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Dunce

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During residency who usually takes care of your post-op patients?
I am only referring to time when you are on an ENT service, not during some SICU month or other service.

Do you often have full management or do others, say medicine or gen surgery for example, take over the primary medical management of the patient?
This certainly must vary some between floor pts vs ICU pts.

I have heard of some variability from one institution to another and would appreciate a better opinion on the subject. Thanks
 

resxn

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In my residency program, we owned our post-op patients regardless of whether they were ICU or on the floor. The only thing we didn't really do was vent management, but other than that we did everything. We did all of our own free flaps so plastics was never involved. My attendings would rather poke out their eyeballs with a stick rather than having general surgery or the ICU team manage the patient.

On occasion we'd double-team with neurosurg on a craniofacial resection or acoustic neuroma. Neurosurg would take care of them in the neuroICU and ENT would take over once they got on the floor.

For traumas that were not isolated to the head and neck often the trauma surg team would be primary with us, neurosurg, and/or ophtho, as consults.
 

toofache32

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Are there places where you operate on your own patient, but someone else takes care of them? I'm confused.
 
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aggernodi

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Ditto what rsxn said...

With one exception...

If ENT is consulted on a patient admitted to a different service upon who we do operate on, we remain as a secondary service with the primary taking care of the patient...

For example, trachs, abscess I&Ds, T&A, B M&T on hyperbaric patients, etc.
 

resxn

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Are there places where you operate on your own patient, but someone else takes care of them? I'm confused.

There might be a couple of private docs out there who utilize hospitalists to take care of their inpt's and post-ops, but I'd look down on them quite a bit if there were. I own my surgical patients. No one knows them better than me and no one orders on them unless they have some other condition which I do not have enough expertise in to handle. I would bet that the majority of surgeons feel this way as well.
 

Dunce

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Ditto what rsxn said...

With one exception...

If ENT is consulted on a patient admitted to a different service upon who we do operate on, we remain as a secondary service with the primary taking care of the patient...

For example, trachs, abscess I&Ds, T&A, B M&T on hyperbaric patients, etc.

This was a good example of what I was thinking.

I guess it seems clear that a patient admitted by ENT and operated on will be taken care of by that same team under the vast majority of circumstances. The ICU is really the only place where I would actually expect to see other people managing the patients occasionally.

Thanks for the input
 

resxn

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Ditto what rsxn said...

With one exception...

If ENT is consulted on a patient admitted to a different service upon who we do operate on, we remain as a secondary service with the primary taking care of the patient...

For example, trachs, abscess I&Ds, T&A, B M&T on hyperbaric patients, etc.

Sorry, I forgot to mention that. I agree we rarely take over the care of a patient on which we consult during the same hospitalization, even if we operate on them. It happens, but rarely.

That's one of the nice things of being a consultant.
 
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