If you needed surgery...

[ichy]

And if you think this is restricted to teaching hospitals, search ghost surgery....a phenomenon by which your "attending" surgeon sees you up to the point where you're snowed for surgery and then a "substitute" surgeon actually does the surgery while your attending is off playing golf.

That kind of crap would get the doctor sent to prison for Medicare fraud nowadays.

 

[ichy]

He said he never lets the residents do anything but tie off the final suture anyways.

I really doubt he was an attending at a teaching hospital if that's the case.

 

[ichy]

Also, if you're actually having surgery then there's almost no chance that an intern (first-year resident) will be doing anything significant during the operations. Interns mainly handle scut (chasing down lab and radiology results, admitting patients, managing patients on the floor, etc. Most of the actual slicing and dicing comes later on during their training.

 

[brainhulk]

Ok since we're hounding the students/residents, I shall share more.

So pt was seizing on the floor, attending tells resident give some ativan and load dilantin. When resident is writing order, he turns to me asking, did the attending say dilantin or digoxin? I just loled

 

[Meghan54]

Ok since we're hounding the students/residents, I shall share more.

So pt was seizing on the floor, attending tells resident give some ativan and load dilantin. When resident is writing order, he turns to me asking, did the attending say dilantin or digoxin? I just loled

4th year cardiothoracic surgical resident doing a mitral valve replacement on a 12 y.o. kid. A more junior surg. resident gets asked a question about the procedure during the surgery, gives answer (which was wrong) and the 4th year, who is doing the surgery, goes to point out some structure around the valve. Unfortunately, he's a hamhanded idiot and puts his finger through the valve and surrounding tissue.

No problem, right, esp. since they're replacing the valve anyway, right? Nope....conduction system is completely distrupted making a pacemaker insertion necessary a week later. (They kept the kid in our SICU for a week to see if the conduction would "fix itself." It didn't....)

Where was the attending during this surgery? In his office doing paperwork......

 

[BornStar]

My wife is a resident in OB/GYN which is a surgical specialty and she started doing parts of surgery as an intern. In her specialty you don't always have time to wait for an attending to make it to the OR before you start a c-section so she's been involved in a lot of surgeries with no attending in the room. Attendings will follow up with the patient if necessary but lots of people get discharged from the hospital without being seen by anyone other than a resident. The LRC (triage for labor and delivery) is staffed by midwives during the day and second year residents during the night and they get a lot of patients that just don't need to be in the hospital so they get sent home. An attending will review the chart.

Also, if you want to guarantee you don't get the best care possible, feel free to request no residents will touch you. In a teaching hospital attendings don't scrub without residents and they rely on their participation. Even in c-sections where the attending is in the OR they generally aren't involved in the procedure.

 

[rcpratt]

I really doubt he was an attending at a teaching hospital if that's the case.

Good thing I never said anything about a teaching hospital, huh? It's a private practice. I don't really know the details of how exactly the resident was affiliated.

 

[ichy]

Attending supervision can vary wildly. I recall hearing horror stories about Parkland Memorial Hospital in Texas just a few years ago. They had a rather old-school culture that allowed significant "resident autonomy" (aka unsupervised surgery.) Not cool at all, although that sort of behavior is a great way to end up in trouble for Medicare fraud nowadays.

Up here in Baltimore at Johns Hopkins I've heard it's completely different, and attendings must be scrubbed in at the start of a case and can only leave at the very end when residents are closing. With a system like that I would have no problem with residents being involved in care. Just saying "don't let residents touch me" is retarded because it screws with the normal workflow and puts you at greater risk.

 

[brainhulk]

4th year cardiothoracic surgical resident doing a mitral valve replacement on a 12 y.o. kid. A more junior surg. resident gets asked a question about the procedure during the surgery, gives answer (which was wrong) and the 4th year, who is doing the surgery, goes to point out some structure around the valve. Unfortunately, he's a hamhanded idiot and puts his finger through the valve and surrounding tissue.

No problem, right, esp. since they're replacing the valve anyway, right? Nope....conduction system is completely distrupted making a pacemaker insertion necessary a week later. (They kept the kid in our SICU for a week to see if the conduction would "fix itself." It didn't....)

Where was the attending during this surgery? In his office doing paperwork......

D:

then again attendings screw up too this old cardiologist inflated the balloon too much during an angioplasty and ruptured the vessel. So on the screen you could see every time the heart pumped, blood was squirting out...and all everybody could do was watch the patient die because the cardiothoracic surgeon got into an accident while on the way to the hospital

 

[Kyle]

Don't have time to find it now- but I actually was just reading about a study that showed a lower mortality rate for surgeries performed by interns/residents....you have to assume they are going to be much more paranoid/"think twice cut once" compared to someone who's performed the surgery a thousand times and is just on auto pilot. And as others said, they are usually being assisted or monitored by a more experienced MD.

 

[ichy]

The most recent findings are a bit complicated. Surgical cases with resident involvement have higher morbidity but lower mortality rates. You're more likely to suffer a complication but less likely to die.

http://www.beckershospitalreview.co...nt-morbidity-but-lower-patient-mortality.html

 

[jlee]

Depends what it is. I had eye surgery and I asked not to have any interns there.

 

[Kyle]

The most recent findings are a bit complicated. Surgical cases with resident involvement have higher morbidity but lower mortality rates. You're more likely to suffer a complication but less likely to die.

http://www.beckershospitalreview.co...nt-morbidity-but-lower-patient-mortality.html

Thanks- that was what I was refering to

"Resident intraoperative participation is associated with slightly higher morbidity rates but slightly decreased mortality rates across a variety of procedures and is minimized further after taking into account hospital-level variation. These clinically small effects may serve to reassure patients and others that resident involvement in surgical care is safe and possibly protective with regard to mortality."

 

[Gooberlx2]

Where was the attending during this surgery? In his office doing paperwork......

Did you (or someone) file a complaint? I'm assuming an attending is required to be present for open heart surgery.

 

[Mr. Pedantic]

I'm not sure when a plumber and accountants perform life threatening procedures. You could argue with an electrician and engineer (civil engineer designing a bridge... ), but it's a pretty weak argument at best.

I always thought that medical interns aren't going to be performing "like crazy brain surgery" alone. They will assist and watch those procedures before given the knife?

Most of them aren't even going to be doing anything.

And arguably builders, plumbers, and electricians are nearly as important, since if they screw up it's a huge impact on quality of life, and apprentices in my experience get a lot more leeway and freedom. Engineers are arguably more important because they are responsible for the safety of hundreds, thousands, or sometimes even millions of people, and again, they are given a huge amount of leeway.

And as I said, interns aren't really called upon to do anything. Most of the time they just stand there watching, or holding a clamp. Plus, dissecting a cadaver not the same at all to operating on a live human being.

Lots of ignorance about how medical education works. Patients in teaching hospitals have better outcomes in general, because two hands/eyes are better than one. Residents don't operate on their own, they always have an attending there with them.

If you don't want residents involved in your care then go to a non-teaching hospital. Going to a teaching institution and screwing with their regular workflow is an excellent way to get sub-par care.

This. It seems you are under the impression that fully qualified professionals don't make mistakes. The fact is they do, and when they do they're usually worse about it than residents, interns, and students, because they haven't yet developed the arrogance and cynicism to think that nothing could possibly be their fault.

 

[Inspector Jihad]

HAHAHAHAHAHAHAHAHAHAHAHAHAAAAAAAAAAAAA!!!

Oh, you of little knowledge........guess living in a world of idealism is great. Just never go to a hospital.


And sorry for the laughter, but it comes from working for over a few decades as a CCRN in more than a few teaching hospitals in their ICUs....surgical mostly, but also medical, burn units, neonatal ICU, etc.

And if you think this is restricted to teaching hospitals, search ghost surgery....a phenomenon by which your "attending" surgeon sees you up to the point where you're snowed for surgery and then a "substitute" surgeon actually does the surgery while your attending is off playing golf.

if you go to a doctor that works like that, i think you probably have more to worry about than an intern screwing up.

 

[hanoverphist]

Absolutely. But then, I'll be one of those interns in a few years. But I would trust most of my classmates with my life.


By this logic apprentice builders should go work on houses in the third world, and so should apprentice plumbers, electricians, accountants, and engineers?

if an apprentice electrician miswires my threeway switch in the living room, its a bit easier to deal with than having my foot twitch every time i bend my pinkie

 

[Mr. Pedantic]

if an apprentice electrician miswires my threeway switch in the living room, its a bit easier to deal with than having my foot twitch every time i bend my pinkie

1) What complication could you imagine where if you bend your pinkie your foot twitches?
2) If an apprentice electrician miswires your house so you get electrocuted, is that a bit easier to deal with than a twitching foot?

 

[Slew Foot]

Having spent the last decade in academic medicine, unless you're a big VIP you don't want to ask that only the attending works with you. You'll get labeled as a jerk and no one will care about you. If you want only an attending go to private practice.

 

[Dominato3r]

Don't interns usually have a vet with them in the OR anyway?

 

[bfdd]

sure why the fuck not? they gota learn sometime.