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  1. #1
    utorontograd's Avatar
    utorontograd is offline GPA Advisor 515 points
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    What Surgeons Think About That You Probably Donít

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    Every surgeon, perioperative nurse and support staff member in the OR has to develop a surgical conscience. In one respect, this is an unwavering adherence to aseptic technique during the perioperative period. Every aspect of the environment in the OR - equipment and personnel, are inspected and monitored closely for the entire duration of any surgical procedure.

    If you consider that some of the predominant resident microorganisms on the skin include Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus viridans, Corynebacterium diptheriae, Enterococci, Proprionibacterium, Peptostreptococci and many others, itís pretty clear that anything less than the strictest adherence to sterility will increase the potential for postoperative infection. Thatís why you canít come near an OR without first having put on hospital-issued scrubs, a surgical cap, a face mask, shoe covers and gloves. If youíre actually going to participate in the procedure, then weíre talking about a PAINFUL, 5 or 10 minute mechanical cleansing of the hands and forearms, followed by being dressed in a sterile surgical gown and gloves by a staff member.

    You have to take a scrub class prior to being permitted to enter the OR, and during the class you think to yourself, ďEasy enough. I got this.Ē only to find out during your first real experience scrubbing in, that you really donít. You walk into the OR and everyone around you can literally smell the scent of rookie emanating from your apocrine sweat glands. Everyoneís eyes immediately begin looking you up and down to see if you forgot any of the mandatory accoutrements. Theyíre just waiting for you to touch an instrument that hasnít been prepped or part of the patient that hasnít been painted with iodine solution; theyíre waiting for your biceps to tire and slowly let your hands down from the altar boy position (elbows flexed, with your hands interlocked in front of your sternum - like youíre praying). The second you let up your vigilanceÖ you and everyone else is going to hear about it.

    Truthfully, itís a pretty scary experience. Itís supposed to be. Knowingly or not, the surgical staff wants to scare the bejesus out of you because they know that even if you donít yet fully appreciate just how vulnerable to infection a patient with an open incision can be, at the very least, youíll try your damndest not to contaminate the sterile field and risk being humiliated in front of your attending.

    So the first time you walk into an OR, you enter with an appreciation for clinical hygiene, but as you walk of, you do so with the beginnings of a surgical conscience engrained in your mind.

    This is the voice within you that holds you to the same standard of aseptic technique when youíre scrubbing in alone and no one is around, as when youíre you being scrutinized by your superiors. The surgical conscience is the acceptance of the fact that every decision you make from the moment you decide to enter the OR, to the moment you leave is critically important to the outcome of the procedure and ultimately to the health of the patient.

    This thought got my philosophical gears going and I came up with a profound thought. Itís intuitive that a high level of attention to detail in the clinical setting is going to save lives. It may not be so obvious, but as a medical student, isnít our attention to detail in our pre-clinical training just as important?

    Maybe itís a bit stretch, but shouldnít be there such a concept as the pre-clinical conscience? If so, making the right decisions about when and how to study would be akin to making the right hygienic decisions in the surgical setting.

    Along that train of thought then, the ritual of the scrub-in would be to surgery, as your independent study ritual in your pre-clinical years would be to your future clinical practice.

    What if you applied the same standard of conduct in the OR to other areas of your medical training? How much better would you be as a medical student? I certainly believe that your conscience will dictate the caliber of student one will be. I also believe that it will dictate the caliber of physician one will be.

    Hereís why:

    When faced with a decision, the conscientious student of medicine will choose to dedicate the right amount of time to focus on the course work they are expected to. The conscientious student will choose to discern data that is relevant to clinical practice from material that isnít. The conscientious student will then choose to learn that information. Later, the conscientious physician can choose to draw upon the relevant data they have identified and learned prior, to make the right medical management decisions.

    Letís look at a clinical scenario to illustrate this:

    A 24 year old Asian female phones your clinic complaining of dysuria (burning when she pees) . She also thinks sheís running a fever. A conscientious physician knows that her symptomatology is consistent with a urinary tract infection. They also know that they should have her come into the office immediately for further work up. They also know the test of choice is a urinalyasis, which in this case came back positive. The conscientious physician knows that urine culture is not necessary at this stage. And they also know that first line, empiric antibiotic treatment is a double strength tab of Bactrimô every 12 hours for 10-14 days. The conscientious physician also knows that Bactrimô is a synergistic combination of the drugs trimethoprim and sulfamethoxazole (double strength tab 800mg of sulfamethoxazole and 160mg of trimethoprim). Further, they would not forget the fact that sulfamethoxazole is a sulfa drug. Surely they know they had better inquire if the patient has a known sulfa allergy. If they do, an alternative antibiotic they would know they could use is Ciprofloxacin. They also better be sure that the patient doesnít have renal insufficiency, as Bactrimô is excreted in the urine.

    In order to ensure that the above information was memorable and accessible, the conscientious physician might have chosen to ignore the fact that sulfa drugs are named as such because they are derivatives of para-aminobenzenesulfonamide when they were learning this material as a student. I canít see how that bit of data would influence anyoneís medical management. Can you?

    This scenario is a vivid example of how to take information that may be presented to you in a vacuum in medical school and how to have the foresight to apply it to clinical practice.

    So I hope you can see how being a conscientious student of medicine can have a huge impact on the quality and quantity of information you are able to learn and apply. Itís the right approach to take in your training, not only because itís ethical, but because it will also help you get the best grades in school.

    Take away point: The concept of the surgical conscience is having the highest standards for your conduct and your decision making, whether others are watching you or not. In the OR it means scrubbing in properly and adhering to aseptic techniques. Similarly, in your pre-clinical training it is committing to finding and learning as many clinically relevant concepts in your course work. Knowing and being able to apply what you have learned will ultimately dictate the quality of healthcare you can deliver for your patients when the time comes.

    Yours for higher grades and an infinitely better lifestyle in medical school,

    Cesar E. Orellana
    VMD GPA Advisor


    References:
    Levinson, Warren. Review of Medical Microbiology and Immunology, 10th Edition. Lange. 2008.
    McGraw Hill Medical. Drug Monographs.

  2. #2
    5thSemesterRep is offline Permanently Banned 510 points
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    I assumed surgeons only had this going through their minds, "cut cut cut," as opposed to worrying about the basic science concepts that help them relate to the pt.

  3. #3
    PaulettB56 is offline Newbie 511 points
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    That program comprises altogether of pitchers, however Wieters' disaster demonstrates that position players can blow their ulnar guarantee ligaments, as well. It's not all shock
    http://laustan.com/

  4. #4
    davefranco's Avatar
    davefranco is offline Junior Member 510 points
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    "Someone's life was depending on that man turning his hybrid into a blood wagon, so he stepped up to the plate and took several pounds of leeches for the team."

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