trauma

[Aimless]

Last night I saw my first serious trauma case. Almost four years in--the cautiousness of the Swedish people has been working against me in this regard. It didn't go well for the patient, and his chances were slim even before he got there. However I can report that it was a little like it is on TV, except much more controlled and much more professional than I was worried it would be. A thoroughly well-oiled machine. I have been worrying a little about this "we did everything we could" business, but they really did seem to do everything they could have done, in a systematic, thorough, decisive and critical way, and for as long as there seemed to be even the slightest hope.

end report

[Dreadnaught]

I didn't know you were working in trauma. Interesting that you've been worrying about whether people really do "everything" in every situation, that's not a worry I ever considered.

Do you think you would get demoralized if "everything" kept repeatedly not working out in these kinds of extreme cases, and thus not try "everything" in some cases? I imagine it would for me.

[']['ear]

If he's in the end stages of med school, he will be rotating through all the different departments. At least in the US, all med students rotate through Emergency.

[wiggin]

Not at EDs are trauma centers; in fact, most aren't.

[Ominous Gamer]

Isn't the summer the deadiest time to end up in the hospital because of fresh interns?

[wiggin]

I wouldn't say 'deadliest', but July 1 is the date in the US when all programs rotate - residencies, internships, med students, etc. That means that you will have a fresh crop of 'inexperienced' physician trainees in the beginning of July.

This is somewhat disingenuous since every new rotation occurs approximately every month depending on the program, and the students/SubIs/interns are just as experienced at a new hospital/department as they were at the old one. But certain constants abound in medicine, and the responsibility placed on an intern is much greater than that of a student, meaning mistakes are magnified.

[Ominous Gamer]

I wouldn't say 'deadliest', but July 1 is the date in the US when all programs rotate - residencies, internships, med students, etc. That means that you will have a fresh crop of 'inexperienced' physician trainees in the beginning of July.

Thats the date i was looking for. Its called the July Effect.

fatal medication errors rose 10 percent in July in U.S. counties with teaching hospitals, giving credence to what’s long been known as the “July effect.”

http://www.msnbc.msn.com/id/38248607
http://www.usatoday.com/news/health/...lth28_ST_N.htm
http://patients.about.com/b/2010/06/...rs-in-july.htm

Read somewhere that there is also an increase in complications from incorrect tube switching around the same time, always wondered why those things weren't color coded more often.

[Aimless]

I didn't know you were working in trauma. Interesting that you've been worrying about whether people really do "everything" in every situation, that's not a worry I ever considered.

I've been worrying in part because I was afraid that our options are very limited in real and serious emergencies. It was a relief to see first hand just how much we can, do, and should try. The thorough and systematic handling of every medical aspect was reassuring. My own role was almost exclusively as an observer and I was kinda overwhelmed by trying to keep track of everything that happened, but it was very good to see how well everyone worked together, and it was good to know that they've developed that teamwork through extensive training, that I'll have myself.

Do you think you would get demoralized if "everything" kept repeatedly not working out in these kinds of extreme cases, and thus not try "everything" in some cases?

Hmmm. I don't know, but I don't think so. When you have half a dozen or more people all working together systematically it gets easier to "try everything". I also know that very many cases do go well, even if it takes a great deal of time in intensive care, even when it might look hopeless from a student's perspective.

I haven't seen many doctors who've been demoralised by this sort of thing. They've mostly had the attitude that you win some, you lose some, but you always do your best and then if you need it (or even if you don't) you get pretty thoroughly debriefed. I think keeping up morale may be harder for docs that constantly work with chronically ill patients while under a great deal of constant pressure.

If he's in the end stages of med school, he will be rotating through all the different departments. At least in the US, all med students rotate through Emergency.

I'm on a very short anesthesiology rotation, and was on call last night. We end up in the ER no matter what rotation we're on

Isn't the summer the deadiest time to end up in the hospital because of fresh interns?

I wouldn't say 'deadliest', but July 1 is the date in the US when all programs rotate - residencies, internships, med students, etc. That means that you will have a fresh crop of 'inexperienced' physician trainees in the beginning of July.

This is somewhat disingenuous since every new rotation occurs approximately every month depending on the program, and the students/SubIs/interns are just as experienced at a new hospital/department as they were at the old one. But certain constants abound in medicine, and the responsibility placed on an intern is much greater than that of a student, meaning mistakes are magnified.

From what I've gathered, this sort of thing is not dumped onto interns if it can at all be avoided. If there is only one person there and it's an intern that's one thing, but usually you have a team in place and they've trained together to handle traumas. There were a couple who were almost done with their surgery and anesthesiology residencies and there were also two senior surgeons and three senior anesthesiologists in the room when the patient arrived. Not to mention a cadre of nurses and a couple of slightly stunned med-students ready to hand anyone anything they may have needed (which wasn't much)

Thats the date i was looking for. Its called the July Effect.

http://www.msnbc.msn.com/id/38248607
http://www.usatoday.com/news/health/...lth28_ST_N.htm
http://patients.about.com/b/2010/06/...rs-in-july.htm

This is very interesting I wonder if they've looked at it in Sweden

[wiggin]

Minx - the issue is generally that interns are largely on their own for overnight calls. Sure, they have a resident they can talk to - and if they really need they can get a hold of an attending - but they are expected to be much more independent. Trauma, of course, is a little different than most departments.

[GGT]

for minx: http://www.nytimes.com/2010/09/03/ny...l?pagewanted=1

[Aimless]

Minx - the issue is generally that interns are largely on their own for overnight calls. Sure, they have a resident they can talk to - and if they really need they can get a hold of an attending - but they are expected to be much more independent. Trauma, of course, is a little different than most departments.

Hehe residents and attendings here seem to be the most worried when interns don't call But I get what you're saying, and I agree. We tend to phase interns in rather slowly, but in some smaller hospitals they may be tasked with managing the ER on their own overnight. However, they're still students and their seniors are still teachers, so they have obligations towards one another as well as towards their patients. They may be expected to be more independent, but they're also expected to air their questions, doubts and concerns frequently and to run things by their senior colleagues because that's the only way to get better at doctoring without jeopardising too many patients.

for minx: http://www.nytimes.com/2010/09/03/ny...l?pagewanted=1

Might be a very good trend. All things require training, and without structured training the rigors of medical studies may jeopardise the development of the personal aspects of medicine. At my uni we began with patient interviews in the second week, and they were careful to keep us from entering the med-student/doctor role for the first few encounters. We have a professional and personal development course that runs through the course of the programme, and they are important features of the internship and residency periods as well. I don't think there's a single medical faculty on earth that doesn't understand the importance of personal and professional development eg. wrt patient contact, but they're not always equipped to offer that training and it may come second to features of medicine that may be easier to measure and to use for selection purposes.

These initiatives may not reduce the problems brought on by stress and structural problems. I think that if you want humane and empathetic medicine you'd do well to help students and doctors handle stress (individually and in groups) as well as to reduce the stress they encounter by giving them the time and the resources (= more time? ) to be good doctors.