When I told one of my friends that many ophthalmologists operated without wearing shoes, she responded with an insightful remark: “Isn’t that dangerous?”
In medical school, we were forbidden to wear open toed shoes while in the hospital. After all, who wants to have ascites or a bloody mess on your feet? The potential consequences of walking barefoot in the operating room are even more severe. Imagine delivering a C-section without proper gowns! With needles and other dangerously sharp equipment lingering around the OR, who wouldn’t be wearing shoes?
Indeed, I was uneasy the first time my attending told me to take off my shoes when I was operating as primary surgeon. Since then, I’ve realized that it’s nearly impossible to control the microscope and the Infiniti (I’ve only used the cautery mode) while wearing shoes. The pedals for the operating microscope control the focus and zoom on the operating field. A four-way joystick is situated above the pedals. An additional four buttons are also on the platform surrounding the pedals. All of this is controlled using ONLY your LEFT foot. A similar configuration to control the phacoemulsification machine is located on a separate platform for your RIGHT foot. Having tactile sensation on the pedals eases the difficulty of learning the machine, especially for newbies like me.
Still, I cringe every time we lose a needle (or #57 blade) on the ground.
I always assumed that tertiary academic medical centers were bastions of excellence. We always received transfers from “outside hospitals” (OSH) with half-assed workups and piles of meaningless nursing notes. As a medical student, I’d spend some time in morning rounds with my residents and attendings belittling procedures done at OSH’s.
I’ve begun to reconsider the notion that these academic centers are anything beyond extraordinary. For one, academic centers are training centers. There are residents of all levels caring for the ill; no matter how qualified the housestaff are, there will always be shortcomings. I’ve been at the blunt end of poor decisions too many times already.
One morning, I received a page at 5am from a medicine PGY-2 resident who noted that one of my colleagues had written “I/L: 2+ NS OU” on one of the consults but failed to address any intervention in the plan (The consult was for diabetes evaluation, which is already a dubious inpatient consult). The same resident called me again last weekend at 5:09am requesting a consult for a gentleman with multiple myeloma who was bleeding from his gums and was anemic. He had read of some reported complications of central retinal vein occlusions in hyperviscosity syndrome. The patient had absolutely no ocular symptoms. Moreover, the medicine resident congratulated me for recognizing that there were no pathognomonic ocular findings for hyperviscosity syndrome, but demanded a stat consult anyway. Since when does the “consultee” openly flaunt demands to a consultant? At the same time, I had a corneal ulcer that I was managing in the ED.
It is disgraceful for a notable academic institution to have such prideful individuals with limited insight. I trained at a community center during internship, and never called a stat ophthalmology consult. Most people knew their limitations. In fact, most cases never need emergent eyecare intervention.
Some might say that the mission of the academic center is different from that of a community center. In these differences lie a training and research center that necessitates inefficient consults and a higher operating overhead. Not so much. The community center I worked in certainly had a higher inpatient load than my current academic institution. The community center isn’t burdened by deadbeat unionized employees who show up to work half the time. Many workups are governed by protocol; those that are not are rightfully so. The profit that the community center–a non-profit organization–is converted to education and expansion of the hospital. Complicated cases are indeed transferred to the local academic center, but rarely so. The more common cases are managed far more efficiently than their equivalents in a large academic center.
Indeed there is a role for each type of hospital in every city. However, the discrepancy in the two is startling. Academic centers should excel in “complex case report worthy” medicine, but they should not have to sacrifice quality and efficiency of the entire hospital in doing so.
My residency program just completed its round of interviews for the class beginning in 2011. It was an interesting experience to be viewing the entire process as a bystander already in the training program. There were amazingly talented applicants who appeared to be destined for greatness; there were applicants who appeared fatigued, presumably from the long rounds of interviews that they already had underwent elsewhere. The process reminded me how fortunate I was to be done with residency interviews (But I guess I’ll never be done with interviews).
The selection pool was so rich that I wished we could accept 10 residents for the program. Some applicants had numerous publications. Others had worked on light detecting devices for disabled children. Everyone was gifted in his/her own way. I felt compelled to sell our program to the applicants. I wanted them to rank us high on their list. That said, I can only imagine how difficult it would be to decide how to rank applicants at all. Ultimately, we will only get a handful of newcomers. The rest will end up scattered across the hospitals in the country. I’m eager to await the match results at my program. In a way, I’m nearly as anxious as the applicants. I will be a senior resident the year these people start their residencies. While is would be great to have a highly qualified junior resident, it would be even better to have a highly qualified resident who will be reliable enough to handle the stress and pain of residency.
Best of luck to the ophthalmology residency applicants!
We had a grand rounds topic on the evolution of eyebrow perception. While the topic didn’t stimulate too much discussion from the non-plastics folks, the presenter showed an interesting video on the evolution of reality to public appeal. I remember seeing this video years ago:
Those of you who have scoured the web for ophthalmology educational resources have probably come across Tim Root’s website. I went to medical school with Tim, and he is a tireless and selfless educator. Aside from being able to explain science in a direct, humorous manner, he is also an outstanding cartoonist.
Tim finally published his book and has made it available on Amazon. (Support my link on the image!) I used this book while as a medical student, and it was very informative.
Those of you who have scoured the web for ophthalmology educational resources have probably come across Tim Root’s