Cast & Curious

Tag: Training

  • Training Perspectives Part I: Dummies guide to surviving an Orthopedic pre-operative case conference

    It’s never a pleasant experience for me, as an attending, to see a resident tremble in front of the consultant staff, his pre- op case vanishing in room air and his morale at the level of the floor mat. I was in the same undesirable instances before, as any resident would be, not a long time ago. Often, the deja vu, nauseates my academic appetite. Ironically some of the best lessons I learned in my training came from such spectacular display of “enlightenment”.

    I am in the opposite sitting arrangement now, as an attending, throwing the same bullish questions I lovingly evade before. But then again, if you are a resident and you accept your status as it is, this might be the best way of freeing yourself from such lowly self esteem!

    A word of caution though. This is not Us, The attending vs You The Residents sort of set up. As Someonetc said, were all in these together. Nethier you or us nor the patients should lose. We all learn from it.

    The common question from the frustrated resident is “How will I ever satisfy this ever critical attending? I’m always wrong to him!”So our residents will ask me, “how can I ever avoid such hell questions during pre-op?” In the short time I’ve been an attending (and the long time hibernation as a resident) these are the “attributes” I look for and emphasize during rounds and pre-op. In this particular order.

    1. Present the case for your patient. Know your patient, examine him well, take care of him, and decide according to his realities and situation. Put him in the top of your indication list. Err on his side. Overdo things for his welfare. I cannot emphasize more. Nothing irritates us more when the patient is not on your number one list or if you forgo the patient’s welfare just because you were busy with something else.It is always wrong to reason out that way!
    2. Never lie or bluff your way out. We will be sending you to vacationland for good or force you to jump-off training. Believe me.
    3. It’s the decision making process that I look in more. The logic behind why you do the labs, why did you decide to do the the surgery or not. This separates you from as a scientist and surgeon to a technician. Treatment protocols may vary, gold standard of treatment will change in the future, but logic and decision making attributes remain the same.
    4. Read for your case. Read voraciously what is relevant to your patient and case at hand. Hit your ortho books but new relevant studies will always grab our interest. Never come unprepared to the pre -op. No patient (not even you as a resident) would want a surgeon who doesn’t know what hes doing, to operate on him
    5. Accept mistakes and make good at your promise to do well next time. The attending will always remember the next time.
    6. Talk to your attending or consultant after the conference (and the patient) to make sure you got what they advised you.Its always a mark of a dignified resident to clarify his lessons and make sure he understands them well.

    Again, we’re all in these together, you residents, us the consultant staff and the patients. I still believe no consultant is in there to personally destroy a residents career. Most of us are there to help you learn, learn the right way for you“-free of charge. Perhaps, thats the best assurance you can get from us.

  • Desirable traits of a good (or excellent) surgeon

    What makes a good surgeon?This is a common question that comes into the mind of patients whenever they choose their surgeons or physicians to entrust their life. There are probably a hundred of these “desirable” traits but they generally fall into “categories” of surgeon attitudes and are definitely interrelated. Medical school (and residency training) attempted to make us all adept at new skills and the science behind the art of medicine, yet there are some who excel in the hearts of their patients and colleagues. Here is why .

    • According to Dr. Thomas Russell, Executive Director of the American College of Surgeons“surgeons have to be technically adept…”, able to change when needed “…and have new ways of doing things” . This means that surgeons should have wide array of technical skills and be able to adapt or tailor his expertise to the patients he’s handling or his community of practice. This is remarkably important among us Filipino surgeons, that though we lag behind in technological advances in medicine (notice the disparity between what is taught in med school and what you have in the real life practice), we should be able to innovate from what we have with our solid foundation of scientific knowledge.
    • Compassionate and love for humanity. Filipinos are known for their superior compassion and love for their patients. Our patients expects us to be compassionate every time we deal with them. Being a Filipino, its a terrible offense not to.
    • Surgeons should be approachable and not difficult to deal with. Patients and colleagues hate any surgeon who treats them like they are inferior species of human beings. It will also save you from litigations and malpractice suits.
    • I would love a surgeon who is truthful and is open minded to any questions. He should be ready to answer any question from his patients and explain to them in a manner they can understand and relate. In this age of technological advances, not one patient wanted to be treated without having to know why and how his treated and what is his chances of recovering from the surgery.

    I can enumerate some more but this I think are the most important ones. A peculiar trait that Filipino patients wanted from their doctor or surgeons is their ability of a doctor or physician to “waive” partially or in whole the surgeons fee for rendering his professional service. While this trait is anchored probably on patient’s frugality, it can make or break your practice.