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."
- Excuse me resident, did you happen to do a (insert atypical diagnostic test) before you did (insert standard diagnostic test)?
- Did you do a rectal exam?
- Wait go back (insists on going back to first slide that states only age, gender, and chief complaint), what is the prognosis?
- Did you do a rectal exam? I don't think our residents are giving everybody rectal exams.
- Resident, have you read any studies during your research that explored (insert any question, related or unrelated to case)?
- Did you do a pelvic exam?
- Wait, could you go back and explain (insert exceedingly basic medical knowledge) for the medical students?
- Did you do a rectal exam? I would like to emphasize the importance of rectal exams.
- (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)
- 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.
8 comments:
My favorite is the discussion that follows the actual presentation:
"first of all, I want to say that was a great presentation, very well thought out. However..."
I swear I didn't hear about the rectal as much as you are. Thank goodness.
Hmm...Maybe I should go get a rectal exam? You know, just to be safe?
Nick Carraway - love the name ;)
Very lovely blog! I totally agree with the importance of rectal exams. An underused gem in the field of medicine!!
That funny, in path it's "Do you have the slides?" Nevermind the patients amylase and lipase are 300 times there normal values. It's not pancreatitis until you have the slides.
We do hear about rectal exams at least once a week. Or at least we heard a lot about it one week and they keep bringing it up weekly to reiterate.
Linz, I think you should take your whole family in for rectal exams. Even if a patient is only complaining of a rash on their elbow, a rectal is in order when you're on surgery.
haha - good stuff!
I'm struggling to remember a more nauseating experience than performing a rectal exam.
Opening an ischemic bowel is way more nauseating that rectal exams. Somehow it smells like bad meat and vomit.
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