Physical demand during rotations

Discussion in 'Clinical Rotations' started by TeNa, May 11, 2008.

  1. TeNa

    TeNa Junior Member

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    I was wondering if during 3rd year you are mostly on your feet all day, or do you guys get to sit or lay down once in a while during your shift? My concern is that I have some bad back problems, and although I can stand most of the day I do get pretty sore by the time night comes. I don't know If I could stay on my feet all day for multiple days in a row. I worry that when I do get to 3rd year and most of my classmates are on their feet all day busting their *** and I keep sitting down or asking the attendings/residents if I can sit for a while, they will think that I am being lazy. I guess I was hoping there's enough down time where I can still put in the normal work without being on my feet all day and not look like a need some special situation in contrast to the other students.
     
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  3. smq123

    smq123 John William Waterhouse
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    * You don't have to ask permission to sit down. :) If there's a free seat, and you're not doing anything particularly important at that time, you can sit. (Sometimes, if there's only ONE chair, I'll ask the intern/resident/attending if they want to sit down first, just because they're usually more tired than I am. Generally, though, they'll just tell me to sit down.)

    * It varies, depending on the rotation. Psych, family med, and optho, I sat down for most of it. Surgery and OB, though - since you're always doing something, there isn't a lot of time to sit. Medicine was a mix.

    * If you have bad lower back pain, when you do your surgery rotation, sign up for services that traditionally have shorter surgeries - breast, general, trauma (sort of), ENT, colorectal. Avoid surgical oncology, CT, HPB, vascular - they often have the marathon surgeries that you hear about.

    * Get good shoes.

    * What year are you in now? If you're just finishing up first year (or you haven't started med school yet!), then spend the time until then improving your physical strength. Being in good physical shape will actually help you in third year.
     
  4. Law2Doc

    Law2Doc 5K+ Member
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    There are absolutely rotations where you can expect to be standing on your feet all day. During long surgeries (some lasting 8 or more hours, and at many schools you don't get to select the subspecialties as much as the prior poster described), you may be scrubbed in and holding retractors, while contorting to not be in the way of the surgeons, and have no opportunity to do more than flex your legs. Your back will ache even if you didn't have back problems. During medicine, you may be rounding (walking from patient to patient in the hospital) for many hours each day. So yes, it is an endurance issue. If your back is a serious condition, you may want to discuss the issue with someone at the school and see if accomodations need to be made. If it's just going to hurt at the end of the day, you are probably in the same boat as many others. I agree with the prior poster that good shoes are going to be key for 3rd year.
     
  5. smq123

    smq123 John William Waterhouse
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    Hey...I haven't seen Law2Doc post in a while, it feels like. How've you been?

    [sorry for the thread hijack]
     
  6. Law2Doc

    Law2Doc 5K+ Member
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    I've just been stuck on my feet too many hours a day to get to a computer the last week or two. :laugh:
     
  7. TeNa

    TeNa Junior Member

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    Ohh boy. :(
     
  8. Ashers

    Ashers Bacteria? Don't exist.
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    hehe nice.

    As for laying down. The only rotation on which I've been able to lay down was on OB/gyn in house call where I got to sleep for a record 1.75 hours

    I'd be in CT surgeries and some general surg (really, really slow attending), standing for 8-10 hours. I'd sometimes try to stretch, and I'd have the scrub tech be like, "are you ok? you gonna pass out?"

    Get good shoes. I wore Danskos. My back would still hurt in those 8 hour surgeries, but I don't think that'd be avoided. Walking around all day I'd be ok.

    Peds some days I'd never sit down or eat except the food I had in my pockets, and now on medicine, I'm not doing much. I'm on call, eating dinner and on SDN. In other words... bored.
     
  9. getunconcsious

    getunconcsious Very tired PGY1

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    Awwz...no worries, I'm pretty sure he was just kidding :oops:

    In any case, you do have to stand a lot on MS3 in some rotations, I guess the most troublesome would be Surgery and OB/Gyn. Medicine may also be problematic b/c of loooong rounds where you're on your feet the whole time. Do you see a doctor for your back problems? It might be worth talking to someone (doctor, chiropracter, whatever) and see if you can optimize things before you start the year. Maybe they can give you some heavy duty NSAIDS or maybe a brace you can wear or something.

    In terms of minimizing time spent on your feet, someone already said avoid long surgeries, which is probably a no-brainer. I'm on Surgical Oncology right now and am probably on my feet and scrubbed in for 8-9 hours at a day with surgeries lasting anywhere from 3 to 7 hours, and you have to stand the whole time scrubbed in. On most general surgery rotations the majority of cases are pretty short (Under 2-3 hours). If you really do get into a pickle, the attending, resident, or scrub tech will let you scrub out to sit down for a bit, but your concern about looking lazy is valid; I would not ask to do this more than 2 or 3 times.

    For OB, try to get deliveries mainly on multiparous women, the more kids they've had the faster it goes. If you get a prima gravida, you may be stuck standing there telling her to push for up to 3 hours. If it's someone's 6th kid, it will likely be over in 40 minutes or so.

    On Medicine, you may get lucky enough to have an attending who does sit down rounds, although the vast majority have you walking/standing the whole time (usually 3-4 hours). One trick you could do is when they aren't discussing your patient or are moving between rooms, dart off and check lab results on your pts that might have come online in the last few hours. Your intern will love you for this, and you can sit down AND be helpful at the same time!

    For the others like Psych, Neuro, Family, and Pedi I found that there was usually time enough to sit that my feet/back did not ever bother me (but I didn't have back problems coming in).

    Best of luck, I'm sure that you will find a way to get through it, hopefully my suggestions help a bit.
    :luck::luck::luck::luck::luck:
     
  10. doc20

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    learn some easy techniques so that you dont kill your back, you are in this for life time.
    for ex dont bend while drawing blood etc. instead just raise the patient bed to your height level
     
  11. AmoryBlaine

    AmoryBlaine the last tycoon

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    That sucks. It probably won't be a huge issue on most rotations though. Especially if your places uses EMR you sit down to type notes and stuff like that.

    Surgery might suck though, as might Ob/IM as others have said. Unfortunately people are not very understanding about stuff like this, working so hard tends to give everyone a martyr complex. You'd probably be best off trying to push through stuff rather than asking for special treatment.

    It's not reasonable or fair but if you get an even slightly uncool surgery resident they are going to look at you as "the weak one."
     
  12. Hey, YOU should know better than this! They're not "surgeries." They're "operations" or "cases." We don't "do surgery" or "have scheduled surgeries."

    ;)
     
  13. Ashers

    Ashers Bacteria? Don't exist.
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    Sorry, I'm being indoctrinated on medicine. ;)

    My medicine team also says it's my fault that a hip fracture was missed on a dude they were sending to the geriatrics team despite me never having seen the patient or knowing he had hip pain or x-rays. (They didn't look at the X-ray they ordered, nor did they read the report. What's better is that Gimlet also from SDN was on the accepting team and also said it was my fault.)
     
  14. roja

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    There are a few things you should do:

    1. visit your doctor and have a letter drawn up, explaining your medical condition. (I had to do something similar as I have had horrible joints since I was a kid, but never had to use it). You want it, just in case.

    2. get TWO pairs of good shoes. I found when I was doing 36 hours straight (an anomoly but I learned), even the most comfortable shoes become uncomfortable after more than 12 hours. Switch them out. (although now that i have danskos I'm convinced I iwll never need another pair of shoes)

    3. When standing in OR cases or on long rounds, try to find ways to have one knee propped up (ie your foot on a footstool). this relieves some of the strain on your back.

    4. See if you can get some physical therapy set up so that you can learn exercises that will help out with your back.

    5. Grab time where you can.
     
  15. vtucci

    vtucci Attending in Emergency Medicine
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    I will pass along a gem told to us by our senior neurology resident. In 3rd year, 4th year or residency:

    1. Always sit when you can.
    2. Always eat when you can.
    3. Always s**t when you can.
    4. Always sleep when you can.

    You never know when the opportunity will arise again.
     
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  17. :thumbup:

    *Sit when you can.
    *Eat when you can.
    *Sleep when you can.
    *Call your significant other when on-call.
     
  18. SoCuteMD

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    It really depends on the rotation. Rotation where I sat the least: neurology, oddly enough. Our patients were all over the hospital, our attending was long-winded, and you could exactly go hunt down a chair to sit and listen to him. I was on my feet pretty much all day.

    Close seconds included surgery and medicine. Surgery because, well, it's surgery. Medicine because chairs were scarce at my site.
     
  19. Richie Truxillo

    Richie Truxillo Your Scut Monkey Mentor
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    Totally nailed it. Get yourself some Crocs or Danskos or whatever shoes are comfy to you! Sometimes you'll be on your feet a long time. Particularly Surgery comes to my mind 8) Oh and never ever lock your knees, try to remain relaxed when holding those retractors. On medicine rounds, you'll walk alot depending on the size of your hospital.

    Gosh, I'm glad rotations are over. Now the shock and awe of Residency is looming over me. :scared: :scared:
     
  20. yohimbine1

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    I had a third year orientation which only involved a few days of shadowing, and even at the end of that my feet and back were killing me. What are these Danskos? How much are they, and more importantly where do I find them? Are they appropriate for all rotations?
     
  21. Ashers

    Ashers Bacteria? Don't exist.
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    I wore them on all rotations so far.

    I've bought mine at Nordstroms and a clog shop in Portland, but they also sell them at REI. They're usually about $110, but well worth it. One of my friends buys hers on ebay, she looks for new pairs. The sizing is the European sizing (I have big feet -- I wear a 43, so I can't buy mine at REI.

    If you google Dansko, a lot of stuff will come up that's pertinent (especially the dansko website and "find a store". Before buying them online, I'd suggest finding a place to find your size and then order them if they're cheaper.

    I've got 3 colors (black, brown, and the cordovan). Since I generally don't care what I wear for shoes (compared to my friends who wear heels on the wards); I'll wear danskos to clinic, and nice tennis shoes on the wards as often as I can get away with it.
     
  22. yohimbine1

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    Ok cool I am interested in these...that makes me feel better about my upcoming third year as I was worried about back and foot issues. Hmm I hope my size is available as I wear like a 13 in guys

    Heh, a funny thing I noticed on the Amazon listing for Dansko's--
    Customers Who Bought This Item Also Bought
    Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine
    Maxwell Quick Medical Reference

    I guess I fit the mold, having recently obtained these myself
     
    #20 yohimbine1, Jun 10, 2008
    Last edited: Jun 10, 2008
  23. njbmd

    njbmd Guest
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    Go to a store and get fitted for Danskos. They are expensive and horrible if you have the wrong size. These shoes do not "give" much in terms of "breaking in". Most uniform stores carry Danskos. You can go in, get your size and then order online if you want the best deals.

    I live by Danskos but my Mum sent me a pair, based on my American size, that I ended up selling to a mate because they were too small for me. Don't try to rely on your American size but get these fitted. They are an investment, last forever and worth the money but miserable if you don't have the right size or fit.
     
  24. Good advice above.

    They do indeed last a long time - I think I wore my first pair almost every day between the end of my MS-III year and partway through my PGY-2 year. The insole finally wore out (developed a hole in it) and I bought my second pair.

    So around a $90 investment for almost 3 years? Not bad, IMHO!
     
  25. medsurg2010

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    I'm just starting third year, but I worked as an EMT in a busy ER where I didn't sit but once in 12 hour shifts. I never had back pain, but I have horrible shin splints, so I went through dozens of shoes and the BEST BEST BEST combination I found was:

    (Dansko leather clogs, but take out the insole (It is a good cushion, but mine got wrinkled toward the toes and wore out after awhile).

    Invest in a 20-40 dollar pair of orthotics that can be custom heat molded with a blow dryer or in the oven. I found this brand (Sole) at a local running store:
    http://www2.yoursole.com/products/footbeds/?id=o2w5SDcU

    (If you're a trust-fund baby, you can get some real plaster-fitted orthotics, but in my experience these cost $300-400.:thumbdown:)

    They are amazing!. The Danskos should be loose, so they can fit custom orthotics easily. If they aren't soft enough for you, you can add some of the "gel" heel cushions under the heel of the orthotic. Make sure that when you mold them, you put your foot in an ergonomic position. For example, I know that I naturally pronate my foot and collapse my arch, so when I molded them, I tried to put my weight on the lateral edge of my foot, creating extra arch support in the insole.

    Another tip is that I found that if I didn't keep up with working out (I'm a runner), I would feel horrible, but if I forced myself to run, even if I was tired and my shins never hurt.
     
  26. rochemd

    rochemd New Member

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    TeNa,
    I also have back problems and found it difficult only during my surgery rotation because of all the standing. I worked out during the morning and late evening with back exercises. I used bathroom breaks to rest and then scrubbed back in.
    I mentioned to my physician about my problem but I never backed out of any surgeries. I toughed it out. No one ever thought I was lazy. I was even commended for sticking through it.
    Best advice find opportunities to rest and keep your self strong. It will be over before you know it. Good luck.
     
  27. Akuffo

    Akuffo An Old Folk

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    nothing lasts forever...there is more work after med school, so enjoy it while you can. You will find rest when rigor mortis sets in.
     
  28. Law2Doc

    Law2Doc 5K+ Member
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    I gotta agree with the prior poster. You come out of the clinical years and into a residency. That's basically out of the frying pan and into the fire. So no, it won't be over before you know it. This is an Everest climb. You will be to base camp before you know it. The mountain looms ahead.:eek:
     
  29. Ypo.

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    Maybe so, but you gotta take it one day at a time. And getting to the end of third year is SWEET. (take it from me, I just got there a couple weeks ago). :)
     
  30. getunconcsious

    getunconcsious Very tired PGY1

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    I can think of several specialties where the residents sit most of the time. Pathology (of course), Radiology, Anesthesia, Psychiatry, Neurology, and I'm sure there are a few others. I don't know why you always have to make everything so negative and discourage others. Is it that lawyers generally like to point out discrepancies and technicalities in the interest of making others feel bad?

    OP, I'm not gonna be sunshine and lollipops and say "you can do whatever you want despite your limitations!" Honestly, OB/Gyn, surgery and any surgical specialties, and probably internal medicine will likely not be in the cards for you. But I do think that you can realistically pursue most any other residency without many major difficulties. I'd only buy this BS about "Base camp" and "climbing everest" if one is interested in surgery or medicine or OB/Gyn (in which case it's his own fault for liking a crappy specialty!)
     
  31. Law2Doc

    Law2Doc 5K+ Member
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    Most of these are going to require a prelim year in medicine or surgery before you get to the "sitting" years. And neuro can be pretty rounding intensive actually.
     
  32. getunconcsious

    getunconcsious Very tired PGY1

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    I suppose you are right on this count. However, one can opt for a jokey "transitional year" if one's grades and scores are good enough. We have a TY intern on our path rotation and he gets in around 9 and leaves by 4. He only has 2 ward months, all the rest will pretty much be like this. Pathology doesn't require an internship, Psych only requires 6 months of non-psych stuff (medicine and neuro) in R1 year. Agreed about Neurology but it still seemed less intense than medicine from what I observed. I know of a few people with health issues who went into it and are doing fine, so...

    Anyways I'm sorry I suppose I was way to harsh. I realize you're only trying to be a realist. I agree, but it's better to focus on the positive than the negative, otherwise you just end up depressed!
     
  33. Law2Doc

    Law2Doc 5K+ Member
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    Yeah, I'm not out to rain on anyone's parade. I just think folks shouldn't get lulled into a false sense of security that any of this is easy (on your mind or your back). I'm not sure how feasible transition years are for a lot of the specialties you listed. Most want a prelim year and most of those that I've seen are more or less equivalent to an internship year. Which isn't so bad if you don't care for sleep and think the 80 hour work week limitation is for wimps. I'm not that person though.
     
  34. Dr. McDreamy

    Dr. McDreamy resident hottie

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    to the OP (even tho this thread was started a few months ago!): i feel your pain!

    I love surgery, but a big part of my hesitation to go into it is due to the horrible foot/leg pain i get by the end of the day. I have tried all sorts of different shoes, danskos (HORRIBLE! I sold mine on ebay) and nothing has helped. By the end of the day I feel like i'm dragging 10lb weights on the bottom of my feet. I can't even go for a jog until I am able to elevate my feet for an hour or two after work. It's actually kind of a huge conflict for me since I love operating so much. :mad:
     
  35. Gimlet

    Gimlet Cardiac Anesthesiologist

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    Booooo...I just saw this. I never claimed it was your fault - I blamed Maureen and her intern! :D Just had to get a little razzing in on you since you are so ortho-rific.
     

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