When surgeons shirk having anything to do with medical problems arising

Aneroo, LPN · Jun 5, 2009

Wow. What a liability that could have been! You did the right thing reporting it.

Ahhphoey · Jun 5, 2009

I've noticed this same trait in many surgeons (definitely not all), but most of them will at least begin some treatment while in the meantime consulting a hospitalist or medicine doc. One of our ortho surgeons has a partnership with a medical doctor so all of his patients are seen by the medical doc upon admission which is very convenient for all.

swirlygirl · Jun 5, 2009

I work nights on a post-op floor and a few of our general surgeons are like this. It's so frustrating!! I had a patient a few months ago who was 1 day post-op for an open chole and he also had a medical doc on board for his medical history. (I can't remember his history now, though.) Several times on the daylight shift the daylight RN had to call the surgeon for the patient's intractable nausea and abdominal pain. The surgeon was more than willing to try different nausea/pain meds during the day, but when I called the surgeon at 10:00 that night with the same request, he swore up and down at me and told me to "never f---ing call him again for nausea, only call the medical doctor." So I wrote that as an order in the chart, leaving out the "F" word, of course. Apparently his head nearly exploded the next morning when he came in and saw that order written. He and his brother are in practice together and one of them ALWAYS wants called when there's a problem with his patients, the other one doesn't want to be bothered. Of course I get the one that doesn't want to be bothered.

Oddly enough, now there are signs all over our floor and breakroom with a personal request written from this surgeon's brother that if there are ANY problems with any of their patients, we are to call their service regardless of whether or not the pt has a medical doctor on board.

Jailhouse nurse · Jun 5, 2009

..."so I wrote that as an order in the chart, leaving out the "F" word, of course."

That's just so perfectly awesome, swirlygirl!!!

Thank you for the laugh!

Morning-glory · Jun 5, 2009

I believe that psychiatrists have the same allergy to medical stuff. They may be old and medical school was a long time ago, but the guy needs a tylenol, not brain surgery for his common, run-of-the-mill, headache. Sheesh!!

Mobeeb, RN · Jun 5, 2009

I think that a lot of surgeons went through a course of "if it can't be cut, then I don't care" philosophy. Several years ago a young man (24) was transferred to our Trauma Center with a "severe crush injury to the chest" (according to the transferring MD) which he sustained as he was working beneath his car. The jack slipped and the engine block compressed his chest. Expecting the worst, when the patient arrived I was surprised to see no respiratory distress or other acute ongoing process. We did the routine trauma scans which did not show any broken bones, internal injuries, etc. What the transferring MD had seen on the CXR was a huge hilar mass which he interpreted as some kind of strange traumatic injury with which he was unfamiliar.

The surgeon, along with a couple of the trauma residents, went to the patient while he was still on the CT table and told this young man that "you don't have any acute injuries, but you do have a mass in your lung and it's probably cancer and you need to see an oncologist. We are going to discharge you, yadda, yadda, yadda." He then walked from the CT suite while the poor patient (in a state of shock and awe) was trying to assimiilate what he had just been told.

I "tactfully" grabbed the surgeon and after a long heated "discussion" he finally agreed to admit the patient and get an oncology consult. During this conversation I could see the trauma residents stretching their ears and mentally placing bets as to who would win. I only hoped that they would begin to learn that the patients who will be entrusted to their care in the future are fellow human beings and not just a "grade III spleen, or PTX or fx femur, etc."

But, to be fair to surgeons, I have seen many who go out of their way to try to get folks the care that they need.

BTW.......the above mentioned surgeon left our facility to practice in another state. He died 3 years later of liver cancer at the age of 50.

Pediatric Critical Care Columnist · Jun 6, 2009

I work in a primarily cardiovascular surgical PICU. Our three CV surgeons are notorious for pushing the envelope of surgical wizardry and taking on cases that every other CV surgeon in the country has dropped. The end result of this umm... hubris is that many of their patients suffer a wide range of complications and unbelievably long PICU stays. (One kid was with us for 514 days before dying and another for 351 before finally graduating to the HDU!) But let us cancel one of their ORs because we don't have a bed or a nurse and they're pitching fits at the nurses' station. Look around dude!! We have 17 beds and 6, 7 or 8 of them are occupied by YOUR oopses. How many times can you repair a mitral valve in one 9 month old baby with hypoplastic lungs? Is a transplant really a good idea for someone whose kidneys haven't worked in months? Remember that infant with the known-to-be-lethal chromosome abnormality that you repaired back in the fall? Well, that's a floor bed we can't have. Oh, and congenital pulmonary vein stenosis isn't fixable. It just keeps coming back, worse than before. Sorry but we can't save 'em all and there are some who would be better served if you DIDN'T cut them!!

FireStarterRN, BSN, RN · Jun 6, 2009

Wow, Jan, that sounds like an intense unit with lots of heartbreaking cases!

Pediatric Critical Care Columnist · Jun 6, 2009

It really is, Firestarter. We've had a really bad spell lately and there have been six deaths in the last two weeks. I wish I could say we might be done with the deaths for a while, but I suspect we aren't. There are at least three who could just go at any minute right now. Two of them spent the better part of Thursday night trying. Most of my shift was spent helping others keep their kids alive; thankfully my little one was stable and could be ignored for much of the time. To top it off, we had NINE nurses in on overtime that night because we're so short-staffed all the time. I don't know how long we'll be able to keep up the pace.

mustlovepoodles, RN · Jun 6, 2009

Why are some surgeons totally unable to deal with any type of medical complication their patient might encounter? I've seen this before, with surgeons being totally unwilling to address problems and the patient being left in the lurch like this, although this delay was particularly long.
Grrrrrr

I do not know, but it irks me to no end. When my father was in CCU after an MI and quad bypass he had a cardiologist, a pulmonologist, an ICU hospitalist and NONE of them thought to order blood glucose and insulin coverage. He was a fricking diabetic! Each one thought the other one was going to do it and none of them ever called his internist or just dealt with it. Maybe they knew he was going to die anyway and figured it wouldn't matter.:angryfire