gown getting ripped between their buttcheeks and the bed. What's really bad is the gastric bypass pt who has their gown tucked so tight that not even the hulk could pull the thing up.

Is anyone else frustrated by this? Probably not enough to post on SDN, right?!

 

[Vincristine]

there's too much else in life to be pissed off by that I can't belive this even ranks.


You can say something poliet like, "now I need to take a look at your incision" (most people usually understand that means you don't have xray vision.) If they don't make a movement, when you're pulling on the gown ask them to gently lift or roll off to one side.

 

[CUarzt]

do abdomenal exams come before or after the abdominal exam? 😳

 

[bobbyseal]

Fair enough. I'll leave my gripes about *abdominal* exams elsewhere. Thanks for the spelling hint.

 

[CUarzt]

no harm intended

i cant relate, so ill have to take your word for how frustrating it is

 

[njbmd]

I'm starting to notice something that kind of bothers me on my morning rounds. First, I do my heart and lung exam (albeit in a half assed manner through the gown) which isn't a big deal. However, when I get the abdomen, I want to see the incision and feel how the pt's pain is. Why is it that pts just lay there while I'm struggling to get the gown up to see the belly? I mean, just lift your fat ass off the bed so I can get the stupid gown up. They just seem so content to feel the gown getting ripped between their buttcheeks and the bed. What's really bad is the gastric bypass pt who has their gown tucked so tight that not even the hulk could pull the thing up.

Is anyone else frustrated by this? Probably not enough to post on SDN, right?!

Hi there,
After a couple of mornings of me asking very politely for the patient to turn to the side so that I can free the gown, most of my patients are already untied and ready for exam. Of course when you are in the greatest hurry, the patient is moving the slowest.

I was never a big fan of gastric bypass patients lying in bed more than a couple of hours after the anesthesia wore off. Sometimes I had to threaten to take their beds if they did get out of them. They got the message pretty quickly. Also, my institution has enormous gowns that could be easily pulled up on the largest folks (some were 600 pounds) so that I could look at incisions and port sites.

Ah, the joys of morning rounds!

njbmd 🙂

 

[bobbyseal]

Yeah,

I guess the patients get used to the idea of morning rounds. I guess it's just that when I'm the most busy is when there's some patient who's just sitting there regressing into childhood waiting for mommy to take care of them.

I changed the spelling on the title. Maybe next time I'll try using that spell check thingy.

Hi there,
After a couple of mornings of me asking very politely for the patient to turn to the side so that I can free the gown, most of my patients are already untied and ready for exam. Of course when you are in the greatest hurry, the patient is moving the slowest.

I was never a big fan of gastric bypass patients lying in bed more than a couple of hours after the anesthesia wore off. Sometimes I had to threaten to take their beds if they did get out of them. They got the message pretty quickly. Also, my institution has enormous gowns that could be easily pulled up on the largest folks (some were 600 pounds) so that I could look at incisions and port sites.

Ah, the joys of morning rounds!

njbmd 🙂

 

[imtiaz]

we have an M3 on the service now who on rounds said:

the patient has a grade III systolic ejection murmur best heard in the aortic position that radiates to both carotids.

the chief resident stopped the presentation and said:

dont ever say that again. ever.

i love surgery 🙂

 

[DO_Surgeon]

For the vitals do you still write out the temp, BP, etc or is it just AF/VSS. I am still writing them out, when is it acceptable to shorten it down to five simple letters?

 

[ivan lewis]

You mean the fat lazy patient who just had an open abd surg (whipple? gastrectomy? colectomy?) won't help you out by jumping out of the bed and letting you exam his belly when you pre-round at 5am? What an inconsiderate bastard! Right......

 

[Blade28]

Usually I just say "let me take a look at your belly/incision" and the patient will lift their body off the bed a little so I can pull their gown out of the way.

we have an M3 on the service now who on rounds said:

the patient has a grade III systolic ejection murmur best heard in the aortic position that radiates to both carotids.

the chief resident stopped the presentation and said:

dont ever say that again. ever.

Great story! 🙂 We had a third-year med student (at the end of his M3 year) begin a presentation by saying:

"Here in room 806 we have Mr. Smith, a 55-year-old Caucasian male who is post-op day #2, status-post partial gastrectomy. He says that he hasn't had a bowel movement yet, but passed some gas yesterday..."

And then the chief got impatient, interrupted the med stduent, looked at me, and said "Give me the quick version."

My version was:

"Post-op day #2, passing gas, on clears, afebrile, vital signs stable, incision looks good." 😀

 

[Apollyon]

For the vitals do you still write out the temp, BP, etc or is it just AF/VSS. I am still writing them out, when is it acceptable to shorten it down to five simple letters?

Haha, you're funny. The COMPLETE surgical progress note:

af/vss
SNT
C/D/I
CCM

Being EM, I appreciate brevity, and, where I'm at, GS is a GREAT bunch of folks (as one attending said, the best, ever, anywhere, by far - never an argument about a consult or admit, they're fast, and they're virtually all just nice people).

 

[LovelyRita]

"I have to look at your belly. We need to lift up your gown."

 

[Lemont]

I find it funny how surgical residents act like they're nonchalant and pretend to get upset if detailed info is given to them so they can seem too cool to be 'bothered' by anything but the basics. When in reality most of them are among the most anal people I have ever met. Too many phonies in medicine, a lot of them in surgery.

 

[Silverfix]

we have an M3 on the service now who on rounds said:

the patient has a grade III systolic ejection murmur best heard in the aortic position that radiates to both carotids.

the chief resident stopped the presentation and said:

dont ever say that again. ever.

i love surgery 🙂

That's awesome.


I've never had any trouble with lifting patient's gowns. I just ask them to do it. I think that's actually what your supposed to do anyway, right?

 

[imtiaz]

For the vitals do you still write out the temp, BP, etc or is it just AF/VSS. I am still writing them out, when is it acceptable to shorten it down to five simple letters?

it depends on the service. ive never been able to get away with WRITING it in a note, but they let me present patients that way verbally on rounds. i would err on the side of caution unless told otherwise.

 

[tussy]

Haha, you're funny. The COMPLETE surgical progress note:

af/vss
SNT
C/D/I
CCM

).

Okay, I'm a PGY5 in gen surg and i can't figure out what the middle 2 lines are. I know the first is afebrile, vital signs stable, and the final line is continue current management, but what are the other two??? In my institution we are only allowed to write "recognized" abreviations. CCM is not allowed, AVSS is tolerated. The rest needs to be written out. Of course the clerks and interns write all the notes, but i definitely get on their case if the notes are too brief. I want to know all the ins and outs and pertinent bloodwork (like bili, wbc, hemoglobin etc.). If a patient ever sued you and you had to read out the above note in court you would surely be embarassed.

 

[bobbyseal]

Okay, I'm a PGY5 in gen surg and i can't figure out what the middle 2 lines are. I know the first is afebrile, vital signs stable, and the final line is continue current management, but what are the other two??? In my institution we are only allowed to write "recognized" abreviations. CCM is not allowed, AVSS is tolerated. The rest needs to be written out. Of course the clerks and interns write all the notes, but i definitely get on their case if the notes are too brief. I want to know all the ins and outs and pertinent bloodwork (like bili, wbc, hemoglobin etc.). If a patient ever sued you and you had to read out the above note in court you would surely be embarassed.

C,D,I = clean dry and intact (in regards to the wound). Not sure about SNT

 

[SocialistMD]

Not sure about SNT

Soft, Non-Tender

 

[boston]

I find it funny how surgical residents act like they're nonchalant and pretend to get upset if detailed info is given to them so they can seem too cool to be 'bothered' by anything but the basics. When in reality most of them are among the most anal people I have ever met. Too many phonies in medicine, a lot of them in surgery.

That is some profound insight you have. Your psychoanalytical skills are truly amazing. It never hit me before, but it's true... my most immediate concern on morning rounds is to look cool in front of the med student.

Clearly, you have never been in the position of a chief resident trying to manage a service with, say, 18 patients, 3 of whom are in the ICU. You have 60 minutes to get through rounds and report to the attending on time. That's 60 minutes to evaluate each patient and make a plan. Do the math. 6 minutes for an ICU patient, 3 minutes for a floor patient. There is simply no time for extraneous information that only serves to distract and does not influence management decisions. You'll be a good doctor some day when you are able discern signal from noise, filter important information from unimportant.

Surgical residents are probably among the most anal people in society, but that is a good thing. Trust me, if you ever need surgery in the future, you want the person operating on you to be meticulous and detail-oriented. The real "phonies" in medicine are doctors who make mistakes because of laziness or arrogance.

Lastly, please do not make uninformed assumptions when you do not understand the situation. When you assume, it just makes an a$$ out of u and me. 🙂

 

[Apollyon]

Okay, I'm a PGY5 in gen surg and i can't figure out what the middle 2 lines are. I know the first is afebrile, vital signs stable, and the final line is continue current management, but what are the other two??? In my institution we are only allowed to write "recognized" abreviations. CCM is not allowed, AVSS is tolerated. The rest needs to be written out. Of course the clerks and interns write all the notes, but i definitely get on their case if the notes are too brief. I want to know all the ins and outs and pertinent bloodwork (like bili, wbc, hemoglobin etc.). If a patient ever sued you and you had to read out the above note in court you would surely be embarassed.

You think I'm kidding? I've SEEN the note I put above.

No matter how clear, concise, and in-depth your note, you will STILL be embarassed in court. That's a given.

 

[Lemont]

That is some profound insight you have. Your psychoanalytical skills are truly amazing. It never hit me before, but it's true... my most immediate concern on morning rounds is to look cool in front of the med student.

Clearly, you have never been in the position of a chief resident trying to manage a service with, say, 18 patients, 3 of whom are in the ICU. You have 60 minutes to get through rounds and report to the attending on time. That's 60 minutes to evaluate each patient and make a plan. Do the math. 6 minutes for an ICU patient, 3 minutes for a floor patient. There is simply no time for extraneous information that only serves to distract and does not influence management decisions. You'll be a good doctor some day when you are able discern signal from noise, filter important information from unimportant.

Surgical residents are probably among the most anal people in society, but that is a good thing. Trust me, if you ever need surgery in the future, you want the person operating on you to be meticulous and detail-oriented. The real "phonies" in medicine are doctors who make mistakes because of laziness or arrogance.

Lastly, please do not make uninformed assumptions when you do not understand the situation. When you assume, it just makes an a$$ out of u and me. 🙂

Get over yourself already. Self rightous residents (or whatever you are) who think they have got it all figured out come a dime a dozen in this profession.

 

[boston]

Get over yourself already. Self rightous residents (or whatever you are) who think they have got it all figured out come a dime a dozen in this profession.

Originally Posted by Lemont
I find it funny how surgical residents act like they're nonchalant and pretend to get upset if detailed info is given to them so they can seem too cool to be 'bothered' by anything but the basics. When in reality most of them are among the most anal people I have ever met. Too many phonies in medicine, a lot of them in surgery.

Hilarious, dude. Calling me self-righteous... read the tone of your original message. Who's the self-righteous one? Just wanted you to consider what your resident's perspective might be before you make uninformed generalizations and dismiss their behavior as "phoney" or "trying to look cool." Perhaps one day you may find yourself in their shoes.

Can't take criticism too well eh? Don't worry, you've got everything and everybody figured out already anyway - you'll be a perfect surgical resident.

 

[Lemont]

Don't worry, you've got everything and everybody figured out already anyway - you'll be a perfect surgical resident.

I know. But thanks anyway.

 

[Doc Ivy]

You mean the fat lazy patient who just had an open abd surg (whipple? gastrectomy? colectomy?) won't help you out by jumping out of the bed and letting you exam his belly when you pre-round at 5am? What an inconsiderate bastard! Right......

Amen!

The OP's post is clearly coming from one who's never has abdominal surgery---it hurts to move, got it?? After chest surgery, I got hypercapnic cuz it just hurt too much to breathe. It's a simple hokey message that's tried and true: Try to have empathy in everything you do