Trauma Surgery worse than GenSurg?

[Khaos05]

Hey everyone,

I've searched on here (and read a lot of threads) but didn't find any complete answers.

Here's my question: why does everyone say that trauma surgery is worse (hours and lifestyle) than other surgical specialties? I thought that since level 1 trauma centers had to have someone from each specialty in-house 24/7 then they would have a trauma surgeon in house, but life everyone else work ~12hr shifts (like ER docs).

I know that more trauma happens at night, but surely enough happens in the day to at least have an AM/PM trauma surgeon rather than 24hr one. Also, I know this really applies to lvl1 trauma centers; a trauma surgeon employed at a local hospital would just be asking for it (rounds/clinic/gensurg all day then oops a trauma at night that nooo one else can handle).

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[Winged Scapula]

It depends on the size of the group covering the trauma. If you want to do 12 hr shifts, then you're going to be on call, in house, more frequently, thus many do 24 hr "shifts".

And don't misunderstand - Level 1/2 trauma center surgeons ALSO have clinic, general surgery cases, etc. to do after a night of call. This is not just the province of the community surgeon. THIS is why trauma surgery (and many surgical specialties) have a bad lifestyle - you don't go home after your "shift".

 

[Khaos05]

Thanks winged!

So would you say that in a smaller "community" hospital, the ER docs do most of the trauma and consult gen surg if needed?

Basically, I want to do exciting, always changing, trauma, medicine and i'm trying to figure out which would be better: ER doc or trauma surgeon.

Granted (I know I'm going to get this sooner or later) I have a good bit of time to decide - just wanting opinions...

 

[JackADeli]

...So would you say that in a smaller "community" hospital, the ER docs do most of the trauma and consult gen surg if needed?

Basically, I want to do exciting, always changing, trauma, medicine and i'm trying to figure out which would be better: ER doc or trauma surgeon...

Though you may not be aware, your question is very, very broad. Issue is this:
1. Numerous level one trauma centers are predominantly non-operative care. Some centers have big "knife & gun clubs". But, in general, trauma surgery can be very, very non-operative.
2. Depending on the structure/set-up, as a trauma surgeon you may get only certain types of elective surgical cases or you may do predominantly critical care management when not covering trauma. I have known some trauma surgeons that do bariatrics, others do predominantly hernias, others wound care... etc. In my own experiences, it did seem like most (bread butter) general surgery consults went to the non-trauma general surgeons.
3. centers that are not "trauma designated".... often have their "traumas" managed/triaged by the emergency medicine folks and transferred out to a trauma center... again this is my experience and not necessarily an absolute as to what things are everywhere.

Based on your question.... I think you need to decide if you want to do "medicine" vs "surgery". Do not go into emergency medicine if you want exciting trauma surgery. Do not go into GSurgery if you want exciting and constant changing emergency medicine.

 

[Khaos05]

Though you may not be aware, your question is very, very broad. Issue is this:
1. Numerous level one trauma centers are predominantly non-operative care. Some centers have big "knife & gun clubs". But, in general, trauma surgery can be very, very non-operative.
2. Depending on the structure/set-up, as a trauma surgeon you may get only certain types of elective surgical cases or you may do predominantly critical care management when not covering trauma. I have known some trauma surgeons that do bariatrics, others do predominantly hernias, others wound care... etc. In my own experiences, it did seem like most (bread butter) general surgery consults went to the non-trauma general surgeons.
3. centers that are not "trauma designated".... often have their "traumas" managed/triaged by the emergency medicine folks and transferred out to a trauma center... again this is my experience and not necessarily an absolute as to what things are everywhere.

Based on your question.... I think you need to decide if you want to do "medicine" vs "surgery". Do not go into emergency medicine if you want exciting trauma surgery. Do not go into GSurgery if you want exciting and constant changing emergency medicine.

Thanks Jack,

I figured that response would come too bc obviously every hospital, practicing group, etc. is different.

At the hospital I currently work at, we don't have any "trauma" surgeons. We have every other specialty except neurosurgery. Our ER docs pretty much do everything, consult gen surg if needed or send them to a the larger hospital (level2 trauma, med school/teaching hospital) about 20 minutes away. Anytime a code blue is called, an ER doc and 2 ER nurses come running to take care of the code. However, that may not happen in all hospitals - it's just the way we do things.

My interests (outlined in different thread) are: surgery (gen or trauma), EM, IM, and cards. Yes they are all different in their own ways, but a few are close (IM is the oddball), but I like aspects of all of them. I like the excitement of EM/Trauma - never knowing what's going to walk through the door and sometimes having to decide very quickly what to do or else the patient dies. I like surgery (although the quick, messy, lay them open type appeals more than the planned lap chole). I like the shiftwork that EM and IM (normally) gets and equals better lifestyle and more time for family. I like IM because I can monitor and manage my patients. Cards is just a flat out like - don't know what else to say about that one.

 

[Winged Scapula]

Thanks winged!

So would you say that in a smaller "community" hospital, the ER docs do most of the trauma and consult gen surg if needed?

No, I would not say that. There are a thousand ways to "skin a cat" or to manage trauma. Some hospitals have NO involvement of the ED other than calling the Trauma Code; others are heavily involved up to the minute the patient is taken to the OR or admitted to the Trauma Service.

The way it worked in the hospitals where I trained is that there are "levels" of trauma; the ED would see Level 3 trauma with the senior Trauma Surgery resident; everything else was a trauma call and the entire trauma team came down, along with anesthesia, etc. The ED residents were minimally, if at all, involved (except those that might be rotating on service that month). A friend of mine is a trauma surgeon at a Level 2 hospital - he is called for all traumas which the ED feels needs surgical intervention, so there is a lot more triage that goes on there.

Every hospital will work a little differently within its guidelines.

Finally, the definition of "doing trauma" is highly variable.

Basically, I want to do exciting, always changing, trauma, medicine and i'm trying to figure out which would be better: ER doc or trauma surgeon.

I strongly agree with JAD's comments above:

1) do you want to be a surgeon or a medical doctor? They are vastly different.

2) the management of trauma is often, except in the cases of Neuro and Ortho, non-operative. Most Trauma surgeons also do Critical Care and general surgery to some extent.

3) you have fallen in the the student trap of thinking trauma is exciting. There is a reason all of us farther down the road than you groan when we hear the trauma pager. It is NOT exciting to admit your 14th drunk of the night, to round daily on an Ortho patient (whom you don't get to operate on or have any fun with), writing TPN orders and talking with families, to essentially do all the grunt work with very little operating time save for placing PEGs and trachs. It is NOT always changing.

4) I also suggest you read a little about EM as well; most of their time is not spent doing exciting "ER" or tv type stuff either. Its a lot of psych complaints, sore throats, etc.

 

[Khaos05]

No, I would not say that. There are a thousand ways to "skin a cat" or to manage trauma. Some hospitals have NO involvement of the ED other than calling the Trauma Code; others are heavily involved up to the minute the patient is taken to the OR or admitted to the Trauma Service.

The way it worked in the hospitals where I trained is that there are "levels" of trauma; the ED would see Level 3 trauma with the senior Trauma Surgery resident; everything else was a trauma call and the entire trauma team came down, along with anesthesia, etc. The ED residents were minimally, if at all, involved (except those that might be rotating on service that month). A friend of mine is a trauma surgeon at a Level 2 hospital - he is called for all traumas which the ED feels needs surgical intervention, so there is a lot more triage that goes on there.

Every hospital will work a little differently within its guidelines.

Finally, the definition of "doing trauma" is highly variable.



I strongly agree with JAD's comments above:

1) do you want to be a surgeon or a medical doctor? They are vastly different.

2) the management of trauma is often, except in the cases of Neuro and Ortho, non-operative. Most Trauma surgeons also do Critical Care and general surgery to some extent.

3) you have fallen in the the student trap of thinking trauma is exciting. There is a reason all of us farther down the road than you groan when we hear the trauma pager. It is NOT exciting to admit your 14th drunk of the night, to round daily on an Ortho patient (whom you don't get to operate on or have any fun with), writing TPN orders and talking with families, to essentially do all the grunt work with very little operating time save for placing PEGs and trachs. It is NOT always changing.

4) I also suggest you read a little about EM as well; most of their time is not spent doing exciting "ER" or tv type stuff either. Its a lot of psych complaints, sore throats, etc.

Based on that, maybe trauma surgery is for me. It sounds like a mix of trauma, surgery, and IM (just rounding on sx patients).

I've thought about number 4 and I don't want to go through all this training and spend my 12hr shifts being an after hours FM. I know some of that will always happen, but I'd get fed up pretty quick.

If I could land a job that would do something like rotate 1wk days and 1wk nights and during my 12hr shift I would round on ICU and surgical patients and take all ER/Trauma consults, I think that would be pretty nice (don't know if it's a pipe dream though). Maybe even throw in 1wk of gen surg to soften the alternating of days/nights and get some general OR time without taking ER/trauma consults.

 

[JackADeli]

...do you want to be a surgeon or a medical doctor? They are vastly different.

....you have fallen in the the student trap of thinking trauma is exciting. ...It is NOT exciting to admit your 14th drunk of the night, to round daily on ...essentially do all the grunt work with very little operating time ...It is NOT always changing.

...read a little about EM as well; most of their time is not spent doing exciting "ER" or tv type stuff either. Its a lot of psych complaints, sore throats, etc.

I will agree with WS.
You, OP have expressed a clear recognition that you like adult medicine and you like exciting surgery (but not bread and better per se...). Or to put it another way, you have not really figured out what you like. What WS and any good advisor will tell you is this... You need to examine each specialty and figure out what its "bread & butter", day in day out, 80+% practice is. Then you need to ask yourself if that "bread & butter", day in day out, 80+% is something you can be happy doing for the next 3 decades.

Do NOT, I repeat, do NOT choose a specialty based on the rare and exciting zebra. Do not choose GSurgery because of the selective exposure to exciting ex-laps and thorocotomies. Do not choose EM/ED because of the exciting case you saw during your rotation.

If you choose internal medicine, you need to be happy, satisfied and intellectually stimulated by asthma, diabetes, hypertension, cholesterol, etc..... If you choose pediatrics, you need to be happy, satisfied and intellectually stimulated by asthma, diabetes, growth charts, school performance, vaccination schedules, sniffles and colds, etc.... The list goes on for each specialty. You need to find out what the specialties B&B is then decide if it will be right for you.

 

[calvinNhobbes]

to round daily on an Ortho patient (whom you don't get to operate on or have any fun with),

Hey now, there's no such thing as an "Ortho patient", they are Gen Surg patients with an ortho problem.

And if by some miracle we end up with one or two patients on our primary service, we promptly round on them every day, right after medicine comes by to consult.

 

[JackADeli]

Hey now, there's no such thing as an "Ortho patient", they are Gen Surg patients with an ortho problem.

And if by some miracle we end up with one or two patients on our primary service, we promptly round on them every day, right after medicine comes by to consult.

...or, medicine comes by to complete consult request for "transfer of care/assume primary management" and GSurgery continues to round and order the TPN and bowel regimen

 

[JackADeli]

PS: always loved the question/s I once got while on trauma from a surgical subspecialty colleague:
"can he have pizza?"
We asked,
..........."is it a clear liquid?",
the answer,
..........."well it's soft and if we microwave it, the cheese will be all melty and it should go down alright"

 

[Smurfette]

PS: always loved the question/s I once got while on trauma from a surgical subspecialty colleague:
"can he have pizza?"
We asked,
..........."is it a clear liquid?",
the answer,
..........."well it's soft and if we microwave it, the cheese will be all melty and it should go down alright"

Ha! That's so ortho...

OP, keep in mind also that 12 hour shifts are more of an EM thing. Though it's highly variable, most places do either a 24 hour trauma surgeon call (in house if a busy center)or a week of 24/7 continuous trauma call, or the general surgeon on call is also responsible for traumas.

 

[thedrjojo]

My future residency is a level 1 Trauma... I think they have 8-9 attendings

They do it that each week 1 attending is on service for the day shift, each night there is another attending on call.. not sure how weekends work, might be just 12hr calls... another attending is on service for the ICU during the day, and I think the on call attending is both ICU and Trauma...

additionally, about one week a month, the trauma attendings are the general surgery on call team. The patients go on the general teams list (meaning those residents, not the trauma residents) care for the patients (and do the operations, not the trauma residents) but the trauma attendings are the attendings of record and manage those patients. There is also trauma clinic twice a week

Like they said... many ways to skin the cat...

Also here, EM is pretty weak. Surgery covers all the traumas, then if it is minor/non operative/non admit we triage them to EM, otherwise EM doesn't see trauma. All codes are managed by IM, not EM (i guess unless the code is in the ER... but on the floor its medicine). EM here (and I start my rotation today... ugh, all thats between me and graduation is 10 '12 hour' shifts in the ER) is essentially only those who come in through the ER, assess, triage, dispo, and repeat. Not many procedures, definately not alot of trauma, and not a lot of glory. I may get a better perspective of it after my time there...

 

[SLUser11]

Also here, EM is pretty weak.......ugh, all thats between me and graduation is 10 '12 hour' shifts in the ER) is essentially only those who come in through the ER, assess, triage, dispo, and repeat. Not many procedures, definately not alot of trauma, and not a lot of glory. I may get a better perspective of it after my time there...

Bingo. I think a month in the ER will provide some good perspective. I think it should be a mandatory rotation for med students.

With all the ER hate that circulates through medicine and surgery, I think it's nice for us to go down there and experience what they really do. Usually it causes the future resident to have more respect and understanding for our ER colleagues. They think in a whole different way than we do: they don't care what the patient has, they only care what the patient doesn't have....i.e. MI, PE, surgical abdomen....and what they can prove the patient doesn't have.


It's easy for a medicine resident to roll down to the ER and say "This patient is not having an MI! He doesn't need to be admitted!" I bet the majority of the time the ER doc agrees, the patient is probably not having an MI, but he can't prove it....and if the patient gets sent home and dies on his couch, it's not the medicine resident's @ss that the lawyers will be gunning for....

 

[Buzz Me]

Based on that, maybe trauma surgery is for me. It sounds like a mix of trauma, surgery, and IM (just rounding on sx patients).

Please don't think Trauma Surgery is anything like IM!

Have you shadowed physicians from each of your chosen fields yet? VERY different from just the occasional burst of excitement you may see down in the ER, and certainly very different from what you see on TV.

 

[ACSurgeon]

Bingo. I think a month in the ER will provide some good perspective. I think it should be a mandatory rotation for med students.

With all the ER hate that circulates through medicine and surgery, I think it's nice for us to go down there and experience what they really do. Usually it causes the future resident to have more respect and understanding for our ER colleagues. They think in a whole different way than we do: they don't care what the patient has, they only care what the patient doesn't have....i.e. MI, PE, surgical abdomen....and what they can prove the patient doesn't have.


It's easy for a medicine resident to roll down to the ER and say "This patient is not having an MI! He doesn't need to be admitted!" I bet the majority of the time the ER doc agrees, the patient is probably not having an MI, but he can't prove it....and if the patient gets sent home and dies on his couch, it's not the medicine resident's @ss that the lawyers will be gunning for....

One of our ED docs always says "it's bad form when you're the last doctor the patient saw before dying..."

 

[Moonglow]

Bingo. I think a month in the ER will provide some good perspective. I think it should be a mandatory rotation for med students.

Most MS4's do an EM elective.

 

[MattD]

Just an idea that might approach what the OP is looking for, but what did they call the specialty (practice setup really) being proposed a few years ago, where a surgeon group would be contracted to do shifts where they covered all acute surgical issues that came in through the ER? Did they call that 'Emergency surgery' or was it something else? Basically they would cover trauma and gen surg call, instead of the local gen surg groups. I don't know how feasible it is on a national scale, but I can see a situation where a community is served by a busy gen surg practice that would be willing to have a group covering for them so they can focus on their clinic patients, etc. Thoughts? Has that initiative gone anywhere? I haven't heard about it in a while.

 

[Encephalectomy]

Just an idea that might approach what the OP is looking for, but what did they call the specialty (practice setup really) being proposed a few years ago, where a surgeon group would be contracted to do shifts where they covered all acute surgical issues that came in through the ER? Did they call that 'Emergency surgery' or was it something else? Basically they would cover trauma and gen surg call, instead of the local gen surg groups. I don't know how feasible it is on a national scale, but I can see a situation where a community is served by a busy gen surg practice that would be willing to have a group covering for them so they can focus on their clinic patients, etc. Thoughts? Has that initiative gone anywhere? I haven't heard about it in a while.

I don't know how common it is in general, but what you describe is how the trauma service is run at my medical school's main hospital (I think it is called the acute care surgeon model). The trauma surgeons I've talked to at my school love this model because it means that they get to operate a ton despite the increasingly non-operative nature of trauma (though we have enough knife and gun club that they're pretty busy with penetrating trauma as well). The downside is that with operating a ton (both acute gensurg stuff and traumas) + critical care management of the trauma patients they work a ton, but they are all there by choice and seem to enjoy their practice setup.

 

[Khaos05]

Hey guys (and gals if there are any - hard to tell by username sometimes),

Thanks for all the replies - it's giving me a better idea of what I need to look at and pay attention to.

In response:
I like GenSurg - when I mentioned that I like the "lay them open, quick, messy surgery" better it just meant that a trauma surgery situation appeals MORE than gensurg. I think I would still very much enjoy gensurg as well.

I also didn't mean to sound like I thought surgery and IM were the same. I just meant the aspect of rounding on patients day-to-day, monitoring their progress, making adjustments, etc. I just said that I liked that aspect in contrast to the ER doc who admits or consults then never sees patient again (which also appeals, but more so on the days I'm tired and want to be at home).

I guess there's always the option of doing a trauma fellowship and if it turns out that I don't like trauma (or it's not what I thought it would be) to drop the trauma job and just practice as general surgeon.

p.s. Would being a gen/trauma surgeon in military get me that quick, messy trauma case?

 

[SocialistMD]

p.s. Would being a gen/trauma surgeon in military get me that quick, messy trauma case?

A word of advice:

I'd be careful with the way you phrase things and use emoticons, as your seemingly flippant attitude towards human life might create undue animosity. I'm sure your last post was full of tongue-in-cheek writing, joking about being a trauma surgeon and how much you like that sort of thing, but there are those out there who could interpret your post to suggest that you are a cowboy who isn't in it for the patients, but rather the glory. Making jokes about how the misfortune of soldiers can satisfy your inner Eli Roth may have crossed the line from humorous to poor taste.

 

[JackADeli]

...Making jokes about how the misfortune of soldiers can satisfy your inner Eli Roth may have crossed the line from humorous to poor taste.

Agreed.

...Would being a gen/trauma surgeon in military get me that quick, messy trauma case?

No.
Military does not necessarily equate volume of penetrating trauma, nor does it lend itself to ideal/best care scenarios. Yes, plenty of excellent physicians in service. But, high end, top quality care requires more then just the physician. Our service men & women are by necessity recipients of much "wilderness care".

Hopefully, should you ever become a surgeon, you will not seek out "quick, messy...". Rather, you will practice standard of care and provide your patients with the most meticulous & skilled care possible. The difficulty in providing this level of quality of care is often cited by physicians leaving military service.

 

[LucidSplash]

Hopefully, should you ever become a surgeon, you will not seek out "quick, messy...". Rather, you will practice standard of care and provide your patients with the most meticulous & skilled care possible. The difficulty in providing this level of quality of care is often cited by physicians leaving military service.

Agreed. Additionally, I'm certainly no expert but most of the trauma cases I've scrubbed or observed at this point I would hesitate to describe as "quick." An initial ex-lap can be short-to-long, but frequently the abdomen is left open, you get numerous take-backs for wash-outs and vac changes, staged closure, etc. As for "messy" it seems to me that the idea is to quickly control the mess and then systematically and methodically make the necessary repairs. Generally the adjective of "messy" has a negative connotation, even in trauma surgery.

 

[JackADeli]

...I would hesitate to describe as "quick." ...As for "messy" ...the idea is to quickly control the mess and then systematically and methodically ...the adjective of "messy" has a negative connotation, even in trauma surgery.

Exactly. The sicker the patient the more precise , the more efficient, the more systematic you must be. We are surgeons. If you want quick and messy go work for the meat department at your local grocer/meat packing plant.

It is a common misconception that "urgency" allows you to short cut. That is a trap I have seen too many surgeons fall into.... and the patients will often not be able to climb out of that pit! When the stuff hits the fan... you can really recognize the difference between the skilled surgeon and the quick & messy one.

 

[skiz knot]

Hey now, there's no such thing as an "Ortho patient", they are Gen Surg patients with an ortho problem.

And if by some miracle we end up with one or two patients on our primary service, we promptly round on them every day, right after medicine comes by to consult.

Hahahaha.
So true, except that fact that we will round on our patients and have 3 cases done by the time the medicine team has rounded.

 

[Rabbit Hole]

Exactly. The sicker the patient the more precise , the more efficient, the more systematic you must be. We are surgeons. If you want quick and messy go work for the meat department at your local grocer/meat packing plant.

It is a common misconception that "urgency" allows you to short cut. That is a trap I have seen too many surgeons fall into.... and the patients will often not be able to climb out of that pit! When the stuff hits the fan... you can really recognize the difference between the skilled surgeon and the quick & messy one.

Speaking of quick & messy, do most institutions enforce the "time out" rule prior to surgery or is it largely ignored?

 

[JackADeli]

...do most institutions enforce the "time out" rule prior to surgery or is it largely ignored?

at the institutions I have worked at in the last 3-4 years, time-out has been strongly enforced. My most recent institution has even moved to requiring a participating surgeon/physician mark and initial.... i.e. it has to be the attending or the resident that will actually scrub on the case. It could not just be any resident on the team.

 

[SouthernSurgeon]

at the institutions I have worked at in the last 3-4 years, time-out has been strongly enforced. My most recent institution has even moved to requiring a participating surgeon/physician mark and initial.... i.e. it has to be the attending or the resident that will actually scrub on the case. It could not just be any resident on the team.

My n=2 (med school + away rotation), but I would second this. Strongly strongly enforced. At my school anesthesia won't wheel the patient back until the scrubbing surgeon is physically present, and we do a pre-induction and pre-incision time out which the attending has to be present for. Mark/initialing had to be done by operating surgeon (just like JAD said - couldn't be another resident on the team or a student).

I would be pretty surprised if there were many places left "largely ignoring" the time-out since it has gotten so much attention lately.

 

[Rabbit Hole]

at the institutions I have worked at in the last 3-4 years, time-out has been strongly enforced. My most recent institution has even moved to requiring a participating surgeon/physician mark and initial.... i.e. it has to be the attending or the resident that will actually scrub on the case. It could not just be any resident on the team.

My n=2 (med school + away rotation), but I would second this. Strongly strongly enforced. At my school anesthesia won't wheel the patient back until the scrubbing surgeon is physically present, and we do a pre-induction and pre-incision time out which the attending has to be present for. Mark/initialing had to be done by operating surgeon (just like JAD said - couldn't be another resident on the team or a student).

I would be pretty surprised if there were many places left "largely ignoring" the time-out since it has gotten so much attention lately.

That's good to hear. "Largely ignored" - what I meant to ask was if all parties seriously participated and enforced the time out and not just take a short cut (i.e. initialing by non-operating surgeon).

Is this a part of routine for private practice surgeons as well?

 

[45408]

3) you have fallen in the the student trap of thinking trauma is exciting. There is a reason all of us farther down the road than you groan when we hear the trauma pager. It is NOT exciting to admit your 14th drunk of the night, to round daily on an Ortho patient (whom you don't get to operate on or have any fun with), writing TPN orders and talking with families, to essentially do all the grunt work with very little operating time save for placing PEGs and trachs. It is NOT always changing.

Oh, I didn't know you did trauma surgery at my program.

I guess things don't change much from one place to the next. Trauma surgery was exciting for the students, since we got to go into all the big cases. All the lower-level residents get left out, and the most they do in the OR tends to be pretty minimal.

 

[45408]

Hey now, there's no such thing as an "Ortho patient", they are Gen Surg patients with an ortho problem.

And if by some miracle we end up with one or two patients on our primary service, we promptly round on them every day, right after medicine comes by to consult.

Why is it that ortho does this?

 

[Khaos05]

Hey everyone, I apologize for that comment. I did not mean it crudely or disrespectfully; please accept my apologies.

I understand that surgeries aren't supposed to be messy and sloppy. I just think I would enjoy the thrill of a trauma rolling into the bay and having to decide very quickly what i'm going to do (intubate, chest tube, OR immediately for ex-lap or open). And yes, I'm in it for the patient. I've told many people that barring loans, I would do trauma surgery for <100k/yr - i'm not going into medicine for the money; it's because I love being able to take care of patients at the highest level and when they need it the most.

Again, I apologize for that comment. I have a very high degree of respect for our military and that's why it appeals to me very much to serve in the military as a physician.

 

[Winged Scapula]

That's good to hear. "Largely ignored" - what I meant to ask was if all parties seriously participated and enforced the time out and not just take a short cut (i.e. initialing by non-operating surgeon).

Is this a part of routine for private practice surgeons as well?

I can't speak for other PP surgeons but I take it seriously and so does my staff. I personally mark the patient (although the ORs I go to don't require the surgeon to mark the pt; preop nursing can do it), they don't go back until I've seen the patient, the patient is prepped while I'm in the room and when ready for formal time out, they make me turn down the music and stop what I'm doing, etc.

 

[45408]

I can't speak for other PP surgeons but I take it seriously and so does my staff. I personally mark the patient (although the ORs I go to don't require the surgeon to mark the pt; preop nursing can do it), they don't go back until I've seen the patient, the patient is prepped while I'm in the room and when ready for formal time out, they make me turn down the music and stop what I'm doing, etc.

I can just picture the OR nurse hollering at you over the roar of your music.

 

[thedrjojo]

My n=2 (med school + away rotation), but I would second this. Strongly strongly enforced. At my school anesthesia won't wheel the patient back until the scrubbing surgeon is physically present, and we do a pre-induction and pre-incision time out which the attending has to be present for. Mark/initialing had to be done by operating surgeon (just like JAD said - couldn't be another resident on the team or a student).

I would be pretty surprised if there were many places left "largely ignoring" the time-out since it has gotten so much attention lately.

My n=5 (2 University Public, 1 University Private, 1 University Affiliated Private, and 1 Community Private) and it is fully enforced. I also had a grand rounds where a prof at a major cancer center in Florida who is also an airline pilot came and discussed the idea of checklists and timeouts, and that alone makes me personally wanting to enforce them when I finally will get to be commander in chief of an OR (only 9 years from now...)

 

[irie]

Why is it that ortho does this?

Hip fractures and, I believe, pelvic fractures show better outcomes if a medicine consultant has done their stuff.

 

[Rabbit Hole]

I can't speak for other PP surgeons but I take it seriously and so does my staff. I personally mark the patient (although the ORs I go to don't require the surgeon to mark the pt; preop nursing can do it), they don't go back until I've seen the patient, the patient is prepped while I'm in the room and when ready for formal time out, they make me turn down the music and stop what I'm doing, etc.

Well then, I guess the next logical question would be who is your favorite rap artist?

Found this basic checklist:
WHO_Patient Surgical Safety Checklist 2009


For those reading this thread who are super bored and/or avoiding studying:
WHO_Implementation Manual Surgical Safety Checklist
WHO_Guidelines for Safe Surgery 2009

 

[SLUser11]

Most MS4's do an EM elective.

Where? At your institution? Maybe, but can you really speak for the entire nation? In my experience with students from 5 med schools, only a small fraction of students do ER electives. There are some schools where it's mandatory, but that's not the norm.

 

[Moonglow]

In my experience with students from 5 med schools, only a small fraction of students do ER electives. There are some schools where it's mandatory, but that's not the norm.

Here in Baltimore, doing a 4th year EM block is done by everyone - maybe because our med-schools are in a big city, and we promote the specialty? Getting into an EM residency slot is super-competitive - I mean, which students wouldn't want to do at least 30 days in the ER?

 

[SocialistMD]

Here in Baltimore, doing a 4th year EM block is done by everyone - maybe because our med-schools are in a big city, and we promote the specialty? Getting into an EM residency slot is super-competitive - I mean, which students wouldn't want to do at least 30 days in the ER?

Is it a 2 month block...?

I don't think it is the size of the city, but more the promotion of the specialty, as I've been at two institutions in cities both larger than Baltimore, and it isn't required at either. I do think it is a good rotation to do as a medical student, as you see what actually goes on in the ER so you understand when you are the one frustrated on the other end of the phone, getting the "unnecessary" phone call from the ED; it gives you the perspective of what they have to do and how difficult it can be.

 

[LucidSplash]

Here in Baltimore, doing a 4th year EM block is done by everyone - maybe because our med-schools are in a big city, and we promote the specialty? Getting into an EM residency slot is super-competitive - I mean, which students wouldn't want to do at least 30 days in the ER?

This must be the "east side" Baltimore medical school, as an EM rotation is definitely NOT required at the "west side" school.

 

[Moonglow]

Yes, East Baltimore MS4's must take a one block (30 days) EM; it's just that most med-students here can't wait for the EM block.

By the way, the four year curriculum is really changing for some of the well-known big city med-schools - in the near future MS1s and MS2s will do also clinical blocks, along with a reduction of lecture attendance and class work.

 

[SocialistMD]

Yes, East Baltimore MS4's must take a one block (30 days) EM; it's just that most med-students here can't wait for the EM block.

You missed the joke. EM typicially only works 15-18 shifts per month, thus requiring 2 months to complete 30 days in the ER (as you originally posted).
See, funny...

 

[Moonglow]

You missed the joke.

I gotta' quit posting at 2:00am.

 

[Pickyournose]

I think any specialty with shift work is hard. Man was made to work during the day. Man are not bats and other nocturnal animals.