Are you ready for your surgical rotation?

1

Why should you introduce yourself to each patient and ask about his or her chief complaint?

Symptoms are perception, and perception is more important than reality. To a patient, the chief complaint is not simply a matter of life and death; it is much more important. Patients routinely are placed in compromising, uncomfortable, embarrassing, and undignified predicaments. Patients are people, however, and they have interests, concerns, anxieties, and a story. As a student, you have an opportunity to place your patient’s chief complaint into the context of the rest of his or her life. This skill is important, and the patient will always be grateful. You can serve a real purpose as a listener and translator for the patient and his or her family.

Patients want to trust and love you. This trust in surgical therapy is a formidable tool. The more a patient understands about his or her disease, the more the patient can participate in getting better. Recovery is faster if the patient helps.

Similarly, the more the patient understands about his or her therapy (including its side effects and potential complications), the more effective the therapy is (this principle is not in the textbooks). You can be your patient’s interpreter. This is the fun of surgery (and medicine).

2

What is the correct answer to almost all questions?

Thank you . Gratitude is an invaluable tool on the wards.

3

Are there any simple rules from the trenches?

• a.

  Getting along with the nurses. The nurses do know more than the rest of us about the codes, routines, and rituals of making the wards run smoothly. They may not know as much about pheochromocytomas and intermediate filaments, but about the stuff that matters, they know a lot. Acknowledge that, and they will take you under their wings and teach you a ton!

• b.

  Helping out. If your residents look busy, they probably are. So, if you ask how you can help and they are too busy even to answer, asking again probably would not yield much. Always leap at the opportunity to grab x-rays, track down lab results, and retrieve a bag of blood from the bank. The team will recognize your enthusiasm and reward your contributions.

• c.

  Getting scutted. We all would like a secretary, but one is not going to be provided on this rotation. Your residents do a lot of their own scut work without you even knowing about it. So if you feel like scut work is beneath you, perhaps you should think about another profession.

• d.

  Working hard. This rotation is an apprenticeship. If you work hard, you will get a realistic idea of what it means to be a resident (and even a practicing doctor) in this specialty. (This has big advantages when you are selecting a type of internship.)

• e.

  Staying in the loop. In the beginning, you may feel like you are not a real part of the team. If you are persistent and reliable, however, soon your residents will trust you with more important jobs.

• f.

  Educating yourself, and then educating your patients. Here is one of the rewarding places (as indicated in question 1) where you can soar to the top of the team. Talk to your patients about everything (including their disease and therapy), and they will love you for it.

• g.

  Maintaining a positive attitude. As a medical student, you may feel that you are not a crucial part of the team. Even if you are incredibly smart, you are unlikely to be making the crucial management decisions. So what does that leave? Attitude. If you are enthusiastic and interested, your residents will enjoy having you around, and they will work to keep you involved and satisfied. A dazzlingly intelligent but morose complainer is better suited for a rotation in the morgue. Remember, your resident is likely following 15 sick patients, gets paid less than $2 an hour, and hasn’t slept more than 5 hours in the last 3 days. Simple things such as smiling and saying thank you (when someone teaches you) go an incredibly long way and are rewarded on all clinical rotations with experience and good grades.

• h.

  Having fun! This is the most exciting, gratifying, rewarding, and fun profession and is light years better than whatever is second best (this is not just our opinion).