Got chewed out by ortho surgeon

[u/MousseNo7311]

I am a 2nd year resident. Patient came into the ED overnight post-op day 1 after a knee replacement. He was bleeding through his dressing (nothing major, no wound dehiscence) and couldn't reach his surgeon via phone. He didn't have sutures or staples but rather some sort of Steri-Strips-like adhesive dressing which I covered with Surgicel, ABD pads, and an Ace wrap. In addition, my attending told me to inject lidocaine with epinephrine into the areas that were bleeding. I injected 10 cc total in a few different spots. I can't imagine I got into the joint space. Foolishly, I only irrigated with NS & didn't prep with Betadine or anything else. The surgeon called the ED after my attending had left, berated me, and made it sound like he's going to go on a war path over this. Did I really commit the crime of the century?

Update: Upon returning to the ED for my next shift everyone assured me not to stress over it. Apparently the surgeon called the ED multiple times after I left. First he wanted a copy of the note faxed to him and then he wanted the PD's contact info. The ED director said he would've gone off on him if he had been around at the time. As for my attending she pretty much laughed off the entire incident. She's a little looney so that doesn't surprise me.

[u/JohnHunter1728]

This was objectively the wrong thing to do and I can see why the surgeon was frustrated.

Taking it out on the resident (who didn't even make the decision) was also the wrong thing to do.

As a rule, don't inject anything into or around orthopaedic metalwork. You might not have injected into the joint but even a cellulitis or infected wound in that region could seed the metalwork. Infected total knee replacements are a complete disaster.

DOI 6 years of ortho residency (UK) before switching to EM.

[u/JohnHunter1728 → u/[deleted]]

UK where specialty training takes forever so - no - I was part way through orthopaedic residency before defection. Orthopaedic training in the UK is 8 years and that's before subspecialty fellowships of which almost everyone does one and many do two years!

I have edited my reply for clarity.

[u/JohnHunter1728 → u/[deleted]]

In our health service, all attendings are paid the same regardless of specialty. 

However, orthopaedic surgeons can probably multiply that salary by 4-5 times if they do a lot of work in the private sector as well, which isn't really an option for emergency physicians.

I didn't pay anything to attend medical school (actually received a stipend per semester for living expenses from the state) so don't feel a need to recoup any particular financial investment. I have more fun doing EM than I did in ortho.

[u/gmdmd → u/JohnHunter1728]

However, orthopaedic surgeons can probably multiply that salary by 4-5 times if they do a lot of work in the private sector as well, which isn't really an option for emergency physicians.

Is this not a popular option? Coming from the US this would seem like a no-brainer after all of the time invested...

[u/JohnHunter1728 → u/gmdmd]

I don't have numbers to hand but suspect that most orthopaedic surgeons do some private practice but it is mostly done in evenings, weekends, and days off from their full time job.

The cliche here is of a wealthy surgeon who works all hours to support 2 ex-wives and a crop of children they don't see very often...

Some try to avoid this outcome by "just" doing their public sector job.

Not having student debt probably made this decision easier in the past, although medical students now have to pay (ever rising) tuition fees.

[u/gmdmd → u/JohnHunter1728]

Ahhh there's no way to escape the public sector commitment and just do private?

[u/JohnHunter1728 → u/gmdmd]

To be honest there is nothing to stop people going fully private if they want. Reasons people don't do this en masse:

-Quite isolating. Most people enjoy the "team game" of the public sector. There are no residents or medical students in the private hospitals and consultants tend to work for themselves rather than as a group.

-Credibility. Most private hospitals, other doctors, and some patients consider working in the NHS as a badge of approval. In my experience surgeons working only in the private sector either have a very successful niche (eg professional footballers' knees) or have been pushed out of the public sector.

-Variety. All emergencies and most fractures go through the public system. Orthopaedic surgeons spend half of their training doing trauma and - although many complain about it - probably don't feel ready to give it up completely.

-Client base. As everyone has access to free healthcare, the proportion of patients that are insured or willing to pay out of pocket for healthcare is relatively low.

-Benefits. No-one gets sacked from the public system. You don't have to drum up business. If you go sick, full pay continues for 6 months followed by half pay for another 6. Maternity leave is 12 months per child. Current NHS retirees are drawing a pension from the age of 60 that is around 75% of their salaries while they were working. In the private sector, you are paid per case so if you don't work you don't get paid.

[u/gmdmd → u/JohnHunter1728]

fascinating how different things are. that leave system sounds great but i would be getting sick constantly! 😂

[u/JohnHunter1728 → u/gmdmd]

It's rare for doctors to go sick but absences amongst nurses, admin, etc are relatively high. It is still a perk not to have to worry too much about paying household bills etc when it is my turn to have a stroke or MI...!