Private Practice Procedures

[DrRobert]

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So in residency if you struggle with a procedure, there's always an attending to bail you out.

What happens in private practice if you just can't seem to get a procedure done despite multiple attempts? Whether it be an IV, A-line, Central line, Spinal, Epidural, Regional block, etc.

Do you ask your partners for help? Do you abandon the procedure?

Is this considered a sign of weakness by the other partners? Could this affect your ability to make partner in the group?

Just curious as some patients are just plain difficult.

 

[militarymd]

we dumped a guy because he repeatedly was unable to do epidural/spinals....+ other stuff....although, in his mind, he was as good as any of the rest of us.

I told him he needed to ask for help so that we don't make the patients suffer and hold up the OR, but he never would.

 

[IceDoc]

we dumped a guy because he repeatedly was unable to do epidural/spinals....+ other stuff....although, in his mind, he was as good as any of the rest of us.

I told him he needed to ask for help so that we don't make the patients suffer and hold up the OR, but he never would.

I'm curious about this too. Ignoring the guy with the chronic problems, what does someone normally do if they find themselves struggling with a procedure on a particular patient?


Oh, and your description of that guy reminded me of an attending who thought he was G-d's gift to both anesthesia and surgery. Unprompted, he would start lecturing the surgery and OB residents about surgery and OB topics (not related to anesthesia). Of course he was usually wrong, or outdated. He berated me in front of a patient and gave me this BS physiologic basic science lecture that has actually been disproven by patient outcome studies. This guy was pushed out of a private practice and returned to the academic realm so he could torture us. But I digress. What does a competent person do when they occasionally get stuck during a procedure?

 

[militarymd]

1) ask for help

if no help is available

2) change plans

if plans CANNOT be changed

3) press on

and the progress through the steps is dictated by one's judgement.

I'm curious about this too. Ignoring the guy with the chronic problems, what does someone normally do if they find themselves struggling with a procedure on a particular patient?


Oh, and your description of that guy reminded me of an attending who thought he was G-d's gift to both anesthesia and surgery. Unprompted, he would start lecturing the surgery and OB residents about surgery and OB topics (not related to anesthesia). Of course he was usually wrong, or outdated. He berated me in front of a patient and gave me this BS physiologic basic science lecture that has actually been disproven by patient outcome studies. This guy was pushed out of a private practice and returned to the academic realm so he could torture us. But I digress. What does a competent person do when they occasionally get stuck during a procedure?

 

[2ndyear]

So in residency if you struggle with a procedure, there's always an attending to bail you out.

What happens in private practice if you just can't seem to get a procedure done despite multiple attempts? Whether it be an IV, A-line, Central line, Spinal, Epidural, Regional block, etc.

Do you ask your partners for help? Do you abandon the procedure?

Is this considered a sign of weakness by the other partners? Could this affect your ability to make partner in the group?

Just curious as some patients are just plain difficult.

If you're a resident, watch closely what your attendings do when you can't get a procedure. In my experience, they would usually take a try and then call someone else. If nobody was around then change the plan as above. Biggest thing I learned from residency was "if what you're doing isn't working, try something else". If you've tried an epidural at L3-4 3 times, go up. Can't get a radial art line, get ready to go brachial/ax/fem, etc. Start thinking about cut downs by the surgeon.

I'm still too new at the whole private practice thing to say what happens every time, but I couldn't get a spinal the other day for an elective section (obese lady). Did all kinds in residency. Couldn't get it. 2 levels, long needles out. Called someone else in and they got it.

 

[jetproppilot]

So in residency if you struggle with a procedure, there's always an attending to bail you out.

What happens in private practice if you just can't seem to get a procedure done despite multiple attempts? Whether it be an IV, A-line, Central line, Spinal, Epidural, Regional block, etc.

Do you ask your partners for help? Do you abandon the procedure?

Is this considered a sign of weakness by the other partners? Could this affect your ability to make partner in the group?

Just curious as some patients are just plain difficult.

Doesnt matter how good you are in this biz.....every once in a while you're gonna have difficulty with something.

Ask one of your partners to step in and assist.

If its happening all the time like with Mil's partner, theres a problem.

If it happens a reasonable number of times a year and you ask for help, this means you are a clinician with good judgement who places patient care and OR efficiency over your ego.

Don't be afraid to ask a partner to step in for a few minutes.

90% of the time a new set of eyes/hands can get it.

We help each other.

 

[secretasianman]

we dumped a guy because he repeatedly was unable to do epidural/spinals....+ other stuff....although, in his mind, he was as good as any of the rest of us.

I told him he needed to ask for help so that we don't make the patients suffer and hold up the OR, but he never would.

You can pass the tests required for board certification without being able to do epidurals/spinals well?

 

[Planktonmd]

You can pass the tests required for board certification without being able to do epidurals/spinals well?

Board certification and passing the exams has nothing to do with having the skills to do procedures.
There are plenty of anesthesiologists out there who simply can't do procedures and it's very painful to watch one of them perform any procedure.

 

[militarymd]

You can pass the tests required for board certification without being able to do epidurals/spinals well?

without naming names, I can tell you that there are some nationally recognized anesthesiologists who can't do epidurals/spinals....or other procedures well.

 

[militarymd]

Doesnt matter how good you are in this biz.....every once in a while you're gonna have difficulty with something.

Ask one of your partners to step in and assist.

If its happening all the time like with Mil's partner, theres a problem.

If it happens a reasonable number of times a year and you ask for help, this means you are a clinician with good judgement who places patient care and OR efficiency over your ego.

Don't be afraid to ask a partner to step in for a few minutes.

90% of the time a new set of eyes/hands can get it.

We help each other.

that is spot on.

 

[loveumms]

I'm still early on in residency but, I often see the attendings at my institution help one another out ... just like our residents help one another out.

I would venture to guess that all attendings have something they are especially good at - same with residents. A good example: I had an attending who couldn't get blood from this one pt for an hematocrit. He actually had the ultrasound out to try and find a vein. I saw him struggling and asked what he was doing ... i thought he was trying to put in an IV. He told me, I went up and got the blood on the first stick. Not because I am some awesome vampire but, because I was a phlebotomist before medical school so I can find a vein on anyone. I though have a really hard time with IVs because threading a catheter is really tricky sometimes - and I have to ask for help.