A silly little blog for me to drop the excrement of my mind.
-or- seeing red!
Published on August 29, 2007 By BlueDev In Life Journals

Meade versus Lee.  Optimus Prime versus Megatron.  Gandalf versus Saruman.

Classic battles, all of them.

But the most epic and pressing for me is Medicine versus Surgery.

See, I am no longer the intern.  I am now a Surgical Resident.  This means that I am the one people call when they want a Surgery Consult.  This is fine.  It is an excellent way to learn.  I see patients, assess their problems, examine them and then determine if surgery is indicated. 

The whole consultation system is really great.  If a patient has a problem you aren't the expert on, you do your best and then ask the expert to come and fill in the gaps.  At least, that is the way the system is supposed to work.  Lately, at least as far as our fine Medicine colleagues are concerned, this isn't even remotely close to reality.

No, instead they see, or maybe just hear about something and pull the trigger to "Call Surgery".

I was asked to assess a pressure ulcer on a patient.  I saw it, didn't think it was that bad, certainly not bad enough that an operation would be beneficial for the patient.  More importantly, the nurse who had seen this before reported that it was looking better.  That last part was the clue for me.  I tracked down the resident who had called the consult.

Casually, calmly I asked the resident how the pressure ulcer looked to him.  The answer was unsurprising: "Oh, I haven't seen it for a while."

Again, calmly, I let him know that those who had actually seen the wound felt it was improving.  Perhaps next time he ought to assess something himself before calling me.  Two days later I get a call.  Same resident.  Different patient, but same sort of issue.  A wound that was "concerning", one they wanted me to see, one that again they hadn't even looked at.  So this time I found the resident and physically pulled him into the room so I knew he had seen it.

Two days later the ICU calls.  Medicine wants us to look at a patient's neck.  Just out of curiosity we asked "Has Medicine seen this themselves?"  Again, predictably, they had not.  That is just one team in a week and a half I have been here.  Last night I spent 2 hours dealing with an abnormal, but completely benign and non-surgical abdomen in a patient we have been saying the same thing about for weeks now.  Literally, we told them the same thing 4 times in a row, but they just didn't want to listen.

And, apparently, they didn't really want to go and examine their patient either.  I have had it.  I'm fed up.  This is how Surgeons get a reputation as being rude.  We get dumped on so much by Medicine that we just get fed up.

Look, I ain't your slave, so you better stop treating me like I am.

Do we consult medicine?  You bet we do.  We had a patient with very difficult to control blood pressure.  But we didn't call them until we had made a decent run at it.  This way we called and were able to say "We have done X, Y and Z with results Q, R and S.  We have done this study, have tried these meds, and now could use some help."

What they have done to us is the equivalent of us seeing a blood sugar of 200 on labs and just calling them to manage it.  They would flip out if we did that, but for some reason they think it is okay to consult us about issues they haven't investigated themselves.

I'm growing tired of it.  I have been civil thus far, but it may not be working.  The abuse is really starting to get ridiculous.

on Aug 29, 2007
Needing a sign near the phone - "Do Not Call Surgery Unless You Have Looked At The Problem Within The Last Hour"
on Aug 29, 2007

"Do Not Call Surgery Unless You Have Looked At The Problem Within The Last Hour"

I'd like to think that would help.  The other part of the problem is they just don't want to know what to look at/for.  I understand that we are here for that, in part.  But don't call me and say "Hey, look at this."  Call me and let me know what you think about the problem, why you think that, and what specific question you want from me.  We afford them that simple courtesy.  They should do the same for us.

on Aug 29, 2007
if they'll take an ancient old crone

Oh c'mon dear...you're not ancient.

on Aug 29, 2007
Reminds me of that Scrubs episode where the surgeons and doctors act like they're in a Westside Story like gang.

on Aug 30, 2007

Hang in there. I won't say it gets better (because it doesn't) but you'll get better at screening the "real" consults from the medicine "garbage" flow.

Heh, I look forward to being in the position where I can tell them that that is a garbage consult.

I think what I find most frustrating is the amount of work we tend to create for each other just because we think we are too busy, or some other lame excuse.

on Aug 30, 2007

Reminds me of that Scrubs episode where the surgeons and doctors act like they're in a Westside Story like gang.

You know, what makes Scrubs so funny is just how accurate it is.  Many of us watch it regularly, and while it does exaggerate, we all agree that it is the closest to the truth of any medical show we have ever seen.

on Aug 30, 2007
I love Scrubs. One of the few shows that has me laughing out loud.

The surgeons at our hospital have a fierce reputation but now I think I know why. I say you go mate and let them know you aint no one's biatch...
on Aug 31, 2007

I say you go mate and let them know you aint no one's biatch...

Of course, the hardest part is getting the point across while still being professional.

on Sep 03, 2007
Wow Dev, just seeing this blog. Kinda scary that the docs are too lazy to really see what is going on.