This is ____ 's patient

[The Angriest Bird]

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Well, I'm 2.5 years into general surgery. Actually, I'm loving it. I really do, without sarcasm.

One thing I realize that's unique among surgeons is that we declare very solid ownership of our patients. Perhaps much more than other "non-invasive" specialties. The rule-of-thumb is if you have operated on someone, that person is YOUR patient. It is not a bad thing, because it promotes excellent patient rapport and continuity of care.

For what I'm going to say below, it mostly applies to attending surgeons.

However, often I don't think it's a good tradition or culture. For example, during weekend rounds, when one attending is covering all his partners, it's not uncommon to see him spending 15 minutes talking to his POD3 colon resection patients, then going to next room and just "say hi" to his partner's gallstone pancreatitis patient. The other extreme is also true. I've worked with some attendings who want to be called everyday about his own patients, even when he's not on call, even when he's in Hawaii.

This tradition also affects surgeons' life style greatly. For example, on several occasions, surgeon A (not on call) was called back by surgeon B (on call) to re-operate on surgeon A's patient because of a complication. My gut reaction was "that sucks".

Many years from now, when I join a practice, my preference is that my partners will completely take care of my patients when I'm off. And of course I will do the same for them. I'd love to have good personal relationship with my patients, but I don't want to be eternally tethered to them 24/7. I'm very young in this profession, so I don't know if it is possible or it's just my wishful thinking.

 

[Dr.LeoSpaceman]

Patient ownership is certainly a very important part of surgery. It's one of the reasons why you hear (on this board and in the hospital) the reservations people have about work hour restrictions and their influence on the new generation of surgeon's ability to grasp that importance.

I can tell you what it looks like when there's "surgery by committee", and it's not pretty. On our Trauma/ACS service, attendings take turns as the rounder. It can be very painful as a resident, because every week it's like starting from square one on a complicated patient who has been there for 15 days.

As for getting called for a takeback, I think it's highly dependent on the situation. Something like a fascial dehissence or wound complication, I'd probably let my partners handle it if they weren't getting killed with on-call related things. But if you have an anastomotic leak or some other catastrophe, I think it's appropriate that I would be the one to handle it. Ultimately, I think it's important for the patient to see that you are concerned about correcting the problem yourself.

 

[Buzz Me]

You'll also find that as you progress through residency, your degree of patient "ownership" will increase. Your ability to delegate will, to a certain extent, also improve but I found myself much more heavily invested (at least emotionally, if not through more hours in the hospital) it the patients who I felt were truly "mine." IMHO, many new/junior attendings still feel this way, where it's tough to disconnect from the hospital even on weekends/days off.

 

[Docgeorge]

This tradition also affects surgeons' life style greatly. For example, on several occasions, surgeon A (not on call) was called back by surgeon B (on call) to re-operate on surgeon A's patient because of a complication. My gut reaction was "that sucks".

Many years from now, when I join a practice, my preference is that my partners will completely take care of my patients when I'm off. And of course I will do the same for them. I'd love to have good personal relationship with my patients, but I don't want to be eternally tethered to them 24/7. I'm very young in this profession, so I don't know if it is possible or it's just my wishful thinking.

My future partners and I have talked about this (disclaimer I'm a Trauma Surgeon) in our practice, the patients belong to the group not a specific individual. We all seem to think alike, but we are in the process of making some guidelines for the group. If one of us has a strong attachment to a patient we are free to discuss with the guy rounding that day. If there's a complication we take it to the OR when it's recognized. Help by a second pair of hands is always available if needed. I would be very annoyed with my partners (and visa versa)if they couldn't formulate and execute a plan on someone somebody else operated.

 

[45408]

I can tell you what it looks like when there's "surgery by committee", and it's not pretty. On our Trauma/ACS service, attendings take turns as the rounder. It can be very painful as a resident, because every week it's like starting from square one on a complicated patient who has been there for 15 days.

As for getting called for a takeback, I think it's highly dependent on the situation. Something like a fascial dehissence or wound complication, I'd probably let my partners handle it if they weren't getting killed with on-call related things. But if you have an anastomotic leak or some other catastrophe, I think it's appropriate that I would be the one to handle it. Ultimately, I think it's important for the patient to see that you are concerned about correcting the problem yourself.

Agree on both counts. A patient who has a leak after a colon resection has been seeing you, considers you to be their surgeon, and will be coming to your clinic afterward for months or even years. If I were around, I'd prefer to take the patient back myself too. It's probably only a few hours of your time, and this way, you're going to sleep better knowing what was in there. Plus, I think it helps with patient rapport. We're in a specialty that's very likely to be sued, and I think it probably makes you less likely to be sued if the patient thinks "Dr. Prowler came in on the weekend when the other doctor was concerned, explained what was going on and why I had to go back to the operating room. I can tell he cares." Maybe that's just wishful thinking.

 

[Arcan57]

Agree on both counts. A patient who has a leak after a colon resection has been seeing you, considers you to be their surgeon, and will be coming to your clinic afterward for months or even years. If I were around, I'd prefer to take the patient back myself too. It's probably only a few hours of your time, and this way, you're going to sleep better knowing what was in there. Plus, I think it helps with patient rapport. We're in a specialty that's very likely to be sued, and I think it probably makes you less likely to be sued if the patient thinks "Dr. Prowler came in on the weekend when the other doctor was concerned, explained what was going on and why I had to go back to the operating room. I can tell he cares." Maybe that's just wishful thinking.

As a frequent consultor of most specialties, I find general surgeons ideas about patient ownership to mostly be a positive. It makes me hate people a little bit everytime an IM doc that discharged a patient yesterday insists that the patient go to medicine on call for today. The only time it gets painful is if the original surgeon is unavailable, although I've never had a crashing surgery patient that the surgeon on call refused to see.

If you do have to operate on a crashing patient that you didn't do the initial surgery on, would you expect to be named if there's a suit?

 

[dpmd]

If you do have to operate on a crashing patient that you didn't do the initial surgery on, would you expect to be named if there's a suit?

Yes, but I would be mad about it.

 

[thedrjojo]

I think the best group in my hospital about trusting and working with their partners is Transplant, surprisingly. I think it partially has to do that usually all 3 of them have their hands in the operation (1 procures, 1 does the transplant, and 1 assists / backups during the transplant)... but take backs are usually done by the rounding physician, not the person who initially did the transplant, just like the transplant is done by whoever is on the schedule, not by who initially evaluated the patient or got the patient listed (however the patient is followed in the outpatient world by the doc who does the transplant). You'd think with such a high level of micromanagement that goes on in transplant, they'd be pretty anal about their patients, but its not. And when your life consists of mainly operating in the middle of the night and for 10 hours at a time, when you get that weekend off, you treasure it and the patients learn up front that its a team effort, and most of the attendings come to know about pretty much all the patients (particularly the frequent fliers)

 

[GreatSaphenous]

[QUOTE Many years from now, when I join a practice, my preference is that my partners will completely take care of my patients when I'm off. And of course I will do the same for them. I'd love to have good personal relationship with my patients, but I don't want to be eternally tethered to them 24/7. I'm very young in this profession, so I don't know if it is possible or it's just my wishful thinking.[/QUOTE]

You may feel differently when your partner makes a decision that you disagree with. It is human nature both for us to be slow in concluding our patient has a complication and for our partners to be too quick to declare one.

Two days after I had done the first laparoscopic adrenal in our hospital's history, my partner noted that my patient (who had been having muscle cramping for years) was complaining of severe pain. He scanned the patient and saw what he thought was more air than was normal for a POD #2 laparoscopic case and proceeded to take him to the OR. Needless to say seeing my patient with a stem to stern scar did not make me happy not to be bothered. Hearing another one of my partners express the opinion that "there is no such thing as a negative ex lap" also did not help the situation.

All for now, go back to your meatball and marinara Hot Pockets.
I am the Great Saphenous!!!!

 

[tkim]

I've always understood that when surgeon X's patient shows up y days post-op, I call surgeon X - on call or not.

Imagine my surprise when I started my community ED gig and when I paged the patient's surgeon, who was not on call, I was told to call the surgeon on call.

And when I called the surgeon on call, I was told - "always call the surgeon on call". Perhaps there's a great trust between all the surgeons at my shop - there are only two groups here, but it was a little jarring.

 

[dpmd]

I've always understood that when surgeon X's patient shows up y days post-op, I call surgeon X - on call or not.

Imagine my surprise when I started my community ED gig and when I paged the patient's surgeon, who was not on call, I was told to call the surgeon on call.

And when I called the surgeon on call, I was told - "always call the surgeon on call". Perhaps there's a great trust between all the surgeons at my shop - there are only two groups here, but it was a little jarring.

Maybe they want the on call to see it since a lot of stuff doesn't require a return to OR, but they call each other if it does? That would be how I would want it done if I was in private practice. I'm just glad you call A surgeon. I hate seeing my patients post op and discovering they were in our ED at some point in the interim without surgery having been called.

 

[tkim]

Maybe they want the on call to see it since a lot of stuff doesn't require a return to OR, but they call each other if it does? That would be how I would want it done if I was in private practice. I'm just glad you call A surgeon. I hate seeing my patients post op and discovering they were in our ED at some point in the interim without surgery having been called.

Oh I always call - even if to say 'afebrile, no white count, wound CDI, will tell pt to call office in the AM'. Though at 3am I might skip the call.

 

[SLUser11]

You may feel differently when your partner makes a decision that you disagree with. It is human nature both for us to be slow in concluding our patient has a complication and for our partners to be too quick to declare one.

Wise words from the Great Saphenous!

 

[45408]

You may feel differently when your partner makes a decision that you disagree with. It is human nature both for us to be slow in concluding our patient has a complication and for our partners to be too quick to declare one.

Two days after I had done the first laparoscopic adrenal in our hospital's history, my partner noted that my patient (who had been having muscle cramping for years) was complaining of severe pain. He scanned the patient and saw what he thought was more air than was normal for a POD #2 laparoscopic case and proceeded to take him to the OR. Needless to say seeing my patient with a stem to stern scar did not make me happy not to be bothered. Hearing another one of my partners express the opinion that "there is no such thing as a negative ex lap" also did not help the situation.

Oh man, that's just salt on the wound! Your point is certainly well-taken though. Most of my staff won't take a patient back without pretty convincing evidence that it's an urgent situation, and they usually end up calling each other.