Thursday, June 26, 2008

Healthbeat

Maggie Mahar over at Healthbeat was nice enough to feature a couple of my posts from this past month. Her blog is top notch. Definitely on my short list of med blogs I try to check 5-7 times a week.

I was amused by a comment from someone named Chris Johnson who had responded to my post about the distinction between surgeons who "own" the patient versus those who sort of "hit and run" after the procedure is done. Now Chris Johnson MD ,for all I know, may very well be the world's greatest pediatric intensivist but I don't think I've ever come across such an unintentionally pompous and condescending statement about the role general surgeons ought to play in the post operative period of a patient he/she has just operated on. Check this out:

I have to say that, from my prospective, Buckeye Surgeon represents an example of the kind of problems I encounter every day. For those of us who work in the ICU, the irritation of dealing with surgeons who truly believe they know everything I know (as an intensivist), and they can do surgery, too. On the other hand, I do appreciate the kind of proceduralist, be it surgeon, cardiologist, gastroenterologist, or whatever, who stops by regularly after they have done whatever they needed to do to see how the patient is doing and if we need any more of their help


That's nice that he appreciates when a "proceduralist" stops by occasionally just to make sure that the brilliant intensivist doesn't "need any more of their help". That's not patronizing in the least bit. Wait a second... yes it is. I write all the orders after a perforated bowel case, buddy. You can write your note and make your extravagant rounds with 16 people following you around (pharmacists, residents, students, social workers, etc) at 1pm (after the grand rounds lunch presentation) and I'll read it and implement anything I find beneficial to the patient and we can talk face to face about whatever issues you have, like professionals, but don't think I'm not going to be the Big Lebowski on the case. We're actually trained to take care of post-operative issues as general surgeons. Actually, we spend the majority of our time as residents learning and mastering pre and post-operative care of the extremely ill. So thanks for your help, Dr Johnson. I do appreciate your insight. But excuse me for a second... I have to go write orders for IV fluids, TPN, wound care, electrolyte replacement, and anything else that the sick patient down the hall needs....

11 comments:

Alice said...

Ha. Good answer. I think most training programs are heavy enough on trauma, which is mostly critical care these days, that surgeons should be competent at critical care, even if they then decide that they don't want to spend their time in a non-operative field.

Frank Drackman said...

Ha Ha, take a look at Dr. Johnsons pic. I guarantee you he Never hit a fastball or returned a punt. I know the type, hes the guy who prescribes 1.72 teaspoons of Augmentin. For God's sake hes a Pediatrician, even the sickest Kids are hard to kill even with the worst care.

Chris Johnson said...

"Ha Ha, take a look at Dr. Johnsons pic. I guarantee you he Never hit a fastball or returned a punt. I know the type, hes the guy who prescribes 1.72 teaspoons of Augmentin. For God's sake hes a Pediatrician, even the sickest Kids are hard to kill even with the worst care."
Wrong on all counts. So sorry. But at least I know now to call Frank for my next 3 kg infant with septic shock and mult-system failure. Thanks.

Frank Drackman said...

Been There, Done That, Got the T-Shirt. You're Makin My Point, Dude.

Frank Drackman said...

Oh Yeah, my Bad about the 1.72 Teaspoons thing, I'm sure you do everything in SI Units. 3KG? Thats pretty Big actually, Try keeping a 2 LB Baby alive during a TEF repair.

Bongi said...

i'm half way between. i look after all my icu patients except the paediatric ones. i'm happy to turf them all. that may make me a proceduralist in their eyes, but actually i even try to turf the procedures on the small ones to the big city. on my patients (adults) i am a tad more than a proceduralist, as it should be.

Buckeye Surgeon said...

I'm the same Bongi. Straight forward apendicitis on a kid, I take care of it. But younger than three, I get pediatric intensivists involved.

Pediatric surgeons, however, are one of the more anal retentive specialties around; usually they write their own orders on even very sick children in the ICU...

Anonymous said...

I'm an old woman, and the very best physician I've seen for treatment is an orthopedic surgeon. It occurred to me during my recovery (full) at home that it isn't so much the amount of time a doctor has for a patient, it's the quality of it.

Anonymous said...

Enjoy your blog but it's been my experience that outcomes are better in post-op critical care patients with intensivists overlooking their care. I've found that surgeons, generally speaking, do not know how to manage volume and pressure settings on a vent that match the patient's specific set of lungs!

Also hemodynamics...have taken care of too many complicated post-bowel surgical patients that are flooded with fluid from surgeons that are too afraid to use a pressor.

Sorry, but experienced ICU nurses groan when the surgeon doesn't hand over the case to the intensivist for the very sick surgical patients.

Bongi said...

anonymous, where i work it is an easy choice. you see, we do not have intensivists. recently i operated an american woman with necrotic bowel. her son was an internist. postoperatively i went to speak to him to explain that his mother would spend some time in icu. he asked me to introduce him to the intensivist.
"that would be me" i smiled.

p.s the icu nurses didn't groan and the patient did well.

Buckeye Surgeon said...

Anon from 10:01 Am- By the same token, we've seen just as many patients in medical ICU's go into renal failure with toes turning blue because of a fear of "giving too much fluid" and instead cranking up the vasopressors right away. Neither "side" is perfect. Better collaboration in the future is the key, I suppose, rather than this mentality of medicine vs surgery....


I hear what youre saying Bongi...sad that there exists a perception that surgeons ought not to be able to handle an ICU...