* * Anonymous Doc

Wednesday, November 30, 2011

Rapid response in a surgical suite. I get there, and people are frantic.

"Does anyone have a stethoscope?"

"Yes, I have a stethoscope."

"We have no idea what to do."

"Start chest compressions."

"We don't remember how to do that."

It's amazing how quickly knowledge and instinct can atrophy when they're not used. I mean, I did surgical rotations in med school, but don't remember anything useful, if I ever knew anything useful anyway. And the surgeons don't know anything about medicine anymore. And pretty soon, once everyone starts fellowship and is immersed in whatever specialty they're in, that's all they'll know and a patient comes in with a problem outside of their field and they won't have any idea where to even begin. This is why patients end up coming to clinic telling me they see nine different doctors, and why it's hard to find someone who can effectively coordinate care between them. We pretend we can divide problems into these individual silos, but not every problem is so easy to assign to one specialty. Things interact. The patient's diabetes affects multiple organ systems, etc.

At least we eventually got CPR going. Gosh.


  1. I remember reading an article/blog about how this internist said they used to get consulted by surgical services for things like "fever" or "low blood pressure" - things that even a medical student should have at least SOME idea of what's going on. This author opined that many of these surgical specialties spent 5 years unlearning the medicine they learned in medical school.

  2. I think it depends on where you are training. Where I am training, during codes on other patients we (surgical residents) are expected to get IV access and surgical airways. When surgery patients are coding we run the code (with help from the med ICU fellow). We also run all Trauma codes (and those can turn "medical" quickly). Our surgical ICUs are closed and run by Critical care certified Surgeons. It ends up being a LOT of work for us (especially when we have "medicine" patients sitting on our service until we can get their diabetes/BP etc. under control) but we definitely are learning and trying to be the strongest service in the hospital.

  3. I'm really struck by that observation, especially since I just recently learned the etiology of a chronic malady after seeing roughly 7 specialists. Where absolutely no one followed up on my care, and I basically harassed the receptionists for the US and x-ray results. Of course they came... a month later. Not so helpful.

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