As we all set about our medical careers we understand that there are going to be certain days that stick in our memories for a lifetime. There will be days when the events that unfold make an impression upon us - days from which we learn volumes yet feel as if we have fallen flat on our faces. These days are difficult to bear, but strike so well at our weaknesses that they are essential to becoming proficient medical providers. Today was such a day for me.
Without going into too much detail, we had a number of pretty sick folks come through the ER today. As a student, I was unfortunately a bit hamstrung in what I could do to help in these cases - the bustle of activity surrounding me included skills that I do not possess and skills that are not easily acquired in just a month of emergency medicine. This experience was intensely frustrating in some ways and incredibly valuable in others - frustrating because the skills are ones that I need to know to practice medicine well, yet valuable in that essentially I was allowed to be a fly on the wall observing some talented providers work together to provide good medical care. In my case, the frustration overshadows the value a bit.
But to make good use of the time I spent in the ER today, it is my job to see to it that the value is evident in the end. Our clinical experiences will be what we make them to be, not more and not less. With this in mind, I can let the memories of the events that unfolded today sink in and stay with me so that when I am in practice and begin taking care of patients as sick as those that I saw today, I will at least understand the sequence of the things that need to occur.
As it turns out, I don't think I have a choice about whether or not the events that transpired will stick with me - some things we don't tend to forget.
Wednesday, December 1, 2010
Tuesday, November 23, 2010
SCUT Monkey
Many books have been written on this topic and every medical provider has had to perform this role at some point in his or her career. The role of the "Scut Monkey" is one that some do not desire for, to be honest, it can be an undesireable job. But this work has to be done. I have learned to fulfill this role mainly in the form of taking care of our "frequent fliers." It has been challenging, but interesting, and up to this point I don't mind the job too much.
The situation is usually the same - the doctor (my preceptor) will say, "I think you should go see Mrs. Smith," usually with a sly glint in his eye. The PA working in the department will say, "Ooooh, yeah! Mrs. Smith will be a good patient for you to see," with a wicked grin. Of course the PA really means, "This is going to be a challenging and potentially annoying case that will probably end with the patient making inane requests or having a laundry list of complaints a mile long that we have already worked up literally twenty times without any new results... so let's see if you can get all the right answers." I try to dutifully march off to see the patient, but often I say to myself, "Not another one!"
It is here that I must take pause and mention something that my preceptor and the PAs in the department have already taught me - even frequent fliers get sick sometimes. The same things that can afflict John Doe can effect Mrs. Smith, and it is in this type of patient that we will most likely miss a major medical problem, because we've heard it all before. We have heard the complaints of abdominal pain, or back pain, or headaches a hundred times (sometimes literally) and there is never anything to point to an actual cause of the symptoms, so we think, "Why should this time be any different?" Isn't the definition of insanity something along the lines of repeating the same exact activity a number of times and expecting a different result? Admittedly, it takes a bit of a naive mind to subject oneself to the difficulties of getting an H&P on this type of patient, but that is exactly what I am - a naive mind. I need to fill it with something, right? Who better for a naive mind to see than someone who has a number of complaints without corresponding physical findings? It is this patient who will challenge my diagnostic abilities the most - and one that I have the luxury of time to examine. Will I be allowed to assess a patient in flash pulmonary edema? Not likely - this patient's respiratory compromise warrants more urgency than a PA student in his second week of emergency medicine can provide, especially since this particular PA student has only seen one or two of these types of patients in his entire life. But the frequent flier... This is a patient that the doctor already knows and someone that will allow the PA student the time to perform a solid H&P and the appropriate tests in the hope that this naive mind might give them whatever it is that they seek. And this is why it is a good experience for me to see our frequent fliers.
Interestingly, in one book on the topic of "Scut Monkeys" the charge was given to think of SCUT as an acronym for Some Clinically Useful Training. My charge to those that come after me is to adopt a constructive view of scut work for we will all have to perform these tasks - but they are what you will make of them.
The situation is usually the same - the doctor (my preceptor) will say, "I think you should go see Mrs. Smith," usually with a sly glint in his eye. The PA working in the department will say, "Ooooh, yeah! Mrs. Smith will be a good patient for you to see," with a wicked grin. Of course the PA really means, "This is going to be a challenging and potentially annoying case that will probably end with the patient making inane requests or having a laundry list of complaints a mile long that we have already worked up literally twenty times without any new results... so let's see if you can get all the right answers." I try to dutifully march off to see the patient, but often I say to myself, "Not another one!"
It is here that I must take pause and mention something that my preceptor and the PAs in the department have already taught me - even frequent fliers get sick sometimes. The same things that can afflict John Doe can effect Mrs. Smith, and it is in this type of patient that we will most likely miss a major medical problem, because we've heard it all before. We have heard the complaints of abdominal pain, or back pain, or headaches a hundred times (sometimes literally) and there is never anything to point to an actual cause of the symptoms, so we think, "Why should this time be any different?" Isn't the definition of insanity something along the lines of repeating the same exact activity a number of times and expecting a different result? Admittedly, it takes a bit of a naive mind to subject oneself to the difficulties of getting an H&P on this type of patient, but that is exactly what I am - a naive mind. I need to fill it with something, right? Who better for a naive mind to see than someone who has a number of complaints without corresponding physical findings? It is this patient who will challenge my diagnostic abilities the most - and one that I have the luxury of time to examine. Will I be allowed to assess a patient in flash pulmonary edema? Not likely - this patient's respiratory compromise warrants more urgency than a PA student in his second week of emergency medicine can provide, especially since this particular PA student has only seen one or two of these types of patients in his entire life. But the frequent flier... This is a patient that the doctor already knows and someone that will allow the PA student the time to perform a solid H&P and the appropriate tests in the hope that this naive mind might give them whatever it is that they seek. And this is why it is a good experience for me to see our frequent fliers.
Interestingly, in one book on the topic of "Scut Monkeys" the charge was given to think of SCUT as an acronym for Some Clinically Useful Training. My charge to those that come after me is to adopt a constructive view of scut work for we will all have to perform these tasks - but they are what you will make of them.
Friday, November 19, 2010
Thrill ride
I have been having some trouble coming up with an update about where I am and what I'm doing. I think this is mostly because I've been having too much fun doing it.
Thus the update of the day is that I am currently doing an ER rotation at the largest regional medical center in our area. It is so enjoyable that I hardly feel I am at school. My preceptor has an amazing amount of knowledge to share and has been pretty willing to have me experience new things first hand - like suturing. On my first day a patient came in needing a number of stitches... my preceptor said, essentially, "Go for it," and with the appropriate supervision (he looked over my shoulder the whole time) I closed the patient's wound with no trouble. It was a good experience. I have had many others already, and I've only worked 2.5 shifts (30 hours) so far.
One dilemma I have faced so far - and one that hit a little too close to home - was that of how far we as providers should go for patients in a permanent vegetative state. This came up in my last rotation as my preceptor and I listened to a radio news broadcast on the subject. We discussed this and the question that arises is this: should we do absolutely everything for everyone? Of course, if we say that we should not provide life support for people in permanent vegetative states then at what point will we draw the line? Will we begin to draw it further and further down the line? Will we start withholding medical care from the frail elderly or those who are simply so ill that they have no change of a meaningful recovery? Truth be told, this decision does not lie with us (the medical providers) but often times families ask us what we think - what we would do. It is their decision, but they seek affirmation of their choice and support for whatever they elect to do. The weight of the situation is such that it warrants a great deal of forethought.
One discussion point that I think helps me the most is this: perhaps we should draw the line between prolonging death and preserving quality of life. If a patient is in end stage lung cancer with multiple metastatic lesions to their bones and in excruciating pain all day, every day then perhaps we should not seek to blast them with all sorts of chemotherapy and make them endure their pain longer by only slowing the progression of their disease without hope of a cure (aside from a miracle direct from the hand of God). Perhaps in this situation we should simply help them be comfortable - not hastening or prolonging death, but providing comfort and care for the ill in their final days. And I think that most reasonable medical providers can see the logic and compassion in this situation.
But how does it change in a pediatric patient? Perhaps there is more hope for a cure and long years of a high quality of life, or perhaps a child is so ill that he cannot be saved. This is a huge dilemma for all of us, and the answers are not so clear cut. I have struggled with this recently and will no doubt revisit it. But my preliminary thought is that if, for example, a child has an injury that has left them without higher brain function such that they have a steady heartbeat and steady respiration we should do nothing to prolong their entrapment in that tomb made of flesh and bone. We should not hasten death, but I have to ask a question: what good does it do a person to be trapped without hope of recovery inside a body that itches, that hurts, that will become ill over the years? In this situation there is no expressive faculty left for the patient and no ability to move - in my opinion this would be more like torture than life.
So where should we come down on this issue as medical providers? Well, I have my opinion, and others will have their own. And, to be honest, it is unlikely that all of us will ever agree. But we should all give it a great deal of thought and we should all do it early in our careers so as to be ready for these situation because, as I have seen, they come up often.
Thus the update of the day is that I am currently doing an ER rotation at the largest regional medical center in our area. It is so enjoyable that I hardly feel I am at school. My preceptor has an amazing amount of knowledge to share and has been pretty willing to have me experience new things first hand - like suturing. On my first day a patient came in needing a number of stitches... my preceptor said, essentially, "Go for it," and with the appropriate supervision (he looked over my shoulder the whole time) I closed the patient's wound with no trouble. It was a good experience. I have had many others already, and I've only worked 2.5 shifts (30 hours) so far.
One dilemma I have faced so far - and one that hit a little too close to home - was that of how far we as providers should go for patients in a permanent vegetative state. This came up in my last rotation as my preceptor and I listened to a radio news broadcast on the subject. We discussed this and the question that arises is this: should we do absolutely everything for everyone? Of course, if we say that we should not provide life support for people in permanent vegetative states then at what point will we draw the line? Will we begin to draw it further and further down the line? Will we start withholding medical care from the frail elderly or those who are simply so ill that they have no change of a meaningful recovery? Truth be told, this decision does not lie with us (the medical providers) but often times families ask us what we think - what we would do. It is their decision, but they seek affirmation of their choice and support for whatever they elect to do. The weight of the situation is such that it warrants a great deal of forethought.
One discussion point that I think helps me the most is this: perhaps we should draw the line between prolonging death and preserving quality of life. If a patient is in end stage lung cancer with multiple metastatic lesions to their bones and in excruciating pain all day, every day then perhaps we should not seek to blast them with all sorts of chemotherapy and make them endure their pain longer by only slowing the progression of their disease without hope of a cure (aside from a miracle direct from the hand of God). Perhaps in this situation we should simply help them be comfortable - not hastening or prolonging death, but providing comfort and care for the ill in their final days. And I think that most reasonable medical providers can see the logic and compassion in this situation.
But how does it change in a pediatric patient? Perhaps there is more hope for a cure and long years of a high quality of life, or perhaps a child is so ill that he cannot be saved. This is a huge dilemma for all of us, and the answers are not so clear cut. I have struggled with this recently and will no doubt revisit it. But my preliminary thought is that if, for example, a child has an injury that has left them without higher brain function such that they have a steady heartbeat and steady respiration we should do nothing to prolong their entrapment in that tomb made of flesh and bone. We should not hasten death, but I have to ask a question: what good does it do a person to be trapped without hope of recovery inside a body that itches, that hurts, that will become ill over the years? In this situation there is no expressive faculty left for the patient and no ability to move - in my opinion this would be more like torture than life.
So where should we come down on this issue as medical providers? Well, I have my opinion, and others will have their own. And, to be honest, it is unlikely that all of us will ever agree. But we should all give it a great deal of thought and we should all do it early in our careers so as to be ready for these situation because, as I have seen, they come up often.
Monday, November 8, 2010
PA school interviews
Taking part in an interview for PA school is quite an adventure in and of itself - I should know: I did it twice. The day begins as any other with an alarm clock blaring. The first difference is that the candidate is most likely already awake and just waiting for the alarm clock to go off. The morning routine progresses with more intensity, more enthusiasm, more attention to detail, and often more quickly than usual. The trip to the interview site goes more quickly than ever before, too. It is filled with thoughts about how to answer the questions, about what the future might hold, and often about how much the interview itself means to the candidate. One question that comes up often is, "Why do I want to be a PA, anyway?" Everyone's answer is different, but this is the central question that interviewers want to get at. The interviewers want an answer and then they have to judge whether a person's motives are adequate. This is the tricky part.
It is this last part that I want to comment on today. I have now had the experience of interviewing the next round of candidates to come through my school's PA program. It was my task to assess whether or not the candidate's motives are right, whether they are at the right depth and maturity, and whether or not the candidate really knows what lies ahead - what a PA is and does, what it means to be in PA school, and what taking sips from a firehose is all about. In the end, it comes down to one decision: accept or reject. This was the hardest part for me. Having been in their shoes so recently, I could see the future they were hoping for and that this interview was their first step. I could still see it from their perspective very freshly. Thus it was difficult to weed out those who just didn't have it - I wanted them all to succeed because they all brought some sort of promising characteristics to the table. Some not as much, and these were the ones that I could not decide upon. But weighing these things - desire, motivation, knowledge, maturity, motives - was done well and a good class is coming up for next year.
I was honored to help select them and humbled by those that I did not select. Afterall, I did not get selected once and I remember how it feels. My hope is that all those who didn't make it will show their true character by keeping their chins up, setting goals to improve themselves over the coming year, meeting those goals and re-applying next year. If they do these things, they will shine brighter among a group of bright young people next year and will, in the end, make a fine PA someday.
It is this last part that I want to comment on today. I have now had the experience of interviewing the next round of candidates to come through my school's PA program. It was my task to assess whether or not the candidate's motives are right, whether they are at the right depth and maturity, and whether or not the candidate really knows what lies ahead - what a PA is and does, what it means to be in PA school, and what taking sips from a firehose is all about. In the end, it comes down to one decision: accept or reject. This was the hardest part for me. Having been in their shoes so recently, I could see the future they were hoping for and that this interview was their first step. I could still see it from their perspective very freshly. Thus it was difficult to weed out those who just didn't have it - I wanted them all to succeed because they all brought some sort of promising characteristics to the table. Some not as much, and these were the ones that I could not decide upon. But weighing these things - desire, motivation, knowledge, maturity, motives - was done well and a good class is coming up for next year.
I was honored to help select them and humbled by those that I did not select. Afterall, I did not get selected once and I remember how it feels. My hope is that all those who didn't make it will show their true character by keeping their chins up, setting goals to improve themselves over the coming year, meeting those goals and re-applying next year. If they do these things, they will shine brighter among a group of bright young people next year and will, in the end, make a fine PA someday.
Saturday, October 23, 2010
Sirens awail
This is what I do in my spare time. I am a volunteer EMT with the local fire department's ambulance company.
Let me just say that the folks I work with in the company are an inspiration to me and have been a very strong influence on why I want to practice medicine. They work hard and are available 24/7 to help those who are in need of medical assistance. The kicker: nobody gets paid a dime. Their sacrifice embodies the Christian principle of, "My life for yours," and reminds me every time I run a call with them why the calling of medicine is so great. For another perspective, go here and click on the video at the bottom labeled, "Moscow."
Wednesday, October 20, 2010
More transitions
This week I began a stint with the government. I'm working in general internal medicine, which has been quite the culture shock. I see patients with no fewer than five concurrent medical problems, and during the visits I generally manage to elicit at least two additional medical complaints from side pain to, "Oh yah... I've got this thing on my toe..." This rotation is intimidating beyond what I had initially anticipated, but the biggest challenge for me has been the adjustment from the fast paced and well delineated world of general surgery to the much more relaxed paced (yet still incredibly busy) and nebulous world of internal medicine.
A week ago I was doing rounds on a number of patients each with a clearly defined medical history and all of the necessary diagnostic testing at our fingertips. We would be sent a patient complaining of right upper quadrant pain, for example, and they would have blood chemistries and blood cell counts already done or available within the hour. They would have CT scans already performed and the scan would be accessible to us within two minutes.
But this week I am working in a governmental systems with more "i's" to dot and "t's" to cross than I can keep straight. When the patient comes in with a complaint, we are the ones trying to coordinate the labs and imaging which we won't see for at least a week. We have records dating back YEARS that we must pore through to get to the bottom of the issue. The conversation often goes, "I was seen by a doctor... whatshisname... over there at that one clinic? Yeah, that guy. Anyway, he saw me and ordered all sorts of tests. He called my condition "somerandomname" and gave me these pills. Itinilol or something like that. Can't you just look at the records on your computer?" Of course we do our due diligence and track down all of the records, complete and incomplete alike, and piece together the progress of the problem at hand. It takes an experienced provider at least 20 minutes to get it all together, and it takes me easily three times as long. It is frustrating, but rewarding. I put together the pieces of the puzzle and get to the bottom of the problem, find a solution, and get the patient sent on his merry way. My biggest challenge now has become determining which pieces play a large part in making the diagnosis and which ones are less important. For example, a patient with unexplained weight loss, restlessness, insomnia, and excessively active reflexes doesn't necessarily have a thyroid condition as one would suspect based upon the textbooks.
I think the issue that has come up is that as a student I don't have enough snapshots of what hyperthyroidism, renal artery stenosis, autonomic orthostatic hypotension, etc. look like. I have pre-conceived notions of how these things might present, but these don't match with reality well because of my lack of experience. My hope is that this will come to me quickly and that each time I see something new I will take a good mental "snapshot" of that condition and store it away for benefit to my patients in the future. In the meantime, I need to be wary of trying to shoe-horn symptoms into a pre-conceived mold of what condition a person with mild peripheral nerve problems and large red blood cells has.
What an exciting time!
A week ago I was doing rounds on a number of patients each with a clearly defined medical history and all of the necessary diagnostic testing at our fingertips. We would be sent a patient complaining of right upper quadrant pain, for example, and they would have blood chemistries and blood cell counts already done or available within the hour. They would have CT scans already performed and the scan would be accessible to us within two minutes.
But this week I am working in a governmental systems with more "i's" to dot and "t's" to cross than I can keep straight. When the patient comes in with a complaint, we are the ones trying to coordinate the labs and imaging which we won't see for at least a week. We have records dating back YEARS that we must pore through to get to the bottom of the issue. The conversation often goes, "I was seen by a doctor... whatshisname... over there at that one clinic? Yeah, that guy. Anyway, he saw me and ordered all sorts of tests. He called my condition "somerandomname" and gave me these pills. Itinilol or something like that. Can't you just look at the records on your computer?" Of course we do our due diligence and track down all of the records, complete and incomplete alike, and piece together the progress of the problem at hand. It takes an experienced provider at least 20 minutes to get it all together, and it takes me easily three times as long. It is frustrating, but rewarding. I put together the pieces of the puzzle and get to the bottom of the problem, find a solution, and get the patient sent on his merry way. My biggest challenge now has become determining which pieces play a large part in making the diagnosis and which ones are less important. For example, a patient with unexplained weight loss, restlessness, insomnia, and excessively active reflexes doesn't necessarily have a thyroid condition as one would suspect based upon the textbooks.
I think the issue that has come up is that as a student I don't have enough snapshots of what hyperthyroidism, renal artery stenosis, autonomic orthostatic hypotension, etc. look like. I have pre-conceived notions of how these things might present, but these don't match with reality well because of my lack of experience. My hope is that this will come to me quickly and that each time I see something new I will take a good mental "snapshot" of that condition and store it away for benefit to my patients in the future. In the meantime, I need to be wary of trying to shoe-horn symptoms into a pre-conceived mold of what condition a person with mild peripheral nerve problems and large red blood cells has.
What an exciting time!
Tuesday, October 12, 2010
Interesting experiences...
So today marks the first day that I have been lied to by a patient. Short version: there was a car accident. The patient denied using any "substances" prior to the incident. Toxicology disagreed.
I was notably chagrined to find out that I had not done my best to get an honest and complete history from the patient. But I learned that there are situations that are not acceptable - having a patient's family in the room will not work. I understand that in situations like today, it is not good medicine to have family in the room.
And I have taken another step on the path to good judgment. As they say, good judgment comes from experience, and experiences are gained by having bad judgment. I deemed the patient a reliable source, and my poor judgment on that gave me some more good experience. Experience I hope I won't soon forget.
I was notably chagrined to find out that I had not done my best to get an honest and complete history from the patient. But I learned that there are situations that are not acceptable - having a patient's family in the room will not work. I understand that in situations like today, it is not good medicine to have family in the room.
And I have taken another step on the path to good judgment. As they say, good judgment comes from experience, and experiences are gained by having bad judgment. I deemed the patient a reliable source, and my poor judgment on that gave me some more good experience. Experience I hope I won't soon forget.
Sunday, October 10, 2010
All good things
As I come to the end of my surgical rotation I note that all good things must come to an end. This has been a fantastic rotation for me. I have learned quite a lot about the practice of medicine both from the medical knowledge standpoint and from the practical application standpoint. One of the biggest take home points is that my academic knowledge translates well into real world scenarios, but not always the way that I had expected. For example - a patient with intractable nausea and vomiting whose CT scan shows gallstones doesn't necessarily have cholecystitis and should not necessarily be taken to surgery right away.
That said, I leave this rotation feeling as if there is so much that I don't know that it is frightening. I recognize and fully admit that I don't know everything about medicine, but at the moment I am feeling the weight of precisely how much I don't know. From what I've been told, this is a natural feeling. It's still uncomfortable, and I am even more aware that by the end of the clinical year I will still not know all there is to know. My prayer is that I will know enough, and more importantly that I will recognize when I don't know what I need to know. I think that the latter is the most important thing and I hope that I get a chance to develop that skill in the coming week.
That said, I leave this rotation feeling as if there is so much that I don't know that it is frightening. I recognize and fully admit that I don't know everything about medicine, but at the moment I am feeling the weight of precisely how much I don't know. From what I've been told, this is a natural feeling. It's still uncomfortable, and I am even more aware that by the end of the clinical year I will still not know all there is to know. My prayer is that I will know enough, and more importantly that I will recognize when I don't know what I need to know. I think that the latter is the most important thing and I hope that I get a chance to develop that skill in the coming week.
Thursday, October 7, 2010
Surgical self-reflection
As I muddle my way through the surgical clerkship I am reminded that continuous self reflection and precise revision of ideas, thought processes, and methods for carrying out tasks are skills that are developed alongside clinical acumen that comes with experience.
As we worked through the didactic year, we all had to develop our own studying styles and methods for parsing out the critical information from all of the LOADS of information we were presented. We had to continually monitor the way we learned to get to the key features of what we needed to learn. After each exam we needed to evaluate how we had studied to determine if it was the right way to do it - did we get the result that we'd wanted?
After each surgery and each patient encounter, I have been evaluating the way that things have gone. Did I ask all the right questions? Did I anticipate the surgeon's movements well enough? The most interesting aspect of this has been that the surgeon I've been working with does this, too. After every case he goes through the steps of the case no matter how routine to make sure that it went as well as it possibly could. If something wasn't right, he has to figure out why. This is a skill we could all benefit from developing and one that I know we as students have to work through. But the challenge and the charge is to continue to self-reflect and develop new ways (better ways) of practicing medicine.
It's not that I think this is news to anyone - rather it is probably mundane by the end of your didactic year. But it should not be mundane or taken for granted. We should all work to analyze each suture, each H&P, each patient encounter - and make the most of our experiences so our patients will benefit in the end.
As we worked through the didactic year, we all had to develop our own studying styles and methods for parsing out the critical information from all of the LOADS of information we were presented. We had to continually monitor the way we learned to get to the key features of what we needed to learn. After each exam we needed to evaluate how we had studied to determine if it was the right way to do it - did we get the result that we'd wanted?
After each surgery and each patient encounter, I have been evaluating the way that things have gone. Did I ask all the right questions? Did I anticipate the surgeon's movements well enough? The most interesting aspect of this has been that the surgeon I've been working with does this, too. After every case he goes through the steps of the case no matter how routine to make sure that it went as well as it possibly could. If something wasn't right, he has to figure out why. This is a skill we could all benefit from developing and one that I know we as students have to work through. But the challenge and the charge is to continue to self-reflect and develop new ways (better ways) of practicing medicine.
It's not that I think this is news to anyone - rather it is probably mundane by the end of your didactic year. But it should not be mundane or taken for granted. We should all work to analyze each suture, each H&P, each patient encounter - and make the most of our experiences so our patients will benefit in the end.
Monday, October 4, 2010
Social ettiquette
I have to write about this as a bit of a pointer to those who will come along behind me. In a way it's kind of humorous because most who know me in a professional setting probably understand that I am fairly particular about rules of social behavior. I like my personal bubble and I try to respect other peoples' personal space. "Please," and, "thank you," are common words in my vocabulary (though not common enough to some).
But the world of surgery is different, and I am having some trouble adjusting to it. The other day I asked for, "Scissors, please." When I received them, I said, "Thank you." The surgeon stopped what he was doing and stared at me. His words were, "you need to stop that right now. Stop being so polite." He was half joking, of course, but he had a point. That is that we must be as polite as is feasible but as direct as is required to get our job done. Extra words are, in a pinch, unnecessary. And today I was having some difficulty visualizing the surgical field because of where I was standing - to the right of the patient across from the surgeon. The surgeon was working deep in the abdomen and I could not see what she was working on in order to keep the field clear. But I couldn't see because I was trying to keep my head a reasonable distance from hers (personal bubble). It was frustrating for her that I couldn't do my job, and unacceptable in my opinion. The tech explained that the sense of personal space is modified in the OR and the surgeon explained later on that I have to do whatever is necessary to see the field in order to help her do her job. This might include being nearly ear-to-ear so that I can see what I need to.
So another lesson from the surgical ward: get over being polite... sort of.
But the world of surgery is different, and I am having some trouble adjusting to it. The other day I asked for, "Scissors, please." When I received them, I said, "Thank you." The surgeon stopped what he was doing and stared at me. His words were, "you need to stop that right now. Stop being so polite." He was half joking, of course, but he had a point. That is that we must be as polite as is feasible but as direct as is required to get our job done. Extra words are, in a pinch, unnecessary. And today I was having some difficulty visualizing the surgical field because of where I was standing - to the right of the patient across from the surgeon. The surgeon was working deep in the abdomen and I could not see what she was working on in order to keep the field clear. But I couldn't see because I was trying to keep my head a reasonable distance from hers (personal bubble). It was frustrating for her that I couldn't do my job, and unacceptable in my opinion. The tech explained that the sense of personal space is modified in the OR and the surgeon explained later on that I have to do whatever is necessary to see the field in order to help her do her job. This might include being nearly ear-to-ear so that I can see what I need to.
So another lesson from the surgical ward: get over being polite... sort of.
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