Speculation isn't a crime, but it can be kind of rude and disrespectful.
If you're an attending with a lot of experience, then speculating on what a colleague did wrong can be an interesting, possibly useful exercise. But, as medical students (even as interns), we don't know enough to presume to understand an attending's thought process.
I'm not sure who is being defended here. There's no individual being attacked (except, apparently, me). If you don't want to think about things, that's fine. Don't. I truly cannot figure out why so many people are flocking here to defend this random anonymous person who I'm NOT EVEN SAYING MADE A MISTAKE! I mean geez, will it make everyone feel better if we table the discussion about the OP's friend, and instead have a conversation about a TOTALLY FICTIONAL, COMPLETELY MADE UP BY ME imaginary fake pretend situation where a pretend surgeon was doing a fictional appendectomy and hypothetically nicked what might have been the patient's vena cava and iliac artery? And I ask what mistakes could have been made to cause this? And I even throw in that I'd love to hear things that could have happened out of his control that are NOT mistakes that could have caused it as well? Would that soothe everyone's delicate sensibilities?
One of the things that was so hard about the surgery rotation was trying to follow the attending's line of thought. He was forced to consider so many different aspects of a case, and sometimes under pressured constraints. The things that the attending thought of were things that I'd never be able to think of in a million years - I don't have that knowledge, and I don't have that experience.
I have no doubt that's true. Not trying to downplay the difficulty of surgery at all.
That's not funny, and that's not fair.
Do you really think that a resident is driven by the fear that his attending won't get paid and will then become cranky? (Heck, some surgery attendings get cranky if you take the last blueberry muffin at AM conference, so most residents stop caring about making the attending "cranky" at some point.)
Wasn't trying to be fair. No one here is being fair to me, to be frank. I'm trying to discuss an issue i find interesting, and all anyone else is wanting to do is defend the honor of an individual I'm not even attacking. And no, I don't really think that a resident is driven by that fear. I was being a smartass, which is my response to people who are being condescending.
As you may remember from anatomy, you should begin by identifying 1, preferably 2, landmarks. But what if none of the landmarks are recognizable? Then what do you do? Close the patient up? Or proceed as best you can? I know that you cavalierly supposed that the attending ought to "carefully pick through the scar tissue," but you never really know what lies underneath the scar tissue.
I would imagine you proceed the best that you can. I'm not sure what's cavalier about supposing the attending would carefully pick through the scar tissue. Is it cavalier to think he'd be careful? or is it cavalier to assume he'd proceed at all? What are you trying to say, exactly? I'm sure it would be up to the judgment and experience of the person holding the knife. And no, you don't know what lies underneath the scar tissue. If you reread what I wrote, I think you'll say that I agreed with that point. It's a risk of the operation and out of the surgeon's control at that point. I've already stated my agreement with that point.
a) Because the surgeon who "goofed up" isn't here to defend himself. That's not fair to him.
b) We're NOT the surgeon's "peers." We're med students who don't have anywhere near the training and experience that he does. Just because we all happen to be in medicine does not make us each other's peers. (As you will find out on your surgery rotation!)
a.) I didn't say the surgeon goofed up. I said he MIGHT have goofed up. Which given the info presented is quite true and quite fair. I then wanted to talk about what kind of mistakes COULD have been made, not what kind of mistakes THIS PARTICULAR GUY DID make. The first is speculation on a case study. The second is an indictment of an individual. I NEVER did the second.
Edit: Woops, looking back, perhaps I did. Not maliciously, and really not even intentionally, but I can see where my language waaay back at the start of this thread sounds like I was going after the guy. That wasn't my intention, but I see where things went wrong. My bad 🙂 I still stand by everything else I've said though. /EDITThat was a conclusion some people jumped to, and then when I attempted to explain myself more clearly, the same people didn't want to listen to it. Oh well.
b.) Perhaps, but I'm a "peer" of another medical student. So I feel that I have the right to discuss hypotheticals with other medical students. This is the allo forum, right? I'm VERY happy to have the input of residents as well, as they know much more than us, so long as that input doesn't come in the form of them raining derision down from ahigh.
The thing that surprised me on surgery was how little the abdomen in a live patient resembles the abdomen of a cadaver. I mean, the same parts are there, but they don't lie in the same way spatially.
I haven't had the opportunity to observe this, but I have no doubt it's true, and kinda assumed so. If this was in reference to my comparison of a cadaver and viscera etc., I wasn't trying to presume it was the same, just that I figure the bowel still sat anteriorly to the aorta
🙂
That's true. But you don't have the experience or knowledge, yet, to be able to think through the problem thoroughly. It would be like trying to solve a complicated, advanced level physics problem with only a basic knowledge of calculus. And a superficial "what-the-hell-was-that-surgeon-thinking?!?" approach isn't fair to anybody.
So? I'll think through it to the best of my ability. It's not a crime. It's not disrespectful. It's an attempt to consider an interesting topic. If no one ever thought of things they didn't already understand, we'd never have gotten anywhere as a society. And for the record, I'd like you to review this thread and point out a single time when I gave a "what-the-hell-was-that-surgeon-thinking" type reaction to the OP's story. A few posters did do this. I did not.
To njbmd: I'm posting this publicly, because I'd like to say to everyone reading this (including the OP) that, as medical students, it's not a respectful or worthwhile exercise to speculate on what that surgeon did wrong.
And I disagree. As medical students, it's our responsibility to consider the possible ramifications of events that could happen in the future BEFORE they happen to us. It's our responsibility to learn from the mistakes of others so that we can avoid those mistakes ourselves. This is not 'disrespectful'. That attitude is an unfortunate byproduct of a system in which reverential deference is required of those lower than you on the educational food chain. It's unfortunate, and it's more unfortunate that some individuals are attempting to carry that even to SDN, a social forum that is supposed to be open to all to chat freely about topics of interest. In this case a few allo students interested in discussing a topic were shouted down by residents, who apparently feel this is an inappropriate topic for lowly medical students to discuss. And if you make enough noise, then a.) no one will be able to get a word in edgewise and b.) mods will shut down the thread, thus serving the goals of killing the topic. I submit that as a free and open discussion forum, the mature thing for people to do is to allow the conversation. Contribute meaningfully if you have something to say, or move on silently if you don't. Attacking those you disagree with is not an effective way to get your point across, although unfortunately it IS an effective way of silencing dissention on this forum.
We don't know enough about that particular case, and we don't know squat about surgery in general, to be able to begin to speculate. And presuming to call ourselves that surgeon's "peers" is a little bit disrespectful, because we're honestly not.
It's true we don't know much about this particular case. Does that make it impossible to talk about the case hypothetically? I mean, I could introduce the premise that during the operation a wild gunman burst into the room, and open the floor for discussion of how that might have affected the case. Does that mean I think a wild gunman ACTUALLY burst into the room in the OP's story? Of course not. But we can still talk about a hypothetical situation in which it did.
As far as calling ourselves the surgeon's peers, I don't think I ever did that. What I said was that people are unwilling to discuss mistakes amongst their peers. Define your category of peers however you'd like, I still hold that I've seen the phenomenon and it disturbs me.
Now, this thread has been effectively taken over by a side discussion. I apologize for my part in that. If anyone is still interested in the original topic, I'd love to discuss that, or stay out of the way and listen to others discuss it. I hope that those who've been attacking me will agree to that as well. I will respond to anyone who still wants to call me names, or insult my character, or even claim that no one should discuss medical errors, via PM. I hope that mods will leave the thread open to either continue on the original topic or die naturally, as it is a very interesting topic. I'm not going to engage in this bickering in this location anymore, so I hope that can stave off the locky icon. Really though, anyone who'd like to can feel free to PM me with whatever comments you have.
Cheers!
