Surgery Grand Rounds

 

General surgery M&M and grand rounds conference has been more formulaic than the average medical service grand rounds.  It always starts in the same way.  A resident goes forward to present on a patient who was very sick or died that month (morbidity and mortality for those of you not in the medical field, an M&M unfortunately completely unrelated to chocolate), and the attendings decide to talk about everything that is wrong in medicine in the seemingly impossible aspiration that it will lead to "quality improvement."  But since medicine tends to be practiced in the same way week after week, the conference tends to become repetitive.  Here are ten gems to bring up if you ever happen to be an attending at a surgery "quality improvement conference."

1. Excuse me resident, did you happen to do a (insert atypical diagnostic test) before you did (insert standard diagnostic test)?
   
2. Did you do a rectal exam?
   
3. Wait go back (insists on going back to first slide that states only age, gender, and chief complaint), what is the prognosis?
   
4. Did you do a rectal exam?  I don't think our residents are giving everybody rectal exams.
   
5. Resident, have you read any studies during your research that explored (insert any question, related or unrelated to case)?
6. Did you do a pelvic exam?
7. Wait, could you go back and explain (insert exceedingly basic medical knowledge) for the medical students?
8. Did you do a rectal exam?  I would like to emphasize the importance of rectal exams.
9. (Question resident in audience) Let's make sure we're paying attention and learning, what are the approaches for the procedure? (word this question as bizarre as you can so that you can correct the resident when they are done speaking)
10. I would just like to comment that the rectal exam is very important.  

--By Farrah, who would like the reiterate the importance of rectal exams.  Oh yeah, and shout out to Amar who was sitting next to me in grand rounds while I was drawing the picture.  

Musings while on Surgery Call

I imagine that when you used to tell people you were in medical school in the olden days (i.e. the 90s), they would think "NERD" or "GEEK" or something decidedly low on the social ladder. In the'00s because of popular primetime dramas like Grey's Anatomy, medical school is one's path to a life of nonstop glamor and sexual hijinks with fellow residents. For instance, the "on-call

My On-call room. Notice the Coke. A call must!

room" has a whole new connotation since the crazy cast of Grey's has popularized it with extra-curricular activities other than sleeping.

But here I am, nearing the end of my third year of medical school, and I can definitively say that while there may be some eye flirting between MS3s (the equivalent of "fresh-meat" in college) and the tired residents, life as a student is just one large charade of pretending to be a doctor. Here are some examples:

Seemingly Glamorous Activity: I'm on 24-hour call tonight, and when I tell non-doctors this fact, they are probably thinking, "Wow impressive! Saturday call - you must be really committed to be a doctor to sacrifice weekends." People might wonder what kinds of fun things I do when there is a trauma emergency - as I run in scrubs that fit me perfectly to the ER.
Reality: I've been sitting in a windowless call room with no cell phone reception for over 12 hours. No one has paged me to do anything, and my afternoon has been spent studying and watching a documentary on Roman Polanski (he was unfairly convicted!) and Little Mosque on the Prairie episodes. If there is a trauma, I'll most likely walk at a brisk pace to the ER and then act as an extra as real doctors run the show.

Seemingly Glamorous Activity: Pre-rounding on patients at 6 AM and writing notes about their progress overnight. Improving patient care, saving lives, and taking names.
Reality: I write progress notes that I can't put in the medical chart or the attending physician will get sued. No one ever reads them so my elaborate works of progress note art are relegated to my pocket. The question remains: if a SOAP note is written in the forest, and no one reads it or acknowledges it, does it even exist?

Seemingly Glamorous Activity: Scrubbing into a radical neck dissection surgery in the OR. This is preceded by going through the entire procedure of scrubbing and possibly flirting with cute resident/student by the metal sinks while soaping up one's arms into a heavy lather.
Reality: Scrubbing in for a student means holding a retractor at an awkward position for hours on end. The uncomfortable angle makes me wish that I could cut my arm off just to end the misery. And unless I want to stare longingly into the eyes of the middle-aged scrub nurse, mother of 5, then it's best to look straight ahead into the sterile field.

And so, while rotations are a necessary part of preparing us for the responsibilities and hardship of residency, the tediousness sometimes makes me wish I were an intern already, despite the low pay and lengthy hours. After one year of this, I'm ready to stop playing doctor, and actually, you know, be one.

--By Mariam, who hopes that no one gets drunk and hits their head or gets run over by a car tonight (i.e. the bulk of traumas at the UT ER).