Respectful Insolence

Mark gets some schooling in surgery

I’d be remiss if I didn’t note that Mark Hoofnagle of denialism.com has exited the rarified (and much less stressful world) of the laboratory and has dived headlong right into the clinic again, starting out with his surgery rotation.

As an old geezer (OK, middle-aged; it just feels old when each year’s crop of new interns looks younger and younger), I’m amazed that he has any time at all to blog. Certainly, back in the day when giants walked the earth, such blogging would have been unlikely at best. It must be the 80 hour work week. In any case, he’s made some observations about surgery, many of which are spot-on, even though he’s been at it for only a week. Two cultural oddities among surgeons that he noticed right away:

  1. Surgeons always tuck in their scrubs.
  2. Surgeons must never have their stethoscope around their neck, it must be in their pocket (their least valuable tool – haha).
  3. Carrying anything other than a stethoscope, some gauze and supplies, and a pen light will lead to ferocious mockery. Pity the fool who would dare to bring a reflex hammer onto the surgical wards.

#1 is pretty much true; anesthesiologists and nurses are the only ones who frequently don’t tuck in their scrubs. #2 is absolutely true. In surgical circles, wearing your stethoscope around your neck is known as having a “flea collar” on and will result in serious ridicule. #3 must be institution-dependent. When I was a medical student, surgery interns and medical students loaded their pockets with gauze; IVs (nurses didn’t start IVs and few and far between were the IV teams at the hospitals at which I trained, meaning that medical students and interns did 90% of the IV starting); a stack of 3″ x 5″ cards, each completely covered with patient information, labs, test results, etc.; a pocket full of pens, the better to be able to supply one to one’s chief or attending when he inevitably forgets to bring one; and, of course, the Sanford Guide to Antimicrobial Therapy, that pocketbook of all antibiotic doses and usages that is indispensable on the wards. Basically, I think Mark is a bit off on #3. The rule is that, the higher up one progresses on the food chain as a surgeon, the less one keeps in his or her pockets. Interns and medical students usually pack their pockets full of stuff needed to to scut on the wards. Chief residents will usually have nothing more than a pen, a stethoscope, and either a PDA or (for the old school ones) a pack of 3″ x 5″ cards. Attendings will often dispense with the stethoscope (after all they can always turn to a resident and ask to use his) and the stack of cards.

Comments

  1. #1 NJ
    January 14, 2008

    …the higher up one progresses on the food chain as a surgeon, the less one keeps in his or her pockets

    So when you become an administrator, all you worry about in the operating room is the machine that goes “ping”?

  2. #2 Janne
    January 14, 2008

    …the higher up one progresses on the food chain as a surgeon, the less one keeps in his or her pockets

    I think that’s a pretty general rule, actually. In any group from a hierarchical organization you can recognize the top person by them not carrying anything, and the bottom one by carrying them most. Think ministers coming to a cabinet meeting carrying nothing but a smile, while their assistant whatevers in the background are carrying the briefcases, files and whatnot. If you bring your car to the shop for service they may all wear uniforms, but you’ll inevitably talking to the guy carrying not much at all, while underlings scurry about with tools poking out from pockets everywhere.

    Here in Japan there is even a vaguely standard configuration for business visits: three (sometimes four) people, of different age. The top guy is the oldest and the boss. He never speaks or does much of anything – he just listens and gives the second guy authority to act by his prescence.

    The second guy is his assistant or protege and does most of the actual talking, question and answers, namecard exchanges, actual dealmaking and so on. He is likely the guy who knows all the details of the business in question, and it may well be his project to oversee.

    The third guy is invariably young – rarely over 30, unless we’re talking very high level deals. He’s new and still learning the business. His job is to carry everything except the second guy’s briefcase or file folder (this includes everybody’s luggage, projector, posters…), run and fetch, pay for things, save and organize all receipts and documents, be tech support for the group and set up stuff for presentations, make phone calls … And all the while keep silent, listen intently and hopefully pick up how “doing business” is actually done.

  3. #3 cooler
    January 15, 2008

    Jesus christ that idiot is going to become a doctor. They must have no standards anymore, just have a valid ID and 200,000 dollars.

  4. #4 khan
    January 15, 2008

    Dr. Christ?

  5. #5 trrll
    January 18, 2008

    Actually, cooler, Mark is an MD/PhD candidate, which is pretty much the top of the med student heap. But don’t worry, there are standards; as somebody who frequently Interviews prospective students, I’m fairly confident that you would not get in the door.