Series of Random Questions-Surgery, Physical exams

[jaime244]

Hi all, I just graduated from vet school and am doing an internship soon. I was wondering if anyone has any tips on the below:

1. Feeling not well during surgeries due to standing for hours. I don't at all get grossed out and I am not squeamish at all, so it's not a fear thing. I eat a lot, but it's not really possible to leave often for snacks and water. I try compression socks and will try things like squeezing my legs. Does anyone have any other tips? I usually just feel sort of light headed and like vague-ly like I might pass out but I only almost passed out once and I knew it was coming so I left the room before. Does anyone else every get these feelings? Do basically all GP vets have to do some surgery every week? I also get neck pain with I do spays very slowly since I'm new.

2. There were two times during fourth year where I forgot important physical exam findings. They were found by the clinician above me so no harm but they were serious things like a mouth lesion that could have been cancer bu wasn't. Should I be able to remember it all and write down all the findings at the end for efficiency? Or, do some people write findings down as they go? I know it probably depends just on what works best for me, but hearing what works for you might be helpful for me, since I won't be a student soon with someone checking my work. I realize it might be ridiculous since we remember so much stuff then I have trouble remembering a few things but it's just with everything else going on. Thank you!

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[Minnerbelle]

Hi all, I just graduated from vet school and am doing an internship soon. I was wondering if anyone has any tips on the below:

1. Feeling not well during surgeries due to standing for hours. I don't at all get grossed out and I am not squeamish at all, so it's not a fear thing. I eat a lot, but it's not really possible to leave often for snacks and water. I try compression socks and will try things like squeezing my legs. Does anyone have any other tips? I usually just feel sort of light headed and like vague-ly like I might pass out but I only almost passed out once and I knew it was coming so I left the room before. Does anyone else every get these feelings? Do basically all GP vets have to do some surgery every week? I also get neck pain with I do spays very slowly since I'm new.

2. There were two times during fourth year where I forgot important physical exam findings. They were found by the clinician above me so no harm but they were serious things like a mouth lesion that could have been cancer bu wasn't. Should I be able to remember it all and write down all the findings at the end for efficiency? Or, do some people write findings down as they go? I know it probably depends just on what works best for me, but hearing what works for you might be helpful for me, since I won't be a student soon with someone checking my work. I realize it might be ridiculous since we remember so much stuff then I have trouble remembering a few things but it's just with everything else going on. Thank you!

1.) having an anti-fatigue mat might help? Also I know many gps who don’t do any surgery at all, so that’s an option ifyou know you don’t ever want to do it. There are enough sx loving gps that will gladly trade you an appt day for a sx day.

2.) As far as making sure you don’t miss PE findings, ALWAYS doing your complete PE in the same order helps. Remembering your findings do tend to get easier as you become more experienced. Clinicians develop an uncanny ability to associate animals with their clinical hx. Like if a coworker asks me about a pet I saw two weeks ago, I can often recite abnormal lab values, abnormal PE findings, and Hx of pet and client. That being said, I’m horrible with remembering R vs L (I can picture the pet l, but I can’t remember if the pet was facing me or away from me) so my techs are good about typing in the history which leg is lame, where the mass was that the client was concerned about, which eye/ear is affected or which is worse. That helps a lot. If I saw 28 patients in a day, do I remember what the teeth looked like in every single patient? That gets a little hard. For most of them yes, but there are a few patients where I’m racking my brain at the end of the day... If I can, I will try my best to at least write down PE findings on one patient before going on to my next. But it can be hard when I’m super busy

 

[CalliopeDVM]

Hi all, I just graduated from vet school and am doing an internship soon. I was wondering if anyone has any tips on the below:

1. Feeling not well during surgeries due to standing for hours. I don't at all get grossed out and I am not squeamish at all, so it's not a fear thing. I eat a lot, but it's not really possible to leave often for snacks and water. I try compression socks and will try things like squeezing my legs. Does anyone have any other tips? I usually just feel sort of light headed and like vague-ly like I might pass out but I only almost passed out once and I knew it was coming so I left the room before. Does anyone else every get these feelings? Do basically all GP vets have to do some surgery every week? I also get neck pain with I do spays very slowly since I'm new.

2. There were two times during fourth year where I forgot important physical exam findings. They were found by the clinician above me so no harm but they were serious things like a mouth lesion that could have been cancer bu wasn't. Should I be able to remember it all and write down all the findings at the end for efficiency? Or, do some people write findings down as they go? I know it probably depends just on what works best for me, but hearing what works for you might be helpful for me, since I won't be a student soon with someone checking my work. I realize it might be ridiculous since we remember so much stuff then I have trouble remembering a few things but it's just with everything else going on. Thank you!

1) in some places, you may be able to do surgery sitting down, if your problem is joint or muscle pain, or try using an anti-fatigue mat. Also, remember to breathe -- it sounds silly, but sometimes when we're concentrating a lot, or are either nervous or excited, we hold our breath without realizing it. And, don't lock your knees -- another circulatory inhibitor, especially for people who have a slight hyper-extension of the knees. It's OK to tap your toes a little or bend/flex your knees a little while you're standing for a long time. And be sure to eat appropriately (balance of carbs and protein), with as few simple carbs as possible. As far as neck pain goes: Relax. I mean that physically, even if you can't do it mentally. Take some deep breathes and release your shoulders. I find that happens to me when I get frustrated during dental extractions, and I have to physically stop for a few seconds to take a deep breath and consciously relax my shoulders because they get very tense, which travels to my neck. Also, be sure the table height is right for you, you shouldn't be bending over.

There certainly are GP jobs that don't involve surgery -- usually in clinics where another vet (often the owner) really likes surgery and will do all the surgery while the associate does all the office calls. However, they're not as common, and the more restrictions you place, the harder it will be to find a job.

2) If it's a problem of remembering what I've seen, I have employed a few techniques: a) I look again. If I can't remember what the mouth looked like by the end of the exam, I go back and look at the mouth again. No harm, no foul, no embarrassment. b) I write it down. Sometimes I will jot down notes of things I've seen that I know will either be difficult for me to remember (like a heart rate, or which tooth had a problem), or something really atypical but not the primary presentation problem (they came in for limping, which is what I'm concentrating on, but I also found an ear infection). Sometimes I write it in the record directly, sometimes I just make myself a note for when I write the record later. I'm particularly bad at remember left vs right. c) say it out loud, while I'm doing the exam. Hearing myself say it often helps me remember. "OK, it looks like Dakota has a mass in his mouth; not sure what that is yet, we might need to sedate him to get a better look" if the owner is in the room , or a shortened "oral mass, we'll need to sedate him for that" if the owner isn't there. This also helps with the left vs right issue, particularly if there's a tech there listening to you.

If it's a problem of forgetting to look at all, one of the things that is really helpful is always doing the physical exam in the same order. Unfortunately, not all pets cooperate with that, but it's a good habit to get into -- you're less likely to miss things that way. Another thing that can help is a checklist of all the areas you should be checking......on paper, not just in your mind. Before you (mentally ) declare your GPE done and turn to the owner to discuss things, look at your checklist (which might just be a template in the medical record) and make sure you've looked at all those areas (or know those areas to be unavailable to you at this time). I almost failed an examination module because I forgot to check the sex of the patient. Even the basic things get forgotten some time, but you can be sure I verify the sex of every patient now. It's subtle, but I mentally make a note of it now, even 20 years later, because of that mistake.

 

[jaime244]

Thank you both so much! This is really helpful and I'll definitely try your suggestions.