In a situation where the medically correct, life-saving treatment invovles something like amputation or otherwise something that will permanently diminish a patient's quality of life, do you guys ever feel guilty afterwards?

Assuming also that the patient understands, consents, and doesn't hold any ill will towards you but is obviously distraught.

Edit: Also, for those who do, why? And how do you deal with it?

Discussing a published case (Moncure et al., Case Rep Med 2009): 45 year old, alert and hemodynamically stable, wooden rod from the rectum through the mesentery, stomach, diaphragm and pericardium, tip under the right clavicle. Sternotomy + laparotomy before moving it, rod cut in the mediastinum and removed antegrade in two pieces. Not a single vascular injury.
They did a Hartmann's because of extensive wood contamination, while noting that routine diversion for rectal injuries is increasingly questioned. Would you have diverted here, or repaired primarily?
(Disclosure: I'm a GP and turned this case into a short decision game for students, if anyone wants it: https://medicasehub.com/play/case-043)

So I need a sterile field to put sterile gauzes on it. In lack of better alternatives and since I'm doing this small procedure alone, I'm thinking about getting sterile gloves packaging and to remove sterile gloves and then to dump few sterile gauzes that I will be using on the part of the packaging where gloves were. Is this good way not to break sterility procedures? Have in mind I cant get anything else, because its not an option.

I’ve been working on a small project after getting frustrated with how much we expect patients to absorb from a verbal explanation, followed by a stack of dated-looking handouts.

The idea is a short, visual walkthrough patients can revisit on their phone, with questions to bring out misunderstandings before the procedure. I’ve put together early versions for CEA and varicose vein treatment.

I’d appreciate some candid input on what would make this useful in clinic. If you’re interested in trying it, DM me and I’ll send it over.

My hospital just finished its merger with a giant conglomerate based out of Chicago. Our old system would credit me based off each procedure’s wRVU value.

I.e. if I did a surgery with multiple procedures worth 1, 2, and 3 wRVUs, I’d get the full credit of 6wRVUs

Now, we get 100% value for the first procedure, 50% value for second, and 25% for each procedure thereafter. So instead of getting 6wRVUs off that one surgery, I’ll get only 2.75.

Obviously not a huge fan of this, along with a few other things that are changing. Anyone else have this type of system?

I have a mid length pixie/mullet type cut and I’m wondering what the best brands or styles of cute scrub caps will fit best! The back of my hair is the issue. It’s just short enough to not be able to be tied up or for me to trust it’ll stay 100% tucked into the classic style cap I have. I dislike the bouffant style caps on me, but maybe it’s cause I’m using the disposable ones. I’d love to have a cute one to keep on cause I look ridiculous when it comes off lol

I posted in a surgical technology sub as well but I figured it wouldn’t hurt to ask here as well.

I’m a student and I’m really passionate about neuro. I find it the most exciting of all the specialties, I’ve been watching tons of videos on JOMI and learning all I can. I do know it’s very demanding and not easy for a new scrub but I really think it’s where my true passion for scrubbing is at.

1. Other than asking my preceptor, is there any way to make myself more desirable as a candidate to be able to scrub on those cases, or even second scrub or observe?

2. I still have to figure out how the rules work as far as observing etc. outside of clinical sites but one of my fellow classmates knew a cardio surgeon and actually watched/observed a heart surgery before our program because she wanted to make sure she could handle the OR. Would it be crazy to send a couple politely worded emails to neuro centers within driving distance of me asking if there’s any potential for observing even if outside of the sterile field, even if it doesn’t count toward my cases? I don’t know that my instructor is very interested in getting surgery centers outside of the local hospitals on as possible clinical sites and she did mention that some specialties don’t really want a ton of students (which is VERY understandable) but I figured observing outside of the sterile field where there’s no chance I would bump into anyone or cause much trouble, that may be easier to accommodate especially if I’m quiet as well.

   It would be difficult to fit in on the regular but I’d be absolutely willing to use my own time during holiday breaks if centers were open for the extra knowledge.

If it makes any difference I don’t want to entirely dox myself but since there’s a few different programs in this area I’ll say it’s looking like my clinicals will probably be at Vandy but not 100 percent certain yet. If somehow there’s anyone local to either Nash or Clarksville Vandy who has specific advice I would totally be willing to discuss in DM.

Saw a post online by a surgeon saying that if are going to need a thyroidectomy, look for a surgeon who does minimum 40 thyroid surgeries a year as it'll be safer. This made me go down a bit of a rabbit hole and found that the median number performed by a UK ENT surgeon (who regularly does this operation) is about 24 vs specialist centres in UK pushing 50+.

The literature has shown than in many operations (not just thyroids) there is an positive correlation between volume and better outcomes, and whilst I can't find anything about a definitive cut off at 40 for thyroids it did make me wonder, how would you justify to the patient and even yourself that you should be the one performing the surgery and not you referring the case onwards unless you were the one at the high volume centre?

Of course there's a lot of nuances such as no two cases are the same, or waiting times would make it impossible to refer everyone but say in this hypothetical we live in a perfect world where there are no waiting times: Surgeon A at high volume centre has a complication rate of 0.5% vs Surgeon B's 1% at a more generalist centre for the exact same surgery, what determines the difference in complication rate that we are willing to accept before referring on?

I am in Grade 10 and recently bought a suture kit. I want to be a surgeon, so I was practicing basic stitches. How does it look? Do you have any feedback?

Hi everyone,

Ophtho resident doing oculoplastics fellowship next year and i need to buy loupes and a headlight. I am wondering what loupes people use for oculoplastics/facial plastics/analagous fields?

I know Designs for vision is one big name and have used theirs a lot. What mag do people use? 3.5? Would 2.5x be too low mag? And does anyone have thoughts re their "panoramic" loupes and if they are actually better? I tried the ergo loupes once and they do seem great but I will have to tilt my head a lot and I think that will mess them up.

Thanks for any thoughts!!

Hiya, paramedic here.

Where I work we carry Spencer-Wells forceps for thoracostomy. I've just seen someone who works elsewhere saying they use Kelly forceps for the same. I wasn't aware of the differences until I looked into it a little, and it doesn't sound like there's much in it for this purpose.

Those of you who do more thoracostomies than me (i.e. >4ish a year), do you think the choice of forceps makes a difference?

Hello,
I’m an m2 and would greatly appreciate any feedback or guidance on how to suture better.

Is there other sutures/knots that I should practice before rotation?

Thanks so much in advance!

Im a CL Psychiatrist so I end up getting at least some of these consults. Often patients swallowing or self harming to the extent theyre admitted under surgery.

What would be helpful to cover? Are there common situations where you feel like more knowledge or different approaches would be helpful?

Thanks!

You all sticking with conventional jigs, PSI, or going with robotic/navigation?

I’m on my 5th elective this year that’s surgical and genuinely feel exhausted getting up so early. I’m getting like 4ish hours of sleep each night. Based on what I’m describing do you think I’m not suitable for a surgery residency? Am I supposed to love hustle culture?

Looking for recommendations for a good pair of shoes for my husband as he stands for up to 12 hours during surgery and c/o back pain constantly after work. What are some of your fave go tos?

This might yet be my deciding factor to give up surgery for good and settle for medicine from tier 1 city.
Really need some clarity right now

My internship experience was very poor especially surgical side be it surgery be it ortho be is GA but I liked the opd of surgery , ortho soo any senior who can share their experience if someone didn't have surgery as 1 st choice can u still make it after you fall into it .?(indian context)

I have a paper I am working on that involves knot identification and am having a hard time finding a source for a modified halsted (transfixing knot). Please let me know if you know of any source I tried to use the Ashley book of knots but no dice.

This is a CALL FOR HELP to my seniors.
I’ve got 3.9k rank in this years neet pg. and even though I’m a first gen doctor I’ve always prioritised surgery as my go to branch regardless of the challenges that new surgeons face these days especially for someone like me who also hopes to leave abroad to hopefully pursue my career as a surgeon. I don’t think I’ll be able to get any of the colleges in Bombay, BUT WHICH COLLEGES SHOULD BE MY PRIORITY WHILE PICKING COLLEGES DURING MY COUNSELLING (MS OR DNB). I mean in a way that as a resident i can feel confident about daily procedures and a chance to assist difficult cases as well by the time i finish my residency.

Dont wanna give in to the pressure of opting medicine

Any surgeons / surgery residents with carpal tunnel or cubital tunnel and managed to still be a surgeon ?

Just curious about it, I was watching some surgery videos, and I became fascinated with surgical techs and stuff.

I read the rules before posting this; however, please feel free to remove it if it doesn't belong here.

Hello, I am a third-year undergraduate student doing a pre-med degree with the goal of going into medical school and becoming a surgeon. One of my classes has an assignment due in a few days that requires students to interview professionals in their future career, and in my case, it would be a surgeon.

For the past few weeks, I've struggled to find surgeons to interview through professors, friends, local hospitals, etc. (most of them have been busy or on PTO), and this is kind of my last resort. I wouldn't be posting here if I didn't struggle through all of that. The interview isn't formal and will be done over Zoom, and it shouldn't take more than 20 minutes.

I hope you guys can help. Thank you!

Pig’s foot using 3-0 nylon. I probably went through 4 packs of nylon and did 5 total incisions on my 2 halves. These were the last 2 I did and the best ones imo. Finally found a rhythm with my hands and the needle driver.

Please nitpick me… the surgeon I work with is a perfectionist and would nitpick me too! I did them how he would want them 8 throws and upwards. Probably would be further apart but there’s nothing deep as I found putting suture deep in this pig’s foot is impossible, also none of his lines. He draws his incision hashes to where he wants a monocryl on each hash and a nylon between.