My very first intern case

[Foxxy Cleopatra]

Hi guys-

Just wanted to share and vent a little. I did my very first case with a fellow (a R. inguinal hernia and umbilical hernia repair.) I went into the room at about 11:15 and as we were prepping the pt., the anesthesia... (I'm not sure if he was a dr. or a CRNA) started saying, "oh great, a teaching case. Isn't she the one who came in here earlier and said that it was her 2nd day here? This is going to take FOREVER!" So I ignored it, prepped the pt. anyways, and went to work.

The fellow was awesome- was very direct with what he wanted and offered several ideas to help me improve my technique. I thought the case went pretty well (I have never been any more involved in a hernia case than being a human retractor) and we finished around 12:30 (so around an hour total.) Then the anesth. continued to go on (as we were cleaning the pt. up and transferring him) about how he had to delay lunch because of this, about what a rotten day it has been, and reiterated how much he hated teaching cases. He was a pretty big dude so I am sure delaying lunch for 30 minutes is not going to kill him!

I am really trying not to let this shy me away- the fellow is an awesome teacher and I really want to get some cases and learn from him. I didn't want to start at a new hospital telling the whining guy where he can stick it, but on the other hand, I don't plan on backing off of my learning experiences.

Any advice on handling this?
thanks

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[ArrogantSurgeon]

The guy sounds like he's just another anesthesiologist with a case of what is commonly referred to as "scalpel envy".

Next time just tell him to shut his mouth and push the gas and read his newspaper so that you can learn how to operate.

Stand up for yourself once and they'll leave you alone, but if you don't they'll keep disrespecting you. Moral of story: Don't take crap from anybody, especially not a gas pusher.

And if he was a CRNA then you should of just laughed in his face because he is almost a non-entity.

 

[surg]

Foxxy-- I often find that the best advice in situations like this is to do exactly what you did, nothing. Obviously if the Anesthesiologist/ CRNA is directly abusive to you, you should stand up for yourself, but barring that, assume that you can't hear what is happening on the other side of the ether screen that doesn't pertain to you or the surgical team. Popping off this early will likely earn you a reputation as a "difficult" or perhaps "arrogant" surgeon which will often dog you for years, especially if the case then goes poorly. On the other hand a display of confidence and competence (such as getting through the case expeditiously and without incident as it seems you did) will eventually allay the fears of the person on the other side of the screen, perhaps with a few more, he'll amend his tune to say, "I hate teaching cases, but FC is OK! :clap " . Teaching cases do take longer on average, but that's part of the nature of teaching hospitals, to have teaching cases.

BTW-congratulations on your first case!

 

[ArrogantSurgeon]

Surg, with all due respect, doing nothing and pretending not to hear what was said as you advocate is what keeps perpetuating the status quo of interns and junior-level residents being disrespected like FC was.

If you set somebody straight the first time then they'll think twice about disrespecting you ever again.

 

[Skylizard]

1. The guy sounds like he's just another anesthesiologist with a case of what is commonly referred to as "scalpel envy".

2. Next time just tell him to shut his mouth and push the gas and read his newspaper so that you can learn how to operate.

3. Moral of story: Don't take crap from anybody, especially not a gas pusher.

4. And if he was a CRNA then you should of just laughed in his face because he is almost a non-entity.

Just a couple of pertinent negatives and positives.
1. Do not start your surgery career with the mistaken perception that abussive members of other specialties are displaying frustration because "they wanted to be a surgeon" or "they couldn't get into surgery". This is plain arrogant and presumptuitous and displays a lack of general experience and wisdom. The reality is that some people are just jerks...but plain happy with the career choice they made.
2. Do NOT shoot off at the mouth. You can be polite and express to the individual that you feel their comments are innappropriate. You can be polite and inform them that you are sorry if your learning takes a little time but that you are in a teaching institution.
3. Do not assume an attitude as if someone in another specialty is beneath you. There is absolutely nothing wrong with "gas pusher/s". The "gas pusher" in question may have a great deal of knowledge and experience that you may need to rely on later.
4. It is ludicrous to suggest that because the individual is a CRNA they are "almost a non-entity". This "non-entity" is performing a significant and vital role in the overall scheme of your patients care. It is way to early in your career as an intern to start discrediting/disregarding important people in the chain of patient care. I would advise against it through out you career and throughout your internship and especially for someone that might still be a med-student.

Bottom line, you can keep your mouth shut and get the feel/lay of the land. You can say something...BE POLITE. You should not under any circumstance start shooting off, disregarding ancillary staff, or assuming that your chosen specialty implies superiority to someone elses.

 

[eddieberetta]

Just whatever you do, don't be an ArrogantSurgeon.

 

[njbmd]

Hey FC.
That person was having a bad day. You just get about the business of learning surgery just as you did. You never know, that person may be able to teach you something on another day that will help you become a better surgeon. It will amaze you how thick your skin will become and comments like this one will roll off. The important thing was that you got some good teaching right off the bat.

Our new interns started today. It is going to be a steep learning curve for them making the adjustment from medical student to intern. This time next year, you will be suprised at how much you will know and comment like this one will actually be funny. Glad to hear that you had a good teaching experience on your first case. It sounds like you are off to a good start.


njbmd

 

[fourthyear]

Congrats on doing your first case .

Yeah, I wouldn't say anything to the guy. I don't think it can help. He'll just spread the word to all the rest of anesthesia that you are a big fat jerk - and you have to work with these people for years, so you really don't want a reputation like that.

Most anesthesia people I've worked with at several hospitals as a student seem pretty patient with teaching cases - after all, they did sign up to work at a teaching hospital. So don't be discouraged that your 1st experience was not great - hopefully other anesthesia people will be nicer.

This is your learning experience and you have a right to do as much as the attending/fellow/senior resident lets you. Sitting and watching yet another hernia won't make you ever do them any faster.

Sometimes people just like to give the new kid trouble - it's like the substitute teacher phenomenon - it's just too easy to give them a hard time. Try not to let it get to you and go about the business of training to become the best surgeon you can be (which in my book includes not being a rude jerk).

 

[maxheadroom]

Sure wouldn't take AS's advice. Sounds like a good way to start 5-7 years worth of training on the wrong foot. I've seen lots of interns get into pissing matches with other services, nursing, and their own upper levels. It never ends well for the intern. Remember, **** runs downhill. If you start lobbing attitude around the wrong people, it can come back to nail you hard and fast.

Also, Foxy, cliche as it is, the stereotype of the unpleasant female surgeon (often rhymes with "rich") is a particularly hard identity to shake. One of my upper levels (PGY-4) is a woman and she told the female intern whom I'm working with to be extra-special nice. In her words (paraphrased), "While people aren't surprised or upset by a rude or arrogant male surgeon, the mean female surgeon has a much harder life. Don't do anything that would come across as you being mean, unless it matters in patient care." Crappy double standard; we don't make the rules, we just play the game.

Good luck. I'm stuck on ortho this month.

 

[ArrogantSurgeon]

Wow, I never know there were so many people in surgery without a spine and enough dignity to stand up for themselves. Why would you ever take crap from somebody and then try to glorify your passiveness?

 

[powermd]

Originally posted by ArrogantSurgeon
Wow, I never know there were so many people in surgery without a spine and enough dignity to stand up for themselves. Why would you ever take crap from somebody and then try to glorify your passiveness?

Because they're not stupid. The only way to deal with this situation wisely is with caution. An intern has no leverage in the hospital hierarchy and has way too much to lose by taking a risk of earning a bad name early on.

 

[ArrogantSurgeon]

So you're saying that you should allow people to disrespect you because you're worried about what others may think if you stand up for yourself?

 

[Surgdude]

Here's a question for everyone.

Why is Arrogant Surgeon one of the most prolific of repliers and initiators of threads when it has become obvious from one of his recent threads ("Good or bad idea", I believe) that he is in fact a medical student.

I really don't thing that AS has a clue about how the real world works. Creating a negative dynamic from the start will truly hinder you throughout your residency, and if you keep it up, through your career. Being dominating and condescending to others in the OR will only bring you grief. Always remember that people who don't like you can easily make you look bad. This goes especially for the scrub nurse, who can make you look like a chump or a champ.

The anesthesiologist or CRNA may truly hate teaching cases, which is his or her prerogative. Especially when it interferes with either lunch or a smoke break. In the end, it has been their choice whether or not they wish to work in a teaching institution. Working a teaching case that takes longer and may prevent them from earning more money by starting another case that day costs them money. However, I have found that the anesthesiologists are very knowledgeable and often very interesting. Make a point of getting to the OR early to help out, create an amicable relationship with everyone, and life will me easy.

However, if you decide that you want to take a stance, try to flex muscle that you don't have as a resident, identify yourself as a jerk, alienate yourself, become a pariah, and in general just hamstring yourself from the start, listen to AS. I think that he/she will learn from the school of life that the world truly doesn't revolve around him/her, and no matter how many surgical staff asses are kissed, or how frequently, he/she will never look as good as an equal surgeon who knows diplomacy.

 

[apma77]

stop whining FC and learn to work with different personalities!

 

[ArrogantSurgeon]

Originally posted by Surgdude


I think that he/she will learn from the school of life that the world truly doesn't revolve around him/her, and no matter how many surgical staff asses are kissed, or how frequently, he/she will never look as good as an equal surgeon who knows diplomacy.

When have I said anything about kissing a$$? My whole point is that you should never take crap or be reduced to sucking up to anybody. Letting somebody disrespect you is just as bad as you sucking up because it means you think the person can diss you and you should just accept it. Maybe it's only me, but I don't think anybody in this world can diss me without me calling them on it. And if that means they get upset or think I'm a "jerk" or whatever...fu@k them.

 

[apma77]

AS you have a loooooooooooong residency ahead of you full of frustrations with that attitude
when u are a resident you learn to be shi# on ...accept that reality!
even the hospital janitor has more standing than residents..remember that..they have a union you dont!
CIR wont help your cause if you get fired for being "incompetent" as a result of pissing people off!

 

[ArrogantSurgeon]

Originally posted by apma77
when u are a resident you learn to be shi# on ...accept that reality!

It may be reality for some because they passively accept it without ever challenging it. I guess it is easier for some to be like the rest of the sheep and just take it without standing up for themselves.

 

[tussy]

I'm a surgery resident who has low self esteem, but a big mouth. When the nurses and anethetists in the OR start giving me a hard time i often cant resister defending myself - however this only leads to more trouble. The best thing to do is ignore it and prove them wrong by doing the best you can do. Everyone is out for themselves in this buisness. You want to do cases, the anethetist wants to get thru his list as fast as he can so he can go home early. You can't take these comments personally. Just ignore the conversation in the room and concentrate on operating. If you need to vent, talk to your fellow - if inappropriate comments continue he is the best person to defend you without making live difficult.

Happy cutting!

 

[Skylizard]

Originally posted by ArrogantSurgeon
Wow, I never know there were so many people in surgery without a spine and enough dignity to stand up for themselves...

Maybe because YOU are NOT in surgery!

Just a few final thoughts.

I think given the propensity for individuals without experience, maturity, or first hand knowledge to for some reason feel the need to reply to every thread as if they are an authority, It might be nice if you prefaced your replies as:

"I'm a undergrad/1st year/2nd year/third year/fourth year med-student"

Then type, "In my opinion I feel" and/or "my friend/advisor/dean said ..."

You could also add, "I have read/found this information on another forum thread/on the webpage of X/etc...."

Using these caveats/prefaces in your replies would be quite helpful for the readers to have a starting place as to how they might want to gauge the source and accuracy of what someone types. Granted, you could always lie and be completely dishonest/deceptive. An excellent sample preface posted by someone else in an unrelated thread is:

Please don't take this as the gospel because I am in no place to be giving hard facts on this subject...

As to FC, I agree with most replies. I strongly discourage you from acting in a manner that will display ignorance/arrogance/immaturity. However you choose to handle it (i.e. let it pass or talk to the individual), be polite and remember you have quite a few years ahead of you and you will be learning from these people even if they are not physicians. I think Tussy and others have also given good suggestions on dealing with this.

 

[Voxel]

I realize this is very stressful time of year for you and other interns here because the learning curve is very steep. And being in the OR is key for you.

The best solution would seem to be to grin, bear it, develop a thick skin, and concentrate on learning from your surgical fellow. Don't burn any bridges. You don't want the wrong reputation and maybe just maybe you will learn something from this guy in sicu, pacu, anesthesia rotation, or just a nice stock tip.

You need to start to mentally laughing off these silly comments. You're there to learn. Tough luck for the anesthesiologists as you are in a TEACHING hospital. If he doesn't like it there are plenty of other jobs out there. Good luck. Be super nice. People notice super nice and confrontation. You want the former label not the latter. Noone likes a confrontational surgeon (sometimes not even the surgeon themselves).

 

[Foxxy Cleopatra]

Thanks for the replies- this was interesting. I am keeping quiet- I don't like to burn bridges so I'm sure its best to shut my ears. He chewed one of the CRNA's out yesterday so I guess that is just his personality. I want to get all the experience I can, even if I only get to sew the closure.

I'm otherwise outgoing but tend to back down too easily because I don't like to cause controversy or piss people off. However, you don't improve your skills unless you are actually using them.

I feel like a crow hanging around down there, waiting for something to come up that I can do.

-F.C.

 

[njbmd]

Originally posted by Foxxy Cleopatra
I want to get all the experience I can, even if I only get to sew the closure.

I'm otherwise outgoing but tend to back down too easily because I don't like to cause controversy or piss people off. However, you don't improve your skills unless you are actually using them.

I feel like a crow hanging around down there, waiting for something to come up that I can do.

-F.C.

Hey FC,
You have mastered one of the major lessons of surgical internship. Your reward at the end of the year will be a very nice printout of all your cases. I look at mine and beam with pride with well over 100 cases and many more procedures. I was not shy about scrubbing in on anything that would allow me OR time. I pestered every chief resident to do cases with me and I often operated late into the night with my residency director.

I became as effiecient as possible with my floorwork so that I could get into the OR. At UVa, if you are not working on the floor or in clinic, you are expected to get into the OR. If clinic was covered and my floor work was done, I was scrubbed.

Just keep building on your skills and taking every opportunity to learn new skills and procedures. If nothing else, this guy will get used to seeing your bright smiling and enthusiastic face. Good nature is infectious.

njbmd

 

[ortho2003]

Good nature is infectious

So is Chlamydia


Sorry, I couldn't resist. Excellent post and advice NJBMD.

 

[FireAway]

There's really no need to say anything, the guy is making a big enough arse of himself as it is. As an intern/jr rez u can't really "strike back" b/c it will earn u a bad reputation within ur own field.

AS- Don't ever expect your seniors to back u up if you ever act on your forum postings. Personally I imagine u to be a shy little guy with a bad case of short man syndrome who only uses these forums to act out your fantasies of revenge against those who "wrong" you on a daily basis.

 

[duramaterdoc]

I do have an opinion on this. I agree mostly with keeping quiet especially at the beginning. BUT there's only so much *abuse* that one can take given the other more important rigors of surgery internship. AND be aware that sometimes the *abuse* will not stop until you stop it. I had a VERY difficult time during my intern year as a female surg intern (there was only one other woman that year) and I found that A LOT had to do with the staff not used to women...men can be very "dominating" and "authoritative" but women just come out "bitchy". My thoughts were substantiated by female staff, male residents and male staff as well as some nurses...Where I did my internship (which may be [hopefully!] different from where you are) it was very difficult for women.

You're a person too. You do NOT deserve to be treated that way. I found that the best way for me (you'll, of course, have to feel out the general sentiment of your surroundings) was to politely but sternly say in a normal tone and volume, "Please don't make comments like that to me. I don't appreciate being treated in that manner." As silly as this "sounds" you'll be surprised how many people will #1 STOP treating you badly #2 Respect you for your cool response...this response makes you look intelligent, strong and rational and the abuser look irrational and foolish.

But remember, it's only day 2. I would give it some time to simmer down before saying ANYTHING. Everyone gets frustrated when anyone new steps in...trust needs to be built between co-workers first.

Most important when responding...NEVER LOSE YOUR COOL OR YOUR HEAD. A calm person who doesn't "b-tch" always looks smart!

Good luck. I hope this unnecessary abuse stops for you. It can make the difference between enjoying your intern year and hating it.

Just my 2 cents.

 

[ArrogantSurgeon]

Unfortunately dura, some people here seem to not mind being abused by their program. Some even seem "proud" that they can take crap from upper-level residents and attendings without defending their dignity...and paradoxically they call those who stand up for themselves as "weak" and not tuned into the surgical culture.

No thanks, but I for one see no reason as to why a resident who is a few years older than me or an attending who was in my position a while back can disrespect and get away with it as if nothing happened.

And I agree with you in that if you face up to the guy giving you attitude then he'll most likely stop...since most of them are just insecure bullies who continue to abuse residents because nobody has put them in their place.

 

[duramaterdoc]

I'm not advocating having a retort to every sly, abusive thing said...especially if it was said by an upper-level or attending. There is some degree of hazing in surgery and it's just something that you need to learn to laugh-off or ignore--and then when YOU are an upper-level/attending just DON"T DO IT!

NEVER pull rank unless the said upper-level is incompetent and you're sure that YOU are RIGHT and YOU have the backing of the entire department (residents and staff) and nursing staff. I came across an abusive resident and I had to put him in his place.

Anyway, my advice...keep quiet as long as YOU can tolerate it. DOCUMENT EVERYTHING on a list with the time, person and offensive remark/action. When you can no longer take it just calmly ask the person to stop speaking to you in such a manner. NEVER raise your voice or act out-of-control.

I know this sounds very defensive. Not everyone can be trusted in residency. There are many selfish, insecure, abusive people in medicine. You just need to protect yourself.

Keeping quiet is fine. But when it starts to affect you/your love for the job then it's time to speak up and chose your battles. Medicine is a professional environment. It's high time people start acting like it.

2 more cents...

Dura

 

[JasonGreen]

Originally posted by ArrogantSurgeon
And if he was a CRNA then you should of just laughed in his face because he is almost a non-entity.

Wow. I can't believe you just said that. First off, you don't know what you're talking about. I've read a lot of your posts and to me, you sound like you're trying to compensate for being "that kid" in high school that couldn't hack it on the wrestling team and never made the cut for football.

You might be a surgeon, but looks like you need A LOT of social training. Perhaps during one of your cases, you could turn to one of your "non-entities" and learn that from them.

Until you do so, you'll be one of those "dingus doctors" that no scrub, OR Nurse or anesthesia provider wants to be involved in a case with you.

(I bet you throw instruments and piss and moan if 4-0 monocryl is on a PS-1 rather than a PS-2)

And in case you are unaware, 85% of CRNAs practice under no supervision in rural areas where docs refuse to go.

 

[ArrogantSurgeon]

Originally posted by JasonGreen
You might be a surgeon, but looks like you need A LOT of social training. Perhaps during one of your cases, you could turn to one of your "non-entities" and learn that from them.

Hi Jason, this forum is for med students and residents who are interested in surgery or are already in residency. You're obviously a CRNA or training to be one since you're defending them so vigorously. But feel free to participate anyway and pretend you belong with real doctors and med students. Just for your info, most surgeons (or final year med students like myself) would never want to learn anything from a CRNA. If they wanted to learn about anything related to anesthesia, then they'd talk to a real anesthesiologist. Why would we listen to somebody who has less education than we do and isn't even a real physician?

 

[JasonGreen]

Originally posted by ArrogantSurgeon
Hi Jason, this forum is for med students and residents who are interested in surgery or are already in residency. You're obviously a CRNA or training to be one since you're defending them so vigorously. But feel free to participate anyway and pretend you belong with real doctors and med students. Just for your info, most surgeons (or final year med students like myself) would never want to learn anything from a CRNA. If they wanted to learn about anything related to anesthesia, then they'd talk to a real anesthesiologist. Why would we listen to somebody who has less education than we do and isn't even a real physician?

You're only an MS4? That explains everything. You still don't know your ass from a hole in the ground. Actually, I'm not a CRNA, nor am I training to be one.

I watch med students come in and out of the OR, spouting their mouth like they know everything. One med student, in a VERY obnoxious voice said to a scrub tech after the surgeon asked for some trendelenberg, "He saaaaid, he wanted some trendelenberg." As to which the scrub replied, "That's great, you idiot. Trendelenberg isn't an instrument. Now shut up before you break my sterile field with your ignorance." That med student didn't open his mouth the rest of the case. You absolutely don't know ANYTHING until you're in residency and even THEN, do you only start becoming competent in your practice. It's all about experience and by your posts, you show you have none whatsoever.

CRNAs, clinically, as most ologists will agree, know the same and react the same. Sure, a CRNA might not have gone though med school, however, they learn exactly what ologists learn for their clinical practice. The only difference between a CRNA and an ologist is 2 years of school. Two years that doesn't matter whether you use mivacurium vs. succs in a potential MH patient.

When you get out of your diapers and actually make it into the OR, you're gonna find that even your scrub tech is gonna make you feel like you don't know **** in the arena. Take some time before you tromp into the OR thinking you know it all because you'll get chewed up and spit out in no time flat.

Oh, and just so you're in the "know". When or if you do make it into the OR for residency, you'll be doing some anesthesia training. I'll guarantee you that a CRNA is going to be teaching you.

 

[ArrogantSurgeon]

Originally posted by JasonGreen
You're only an MS4? That explains everything. You still don't know your ass from a hole in the ground. Actually, I'm not a CRNA, nor am I training to be one.

I watch med students come in and out of the OR, spouting their mouth like they know everything. One med student, in a VERY obnoxious voice said to a scrub tech after the surgeon asked for some trendelenberg, "He saaaaid, he wanted some trendelenberg." As to which the scrub replied, "That's great, you idiot. Trendelenberg isn't an instrument. Now shut up before you break my sterile field with your ignorance." That med student didn't open his mouth the rest of the case. You absolutely don't know ANYTHING until you're in residency and even THEN, do you only start becoming competent in your practice. It's all about experience and by your posts, you show you have none whatsoever.

CRNAs, clinically, as most ologists will agree, know the same and react the same. Sure, a CRNA might not have gone though med school, however, they learn exactly what ologists learn for their clinical practice. The only difference between a CRNA and an ologist is 2 years of school. Two years that doesn't matter whether you use mivacurium vs. succs in a potential MH patient.

When you get out of your diapers and actually make it into the OR, you're gonna find that even your scrub tech is gonna make you feel like you don't know **** in the arena. Take some time before you tromp into the OR thinking you know it all because you'll get chewed up and spit out in no time flat.

Oh, and just so you're in the "know". When or if you do make it into the OR for residency, you'll be doing some anesthesia training. I'll guarantee you that a CRNA is going to be teaching you.

So now I'm *only* an MS4. Let me ask, what year of med school are you in since you've apparently "watched so many med students come in and out of the OR"? Or should I presume you're already the Chief of Surgery at some medical center?

At any rate, all surgeons were at one time med students and I do realize that every surgeon has to undergo some "trial by fire" as they are gradually allowed greater and greater responsibility in the OR. This also includes being dissed by scrub nurses and other non-physicians when they are just starting out. But realize that the "allied" support staff who do this kind of stuff only do it out of bitterness and jealousy since they know in the back of their minds that the guy/gal they're dissing today will one day be telling them what to do...thus they get all their frustrations out before the resident gets enough clout to start calling the shots. That resident will eventually move up the medical chain of command, while they'll still be stuck where they have always been...and this is where the frustration comes from on their part.

And please don't come in with that weak argument that the only difference between a CRNA and a board-certified anesthesiologist is 2 years of school. That's the type garbage CRNAs and PAs spout when people point out that they are not really doctors. They will always vehemently try to justify why they are the same as doctors, but in the end they don't have an M.D. and will never be considered as physicians by the medical community.

-Have they competed against the brightest of students to get into med school?
-Have they passed hard-core science classes during their first 2 years of med school?
-Have they passed the USMLE Step I?
-Have they busted their butt on the wards in years 3 and 4?
-Have they passed the USMLE Step II?
-Have they competed against other bright med students to get a residency?
-Have they busted their butt in an internship?
-Have they passed USMLE Step III?
-Have they completed an entire accredited residency?
-Have they continusously studied and taken in-service board exams each year of residency?
-Have they passed the written and oral exams to become board-certified in that specialty?
-Have they maybe even completed a 1-2 year fellowship on top of all this to advance their knowledge and skills?

...I didn't think so.

 

[maxheadroom]

Wow, what a ridiculous pissing match!! While nothing makes me happier than seeing AS (who is not a team player, according to his by-line) get dressed down, I'll have to say that you're both acting like idiots.

AS: A CRNA can teach you a ton about running gas on a case. On my gas rotation it was the CRNAs who taught us more than any attending. They know the principles of running a normal case just as well as most MDs. True, they don't have the basic science foundation, so on some of the finer points of pharmacology and physiology they aren't up to speed.

You're going to need to have a major attitude adjustment before you start residency. You need to learn how to work with CRNAs, PAs, NPs, and other ancillary staff; they can make your life much easier or much harder, depending upon how you treat them. No, they aren't MDs, but they have a fund of clinical experience that is usually greater than yours. Particularly, they tend to be highly trained in one specific area of clinical medicine and know it very well. The CT surg PAs are some of the best people that I've worked with in the OR.

Jason: You said that you've read AS's posts, so you should know better than to take him seriously. All you do is goad him post more and more *****ic messages. Any surgical resident will tell you that a good CRNA is a huge asset to the OR. While I'd disagree with you about your being equal to an Anesthesiologist, I'm always glad to see a competent CRNA in the room.

Simmer down, boys. Time for me to scrub.

 

[ArrogantSurgeon]

So far I've ignored most CRNAs and likewise they haven't bothered me...so I can't say it's really been an issue for me in the OR.

My last post was just in response to the person who tried to argue that CRNAs only differ from anesthesiologists by 2 years of education.

 

[JasonGreen]

Originally posted by ArrogantSurgeon
My last post was just in response to the person who tried to argue that CRNAs only differ from anesthesiologists by 2 years of education.

Obviously you didn't read a word I wrote. Let me quote it again for you.

CRNAs, clinically, as most ologists will agree, know the same and react the same. Sure, a CRNA might not have gone though med school, however, they learn exactly what ologists learn for their clinical practice.

Now, by all means. Please come back with something that makes you, again, seem unintelligent and inexperienced.

 

[NaeBlis]

Originally posted by JasonGreen

CRNAs, clinically, as most ologists will agree, know the same and react the same.

I don't think most ologists would agree with that, I've never met one who did. I don't like the idea of posting on the surgical forum, but since the surgeons post over in anesthesia I thought I may as well.

As to CRNA's teaching residents and students, I've never seen a CRNA teach a surgical resident or student anything. CRNA's don't have the same pharm and physio understanding that an anesthesiologist would, or even that of a MS4. That's not a critisisim, they simply aren't taught these sciences to the same level, they are trained react with y when x happens. This is fine with most cases, but in more complicated patients it is important to know why you respond with y, since z may be better. I feel compeled to point out that 95% of CRNA's in the country are supervised by MDA's, and when you see one in the OR, it is because an MDA determined that it was acceptable. In my anesthesia rotations, I have seen 2 operations delayed because there was not an MDA to take the case, and one was deemed necessary. There are CRNA's who practice independantly in small communities, but those hospitals will not take on the more complicated cases, unless it is an emergency.

An anesthesiologist could teach a surgical resident alot about pharm and physio, but they don't because the surgeon doesn't need to know it. There's always talk about the "team" in the OR, but the job of the anesthesia provider is very different and apart from what the surgeon handles. The little bit of overlap is in general things like fluid management, which is not a big part of an anesthesiologists duty and task. Though it is the reason why alot of surgeons think CRNA's are as good as anesthesiologists, they are only familiar with a small part of the disipline.

 

[pelican]

This whole attitude of "there's nothing anyone without an MD can teach me" is a load of crap. Throughout my clinical years in med school, would try to learn as much as anyone was willing to teach me. I didn't care what letters they had after their name -- what I cared about was how confident am I in them teaching me what it was that they were teaching me.

I learned more about patient management from NPs than I ever did from the few residents I worked with during residency. At the same time, I never expected these same NPs to teach me the operative management of a GSW. And since the whole pissing match focused on the issue of CRNAs, they're the ones who took the time to teach me to do RSI intubation and the how to put a person down. At the same time, they were also the same people who started waking the patient up while I was still closing. Annoyed? Yup. But I also got really good at suturing moving targets.

So my suggestion would be to get over the notion that you can only learn from MDs. It's stupid.

 

[ArrogantSurgeon]

Actually you wrote:

Originally posted by JasonGreen
The only difference between a CRNA and an ologist is 2 years of school.

Next time make sure you know what you are talking about before you try to deny what you said.

 

[NaeBlis]

Originally posted by pelican
This whole attitude of "there's nothing anyone without an MD can teach me" is a load of crap. Throughout my clinical years in med school, would try to learn as much as anyone was willing to teach me. I didn't care what letters they had after their name -- what I cared about was how confident am I in them teaching me what it was that they were teaching me.

I learned more about patient management from NPs than I ever did from the few residents I worked with during residency. At the same time, I never expected these same NPs to teach me the operative management of a GSW. And since the whole pissing match focused on the issue of CRNAs, they're the ones who took the time to teach me to do RSI intubation and the how to put a person down. At the same time, they were also the same people who started waking the patient up while I was still closing. Annoyed? Yup. But I also got really good at suturing moving targets.

So my suggestion would be to get over the notion that you can only learn from MDs. It's stupid.

Well, i guess your right, that everyone has something to teach, but after spending 15 minutes trying to explain the difference between rhonchi and rales to an ER nurse and why the poor dehydrated patient could have fluid, I think there is a limit to what lower level practicioners can teach. In the end I had to put the IV in and start the fluid myself because the nurse refused and the ER attending hadn't come back. I don't think it takes long to get a enough clinical exposure that your basic training allows you surpass others. That sounds pretty arrogant I know, but I think its true.

 

[JDENTHOPEFULL]

bump

 

[Chode]

Originally posted by FireAway
There's really no need to say anything, the guy is making a big enough arse of himself as it is. As an intern/jr rez u can't really "strike back" b/c it will earn u a bad reputation within ur own field.

AS- Don't ever expect your seniors to back u up if you ever act on your forum postings. Personally I imagine u to be a shy little guy with a bad case of short man syndrome who only uses these forums to act out your fantasies of revenge against those who "wrong" you on a daily basis.

he posts with his pud in his hand

 

[Chode]

Originally posted by ArrogantSurgeon
So far I've ignored most CRNAs and likewise they haven't bothered me...so I can't say it's really been an issue for me in the OR.

My last post was just in response to the person who tried to argue that CRNAs only differ from anesthesiologists by 2 years of education.

YOU ARE STUDENT !!!!!!!!!!!

The most insignificant piece of stool in the hospital is the student in the OR!!!

dude, do you actually believe anybody but some high school premed buys your total BS????

are you really a med student? I don't believe it
Come on, you're some high school kid, right?
Been watching a lot of ER have you?
Picked up a little lingo from Benton and Romano?

 

[ArrogantSurgeon]

Originally posted by Chode
YOU ARE STUDENT !!!!!!!!!!!

The most insignificant piece of stool in the hospital is the student in the OR!!!

dude, do you actually believe anybody but some high school premed buys your total BS????

are you really a med student? I don't believe it
Come on, you're some high school kid, right?
Been watching a lot of ER have you?
Picked up a little lingo from Benton and Romano?

Wow Chode, your first 4 posts and they're all directed at me...could you just be an already existing member posting under a new name.

 

[Future GI Guy]

AS,

My first four posts weren't directed at you.

Maybe that gives the following statement more weight:

You're an idiot.

GI Guy