Monday, April 20, 2015

Most boring surgery

Of all the surgeries that I did during medical school, the most boring one was probably the laparoscopic bilateral salpingo oophorectomy (BSO).

Most laparoscopic surgeries were less interesting than the open surgeries because you couldn't really tell what you were looking at half the time unless you're experienced, which obviously I wasn't as a medical student. And all you can really do to help is hold the camera, and in GYN they didn't even let you do that much. They just let you hold up the uterus and then yelled at you that you're not doing it right.

Believe me, it's not that fascinating to watch them trying to grab at the ovaries and dropping them for two hours.

I remember one afternoon, there was actually a very interesting GYN surgery that I wanted to see, but if I went, I would have missed labor and delivery sign out. So instead of telling me to read or do something else useful, they had me sit in on a BSO that another medical student was already assisting on. Basically, I just had to stand in the back of the room for two hours, watching the surgeon try to tie off a little tube.

I genuinely have to question the learning value there.


  1. We were just discussing this mentality!
    It seems like a universal obygyn thing. Seriously; round finish by 9:30 and all work is done. They would not let us go to OT, labour room, clinic not even to the library. "Wait here for the exit round ( at 15:30)". Talk about control freaks making up a department. They have no problem seeing us just setting in the doctor room jobless, but do we dare go grab something to eat from the cafeteria ? I had one doctor staring at me while I ate my cereals ( I made eye contact - a prolonged one- so just she know I know she found out I am in the cafeteria. Stop staring women , move on. ) That was the only time I ate something ( that was not a chocolate or a cup cake from patients) while in work (7:30am-16) during the whole rotation!

    I think I was introduced to hate there! I didn't know I could hold to anger before! Bad feeling.

  2. You would think so, Fizzy, until..
    I had to take care of post op pt for similar surg. When she wasn't making any urine, I had to question exactly what got tied off. Turns out they tied off both ureters instead of tubes. Big problems. Sometimes extra eyes paying attention might be helpful. Just sayin.

  3. They didn't just let me hold the uterus. They had me cut sutures (not tie them, of course). The surgeon wanted them 5 mm long. "That's 6 mm you idiot," he yelled, slapping my hand (really). "That one is 4 mm!"

    I politely asked for a sterile ruler and was told my services were no longer needed.

    Thank god.

  4. I definitely think that a lot of surgeries, when you don't know as well what you're supposed to be looking "at" are a lot more boring than to an experienced doctor. Great post here.

  5. Completely agree - this mentality was basically why I hated all my surgical rotations in med school.

  6. Imagine your pilot, flying the plane you are on, only had a few hours behind the stick/yoke. The time is experience.

    1. For docs who don't do BSOs or laparoscopic surgery of any kind, watching several of BSOs as a non-participating or minimally-participating bystander is pretty useless. Can they learn from those hours of observation? Sure, but it's low-yield. Why not instead encourage med students to actively hone their physical exam and clinical reasoning skills during the day when they are cognitively and energetically at their best?

      After a long, tiring day at the hospital they must read on their own as well as eat, exercise, decompress, and sleep. That's a too-tall order for most people. They should actively learn during their clinical rotation time, but instead most are relegated to the role of non-participating bystander. It is very difficult to effectively learn in this role, and it shows when we ask them questions on rounds and when they present to us as near-totally incompetent fresh interns.

      When I get them to walk me through their/our clinical reasoning process and show me their physical exam skills they rapidly improve their skills and increase their knowledge base. They also seem happier and more eager to learn and contribute to team goals. They're all intelligent enough -- we need to do (and allocate time to doing) a better job of teaching them and also not get in the way of their learning.

  7. I'm sorry you had to sit for two hours. Where we come from, it takes about 30 minutes.