Junior surgeons can't even sew up wounds (pretty scarey)

The Straits Times ^ | 2/21/04

[mylife]

Junior surgeons can't even sew up wounds

Drastic cut in training hours, from 30,000 to 8,000, has produced surgeons who lackbasic skills such as tying knots and suturing

LONDON - British surgeons are arriving in operating theatres unable to stitch up wounds or tie knots because of drastic cuts in the length of training, experts have warned.

Reforms that have cut the training period for a senior house officer (SHO) from 30,000 to 8,000 hours have left many taking up consultant posts without basic skills, The Independent reported.

It said the experts, writing in the British Medical Journal, warned that plans to cut training further to 6,000 hours could create a system unable to produce general surgeons.

Ms Joanna Chikwe, Mr Anthony de Souza and Mr John Pepper, who are from the Royal Brompton Hospital in London, said the 1993 reforms by Sir Kenneth Calman had combined with the European Working Time Directive to reduce training so much that most consultant surgeons would not want to be operated on by junior colleagues.

'To become a competent surgeon in one-fifth of the time once needed either requires genius, intensive practice or lower standards. We are not geniuses,' the newspaper quoted them as saying.

There was no evidence of an increase in the intensity of teaching to compensate for the decrease in training.

A survey of SHOs in orthopaedic surgery showed a third of trainees were not taught in theatre or clinics.

'That many SHOs arrive at posts...without any real competence in operative skills as basic as suturing and tying knots is therefore unsurprising,' they said.

They added that most current trainees were supposed to become the new 'generalist' surgeons who carry out common procedures and refer more complex cases to 'specialist' consultant colleagues.

But they said 6,000 hours of training might not be enough to produce the generalists, 'let alone consultants'.

The Independent quoted Royal College of Surgeons president Peter Morris as saying that it supported much of the consultants' views and said it was facing 'serious challenges' as a result of the cut in junior doctors' working hours.

[mylife]

The Independent quoted Royal College of Surgeons president Peter Morris as saying that it supported much of the consultants' views and said it was facing 'serious challenges' as a result of the cut in junior doctors' working hours

[yankeedame]

Ain't "Hillary Care" great? But, OTOH, they do have universal heath care.

[Chris Talk]

Everybody that is anybody goes to the private hospitals in England, which are quite expensive, though I guess no more than any average hospital in USA would be...

[monkeywrench]

They'll be importing them.

[Polybius]

......said it was facing 'serious challenges' as a result of the cut in junior doctors' working hours.

In medical school, the Trauma Surgery rotation consisted of two teams, A and B. Each team alternated in taking every emergent surgery case from motor vehicle accident to gunshot wound from 7:00 AM one day until 6:59 AM the next. In a major metropolitan area, that meant you were going full blast for 24 hours with another 10 hours of post-op duties after that.

The work was therefore 34 hours on all cylinders and then 14 hours off, cycle after cycle, for the entire month.

On the first day of the rotation, the Chief Resident asked us, "You know what's the worst thing about the Trauma Surgery schedule?"

"No", we answered.

"You miss half the cases!"

[BobS]

Get a needle and thread and alcohol or hydrogen peroxide to splash on first. Since heroin is so available there just buy enough to kill the pain while you sew yourself together and for the next 24 hours. THIS is the way to survive with government-controlled health care. Do not inject yourself with anything. After you sewed yourself up, take a megadose of anti-bacterial drugs. You will survive.

[Capriole]

WTF? I'm not a physician, just a former medical student, but even I can do a fine job of sewing somebody up. In the lab I worked in we sewed each other up all the time. It's just not that hard, especially if you have a new needle and fine suturing material. How can someone who has gotten all the way through med school and into a surgical residency NOT know how to stitch a patient?

[BoozeHag]

I think fishing line works better than thread. Lower end test.

[LibWhacker]

Old saying: If you can't tie a knot, tie a lot.

'Course, I don't know if we want our surgeons taking that to heart.

[mylife]

How can someone who has gotten all the way through med school and into a surgical residency NOT know how to stitch a patient?

Good question, I'm sure I could do it.

[jackbill]

Boy, I can't wait for "single payer", Hillary Care health care.

[Polybius]

Old saying: If you can't tie a knot, tie a lot. 'Course, I don't know if we want our surgeons taking that to heart.

That's why you go down to the butcher shop and ask for a pork roast with the skin still on it. Then you practice, practice, practice.

Then you eat your homework. :-)

I agree with Capriole. This tale about "not being able to tie knots" doesn't pass the smell test.

[not_apathetic_anymore]

I spend my time in the OR on the other side of the blood-brain barrier. Watching a technically skilled surgeon can be a thing of beauty. Not a wasted movement. OTOH it can be painful to watch those with mediocre skills. Some seem to have the 'hands' and others (despite years of practice) don't.

[Agnes Heep]

LONDON - British surgeons are arriving in operating theatres unable to stitch up wounds or tie knots because of drastic cuts in the length of training, experts have warned.

Maybe it's just me, but if I were a junior surgeon I'd make damned sure I knew how to stitch up wounds or tie knots before attempting it in prime time, even if it meant I had to do the learning on my own.

[LibWhacker]

I know, it's crazy. First they say that training has been cut from 30,000 to 8,000 hours, then they trivialize it by making a big thing out of knots! I mean, come on . . . You can teach a motivated person to tie a dozen knots proficiently in an hour or two. That's not the problem. What else are they not learning?

[AnAmericanMother]

I don't get this.

I worked a couple summers as a veterinary assistant . . . and I can suture up a storm. I have good near vision and small hands, so I still get called upon to throw in a few stitches. Never sutured myself though (use SuperGlue).

[strongbow]

Residencies today have drifted towards a new kinder, gentler approach to training doctors. Did you know that a resident had "rights" and a list of procedures to address real or percieved grievences? When I was a resident (yes I know these stories get embellished) I had a right to do what the attending staff said or leave the program. There is a reason they call you a "resident". I have had residents tell me that they can't take call or see patients because they have been on duty for 36 hours. You see the resident advocacy committee will make sure they get mandatory time off after prescribed periods of duty. The staff can face consequences for requiring a resident in training operate when he or she feels like they need to rest. This may sound Draconian but picture the "empowered" resident who knows how to work the system. This article doesn't surprise me.

[KarlInOhio]

I have had residents tell me that they can't take call or see patients because they have been on duty for 36 hours

Next time I go to a hospital, I'll remember to bring a large stick to chase away any resident who looks like he has been on call for 16 hours straight, much less 36. Other than a war or major natural disaster, when do patients really need doctors who can work those hours?

I know what I'm like when I've been up for 20+ hours trying to get a project finished at work. I have no business working on electronics, much less making life and death decisions or cutting into human flesh.

I'm sorry, but those hours are just "macho doctor initiation" BS. They have nothing to do with providing proper treatment for patients.

< /pet peeve>

[Polybius]

Next time I go to a hospital, I'll remember to bring a large stick to chase away any resident who looks like he has been on call for 16 hours straight, much less 36. Other than a war or major natural disaster, when do patients really need doctors who can work those hours? I'm sorry, but those hours are just "macho doctor initiation" BS. They have nothing to do with providing proper treatment for patients.

See Post 6.

Inner city public hospitals in major metropolitan areas are war zones.

I had a Navy scholarship to medical school and I did my residency training in military hospitals. When military surgical residents needed exposure to the "Knife and Gun Club", they were were given TAD orders to inner city civilian hospitals.

Even in private civilian practice, someone has to be willing to be the one that drags himself out of bed at 3:00 AM to treat that patient in the Emergency Room that the E.R. doc needs help with.

As the radiologist in a rural county, I put myself on call 24 hours a day, seven days a week for 9 years (except when I hired a locums for vacation) and it got to the point where the E.R. was calling me back from home 36 times a month. I seriously considered moving away and leaving the county without a radiologist.

Since God created Internet tele-radiology, things have been just great.

However, in medicine, sometimes you have two choices:

1. Getting a specialist that is sleep deprived.

or

2. Getting no specialist at all when you need one at 3:00 AM.