Friday, September 19, 2008

Lowered Expectations

"The Doctor" Sir Samuel Luke Fildes
(Source: Wikipedia)

As a medical student, one often has shortened horizons, worried only about the next patient or next pimp question, living from hour to hour, wondering what new challenge will arise next. However, this situation becomes even more frustrating when one is working in an inefficient system, with hundreds of little pauses during the day, time that is wasted and benefits no one. What I have found that helps me get through the day is to have lowered expectations. Whenever I find myself feeling unusually surly in the hospital, I often notice it is because I am the victim of my own expectations.

What does he mean, you wonder? Take one day a few weeks ago, for example, when I once again fell victim to my own expectations. I recently started my Ob/Gyn rotation. By some stroke of luck, I was assigned to the VA gynecology clinic, which as you can imagine, has a relatively low volume of patients. We only have one OR day a week, and on that week, only one case scheduled. The case turned out to be a hysteroscopy with planned polypectomy. I asked my resident when I should arrive; she said 8. I asked her how long the case would be (as I had lectures to attend in the afternoon); she said not very long, 15 minutes tops. So, I dutifully arrived at the PACU at 8am. No resident, no patient. I waited... and waited... and waited. In fact, I saw the attending first, around 9am. He also had seen neither the resident, nor the patient. Finally, around 10:30am, both had been located. Apparently, the patient had not her pre-op chest x-ray. Okay, so waiting was boring, but no big deal. I checked email, surfed the web. The case should be quick. Everything worked out okay, right?


The case dragged on for nearly 2 hours before I finally excused myself to attend lectures. The presumed polyp turned out to be a fibroid, but no one had surmised this after the first hour... or the second. Not only that, but the OR lacked the proper tools to tackle a fibroid. Imagine taking those blunt scissors kids use in kindergarten and try to cut through a piece of rope. The whole exercise was pretty ridiculous. Luckily, in the end, they somehow managed to get it out, but what a struggle.

Why am I complaining about this? Well, I try to temper my own expectations as best I can, but it is shocking to me how wrong residents often are about OR start times and length. For people who work on procedures day in and day out, this should be routine. Sure, complications during the case can affect times, but I would expect that to be true of complex patients undergoing complex procedures. Yet, it is often the "simple" case that ends up taking ridiculously long because no one has the proper expectation for its difficulty level and then end up being unprepared for when the unexpected does occur.

Long story short: never trust a resident's estimate of how long something will take. Never.

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