You're The Captain of the Surgical Ship |
by Jarrod Shapiro, DPM
Joined practice July 2006 of
John K Throckmorton, DPM
Lansing, Michigan
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A weeks ago I operated on a patient who happened to be a nurse. Without getting into the details, I performed a Cotton midfoot osteotomy for an elevated first ray and 2nd metatarsal Weil osteotomy (to treat a painful 2nd MTP joint). Prior to the surgery she requested Percodan for her postoperative pain control, which I don’t use, so I recommended Demerol which I feel is very effective in the right patient population. She continued to request Percodan, so I relented. Surgery went fine, but she had a lot of postop pain. Of course, the Percodan didn’t touch her pain. I received phone calls, and I finally prescribed her the Demerol which worked great. Now, my point here isn’t to argue the relative benefits of Demerol vs. Percodan, but to illustrate another point entirely. Whose fault was it that my patient suffered more pain than necessary? My patient’s? Nope. It was my fault. |
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Simply put, it was my fault because I am the one responsible for my patients’ well-being. I am the captain of the ship. When you’re the surgeon in the OR you are the highest level of responsibility. If a complication happens, YOU are responsible. Not the circulating nurse. Not the scrub tech. Not the CRNA. YOU. Now obviously there’s a limit to what you can do while you’re operating. You can’t administer the anesthesia while you’re performing the surgery. You have to put some trust in those around you. However, just as any good manager in a business watches over their employees, so must you watch the staff around you.
The same is true for the office. I am responsible for what my staff does and how they treat my patients. A very common cause of patients seeing other doctors is dissatisfaction with the office staff. If your staff treats your patient rudely that will reflect on you. Your sterling personality and charm may not keep them coming to your office if the staff is rude.
Here’s one more issue, which for me is a work in progress as a new doctor. For those of you in residency you’re going to experience this feeling just as I did when I started. As a resident your patients are not coming to see you. Your patients have come to see your attendings. Then you graduate from residency, and you’re in practice – now your patients are coming to see you specifically. You’re the expert. This means YOU make the decisions. Don’t negotiate with them. You’re the one who has experience with performing foot and ankle surgery. You know, for example, the level of pain patients should anticipate postoperatively after a  bunionectomy vs. an ankle ORIF and what medications are appropriate for them. You know how to deal with the complications. They’re not coming to you just for your amazing surgical skills. Medicine is about knowledge. You know more than they do. If you didn’t they would be going to someone else.
Back to what I did wrong. I allowed my patient to dictate a component of her postoperative care. I should have provided her the strength and leadership she needed and dictated the terms of her care. If she didn’t like it she could go somewhere else. This is true for casts vs. cam walkers, when patients can return to work or school, disability coverage, etc. We want to be our patients’ friends. We want to be accommodating. We all know that patients who like us are less likely to sue us. Keep in mind, though, that sometimes diplomacy just doesn’t work. Remember, you’re in charge; you’re the captain of the surgical ship. Best wishes.
Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]
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GRAND SPONSOR
This program is supported by
an educational grant from
STRATA DIAGNOSTICS
MAJOR SPONSORS |
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