Tuesday, December 9, 2014

Dr. Orthochick: Listen to your attending

Last day in clinic with Dr. Douche!

The nurses said if they had known, they would have brought in cake, which makes me feel good.

Anyway, Dr. Douche was in his usual mood, which means he does this thing where he seriously does not listen to anything. It's like once he decides what he's going to say, he sticks with it until I give up.

We had a lady come in with a chief complaint of knee and shoulder pain. If you have need a knee and hip replacement then you usually get the hip done first and then the knee because it's easier to rehab a knee after a hip, so I was wondering if there was an order for knee and shoulder.

Me: So, hypothetically, if this patient needs a knee and shoulder replacement, is there an order we do them in?
Dr. Douche: You haven't even seen the patient yet. You can't jump to that conclusion that she needs a joint replacement. First you need to ask about nonoperative management and what she's already tried.
Me: I know...OK, let's pretend you're not you, I'm not me, the patient's not the patient, and you and I are two other people talking about a third patient who does need a knee and shoulder replacement. Is there any special order they should be done in?
Dr. Douche: But we would never just jump to doing a replacement. We would start with physical therapy and long acting anti-inflammatories. We might then ask about injections--
Me: Ok...let's say I'm doing a practice question. The practice question tells me that a patient is having a knee and shoulder replacement. I cannot argue with this practice question so I am forced to do a knee and shoulder replacement on this patient in this practice question. So the question is asking me which procedure should be performed first?
Dr. Douche: You really need to see the patient first before you decide what procedures she's going to have done. We treat people, not xrays. Don't be so quick to jump to surgery, especially replacement surgery.

At that point I gave up and walked over to the next pod and asked Dr. Grandpa, who said it didn't really matter but to wait three months either way.



  1. I am with your attending, you should not start thinking of two replacements before seeing a pt. Also, not even being an ortho I thought the order did not matter since its not the same limb.

    1. Orthochick was asking because she wanted to know what he would recommend if she ever saw a patient who needed both replacement surgeries. She wasn't asking about the patient. I trust at her stage of training she wouldn't think of replacing a joint without seeing the patient. It sounds to me the idea just popped into her head while thinking about the patient.
      It makes sense to ask someone with more experience since I'd guess that's a relatively uncommon situation so it would be hard to find literature on it, but the attending might have come across it at some point. That's the best kind of question to ask. Most attendings value that kind of intellectual curiosity.

  2. Did I just take "crazy pills?" I'm in new territory here !

  3. I get why you were frustrated, but I really gotta admire the attitude of a surgeon who doesn't immediately jump to surgery (highly remunerated surgery at that) as the answer. It's great that he's willing to try conservative therapy first, given the questionable evidence on the long-term benefits of joint replacement surgery for degenerative disease.

  4. I could see after Dr Douche's first response you were talking to a wall. You even said "hypothetically" so that he would answer the question that you were asking. He sounds more like a politician. P.S. I've already had a knee replacement.

  5. Done with your Holiday shopping so soon Dr. Fizzy?

  6. I am definitely with your attending here. As a fourth year med student going into ortho even I know to never make any conclusions without at least talking to the patient, regardless of the imaging. C'mon!


  7. wow..a really nice person to work with.

  8. I'm a Family Med resident and my primary preceptor does this to me ALL THE TIME. Reading this post made me feel better about it...misery loves company!