GP matters

I wanted to call this post ‘why GP’s need to be on top of their shit’, but ended up not doing that.

Every kind of doctor has to be on top of things. The first rule of Fight Club may be not to talk about Fight Club, but the first rule of medicine is to avoid causing harm to your patient. This is super important in surgery, because when things go wrong in the operating room they do so rapidly and spectacularly. Malpractice suits are expensive.

But this post is about why General Practitioners need to be on top of things.

For many patients, their GP is their first point of contact with the healthcare system. Patients bond with their GP’s over many years and they trust them implicitly. This GP splinted their broken arm, took their tonsils out and delivered their babies. If the GP tells a patient that while her breast cancer is very small, it is probably better to have a RADICAL mastectomy or that she is too old or too ill to have a general anaesthetic, the patient will treat this as gospel. Patients are often unwilling to consider the other options offered by specialists, because they have already had their minds made up by the (well intentioned) advice given by their GP.

So in a nutshell- being a GP is a position that comes with great responsibility. Use it wisely.

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Marvel Comics

Damn straight, Spidey.

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Fainting in Theatre

I fainted at the sight of blood before I had even started my medical career.

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As a high school student, I spent a day shadowing a local trauma to doctor to see if I could hack it. The very first patient who happened to come through the door was a young guy who had cut his hand doing I-can’t-even-remember-what. It was deep – no amount of love or money was going to fix this, he needed sutures. As my host was inserting the first suture… I went down like a ton of bricks. I recovered well after being helped up and fed sugary drinks, but my ego was bruised.

And then I started wondering “how the hell am I going to become a doctor if I can’t even stand the sight of a bleeding finger being poked by a sharp object?!?” People tend to judge if a medical student reacts like a corseted victorian lady when faced with carnage and scattered body parts – check out this delightfully snide piece I found on a blog called MD to be. Quelle horreur!

It seems I’ve made a decent comeback, because I am now a qualified surgeon. I’d love to claim that I’ve never been dizzy in theatre since that first episode, but that wouldn’t be true. Luckily I’ve never ended up with my face in the wound and it’s never happened while I am cutting, only whilst assisting (wonder why?!). I’ve also realized that it isn’t this major DISASTER either – I see it as an opportunity to scrub down, take a break and eat a Snickers. If it is the talk of the hospital, you must work in one fucking boring hospital.

So, how to avoid operating room syncope 101:

  • Don’t stress about the possibility of going belly-up. IT. IS. A. NON-ISSUE.
  • Eat before the procedure. And also drink. Not alcohol though, unless you want to make some malpractice attorney’s day.  If you think that you’re going to tackle this Whipple on an empty tank, you Sir are a fool. The Whipple will win: in fact it will take your land, marry your wife and make slaves of your children.
  • Operate if you can. Like I said, by some form of voodoo magic I have never fainted while piloting, only while on co-pilot duty.
  • If you are designated retractor, for heaven’s sake don’t just stand there like a statue! Move your legs, shift your weight, feign interest in the procedure.
  • If you do feel faint, SAY SO. You could ask for a chair, but you won’t use it for long. Trust me, this doesn’t go away if you sit for a bit- it is relentless. Scrub down- get your mask and gown off, they are the equivalent of a mini sauna. Sit down / lie down somewhere cool. Accept all sweet drinks passed your way by kind nurses. Remember to thank kind nurses. Ready your excuse.
  • If your idiot colleague laughs like a braying donkey and says you must be feeling faint because you’re pregnant /premenstrual / a delicate victorian flower – be sure to have a scorching sarcastic one-liner at the ready to cut him down.

 

Bullying in Medicine

This week, a video by Dr Yumna Moosa exposing the culture of bullying at her institution went viral.

 

The University of Cape Town has since released a statement in support of Dr Moosa.

In the video, a senior colleague advises Dr Moosa to keep quiet- as a complaint would ruin her career and make her “unemployable”. Unfortunately, this colleague may very well be correct: as evidenced by the case of Australian neurosurgeon Dr Caroline Tan.

In 2008, Dr Tan spoke out about the sexual harassment she experienced at the hands of a fellow neurosurgeon. The accused neurosurgeon claimed that Tan had falsified these accusations as a cover up for her poor clinical performance (sounding familiar yet?). Despite the judge finding in Tan’s favour, she faced fierce criticism for speaking out and has been passed over for positions in at least 8 public and private hospitals. Australian vascular surgeon Dr Gabrielle McMullin has even said that she advises her trainees to comply when approached for sex (by senior colleagues), as this is the “safest thing to do in terms of your career”.

Surgery has a reputation for having a formal hierarchy. At surgery, we are often told to “toughen up”. To “put up or shut up”. To “look for another job if you’re not happy with it”. To “keep your head down, don’t rock the boat”. The nail that sticks out will be hammered down – or as Dr Moosa’s senior colleague so eloquently puts it “No fuck off! This department drinks beer at lunch time!”  And so, all the female registrars in the room roar along with laughter when a male colleague bellows out that a woman’s mouth should only be open for one thing nudge nudge, wink wink. The female registrar will then try to tell a cruder joke, swear louder and drink more than her male counterparts – because she doesn’t want to be the old bag who can’t take a joke. The Jewish registrars laugh along with the offensive “jokes”, the Coloured registrars laugh along with the offensive “jokes”… and the world keeps turning.

Others become The Loner referred to in the video, and are often subtly hounded out of the department for being different – as happened to a lovely, soft spoken colleague of mine whose only offense was being a vegetarian?!? (and not subsisting on a diet of coffee, red meat and nicotine). Or perhaps you will be not-so-subtly hounded out of the department, like another colleague who was told by a senior consultant that he would personally see to it that this person never qualifies as a surgeon. This registrar never qualified, by the way. And how do you complain to your boss, if the person who is harassing you IS your boss?

Do I have a solution to the problem? Nope. But there is light at the end of the tunnel. The surgeons in our department are for the most part a friendly, diverse group of people- and we far outnumber the few bigots in our ranks. If we start speaking out against harassment (like Dr Moosa), and lead by example, we just may be able to change surgery’s reputation for the better.

 

 

Famous Fibula

X-ray of Dave Grohl's fibula (from the official Foo Fighters site)
X-ray of Dave Grohl’s fibula (from the official Foo Fighters site)

So Dave Grohl from the Foo Fighters fractured his fibula.

He took a tumble over the edge of the stage at a show and snapped it.

Afterwards, Grohl finished the show in a wheelchair. The show medic accompanied him on stage to stabilize his shattered leg. I have since revised my dream job from ‘unicorn’ to ‘medic who gets to hold Dave Grohl’s fracture while he finishes the show’. Grohl has since been operated on and is currently resting up and getting ready to rock out again.

The Naked Surgeon

The theatre scrubs at our hospital only come in two sizes: too big and too small.

They also appear to have been sewn together by elves on crack.

Trouser legs are either way too short, or super long. This results in either a Capri pant effect (with exposed ankles), or a cuff that has to be rolled multiple times to prevent being constantly stepped on. Neck lines are cut down to the level of the umbilicus, leaving an unhealthy amount of either cleavage or chest hair on show (think Burt Reynolds). And the worst part- the trousers don’t fasten properly! At any time during surgery, your trousers may decide to head south. Being scrubbed and elbow deep in blood/guts/pus renders you unable to correct your imminent wardrobe malfunction. You have two options: let your pants complete their descent, and complete your surgery with cold, exposed cheeks… OR get an unfortunate junior to grab them and try to secure them properly. The latter results in awkward fumbling under the surgical gown, much like pinning the tail on the donkey. Only imagine your consultant is the donkey. Both options are accompanied by the snickers of all involved theatre staff.

Scalpelista has been lucky so far- no pants-less surgery for me yet, but I have been confronted by a consultant’s pale, skinny, hairy legs… Adds a new dimension to the professional relationship.

The natural talent vs the rest of us

God save us from the natural talent.

Most of Scalpelista’s consultants believe that surgeons are born, not made. They assure me that they can spot a so-called natural from a mile off. The natural was apparently born with an amazing talent for surgery-  this specimen breezes into theatre and OWNS it. They have supernatural dexterity and learn new procedures lightning fast. Usually they also possess the ‘surgical personality’ (oh, I will DEFINITELY post a rant about this vile condition in future) and consultants love them, interns fear them and students worship them.

Scalpelista was not born with a scalpel in hand… Unless my mother omitted crucial details in the telling of that story. I started off in surgery and I STRUGGLED. I sweated and cursed through every procedure. My sutures looked like a dog’s breakfast. I made plenty of mistakes. I spent nights awake worrying about my patients. I operated so slowly the scrub nurse would ask for a chair… Then doze off mid procedure. I walked away from the table drained, covered in gross fluids and utterly embarrassed at my lack of skill. In short, Scalpelista is by no means a natural.

But lo and behold… I got better. Slowly, but I did. See, I believe that surgery is a motor skill. And it can be learned and improved on with time and practice. I don’t agree with my consultants, who condemn certain registrars to failure because they were not brilliant from day one.

I still have a long way to go, but every time I struggle less with a procedure I do a little victory dance.

You gotta fight! For your right…

…to have a quick snooze. (Thanks ACDC)

Thanks to the #YoTambienMeDormi campaign, the public has realised that doctors tend to fall asleep after 36 hours on their feet. Shame on us.

A survey conducted among my registrar colleagues revealed that they have dozed off while:

– checking blood results

– on the way home after a busy call, waiting for the traffic light to change over

– seeing a patient in the outpatient clinic with a particularly long list of complaints

– in lectures, especially when the lights are dimmed

I fully support this campaign, because everybody knows that the cardinal rules of surgery are: eat when you can, SLEEP WHEN YOU CAN… and don’t f*** with the duodenum!