Surgical culture

I just started week 2 on an inpatient general surgery service. My desire to ever venture into anything surgical has diminished even further. If first impressions are worth anything, then the surgical stereotypes ring true.

I was in the OR today with an old school surgeon. For 3 hours, the surgical resident and I put up with jokes that in any other setting would be misogynistic bordering on harassment. During the case, he tells me, "any attention [paid to the medical student] is good attention, even bad...the worst thing is to be ignored." True, but I think the implied message is I should appreciate that he is even talking to me. Awesome - I'm so grateful that this surgeon is even acknowledging my presence. Perhaps I should turn into a lump of clay. Later, he makes fun of our curriculum in cultural competency, which ironically, he may benefit from.

Rounds work something like this: there's the chief resident, the intern, the night intern, a surgical PA, and the med student. On each bay, the med student pulls all the charts and opens the chart to the proper page so the daily progress note can be inserted quickly. Then I hurry into the room, glove as quickly as possible, and hand dressings to the chief resident, whose path we've cleared so that she can enter the room first. During each 1.2 minute visit with each patient, the chief resident does all of the talking while the rest of us stand silent with gloves on ready to assist. I have never seen anything so overtly hierarchical. No teaching goes on. No one on my team has voluntarily taught unless I've asked a question and even then, the question is either fired back (which I don't mind) or answered very tersely. At times I wonder how surgical residents learn anything. There are no daily noon conferences, no morning reports, and no teaching on rounds.

I suppose I have it good though. My fellow medical student is being scutted out by her intern, who sends her down to the PACU and then to several floors throughout the hospital to collect vitals - on the entire list of patients, not just hers. Seriously, tell me why vitals are not electronically transmitted? It seems incredibly inefficient to run around to several floors, hunt down a paper vitals binder, and write down the vitals which were probably not even taken properly. It is a mess. Thank god my intern is an angel, apologizes for the scut, and sends me home at a decent hour.

Also, thank goodness this rotation is at the end of my third year. I would have been so jaded and disillusioned by now had this occurred earlier.