"Me have mass; Me OPERATE!"

It's so funny how many times I think of Dr. Bob Maier, one of my professors in residency, down here~  he used to really drive us hard during our pre-op conferences where we discussed our patients that were coming up on the surgical schedule.  He would make us really "defend" our decisions to operate, give a credible differential diagnosis, and tell him what we expected to find.  If we couldn't do so, he would usually resort to saying he didn't want to graduate a lot of surgeons that would go out "like monkeys" and just say "me have mass, me operate" (and thus take out every cyst or fibroid that we saw!)

Like everyone who has ever been pushed hard as a learner, we all hated it at the time.  But as I see the effects of some surgeons who apparently DID grow up with a lower level of training, I am eternally grateful.

We often spend more times in a clinic day explaining to patients why they DON'T need surgery (that another doc here has told them is necessary-- and expensive!) than we do setting folks up for surgeries!  Our latest example today was a real gem...

"Naomi" came in with an ultrasound result in hand stating that she needed a hysterectomy.  We reviewed her results, saw a single fibroid less than 2 cm way up high in the uterus where it rarely bothers anything, and clearly asked for a little more information.  It turns out, she has had long-standing complaints of pain in her legs and feet-- especially her left foot.  Apparently at some point, someone figured this must be her gallbladder and ordered an ultrasound of that.  Turns out she did, indeed, have gallstones (which were asymptomatic), and she was prescribed some type of natural herbal medicine to dissolve those (which, to our knowledge, doesn't exist).

So when that treatment didn't work, they figured it must be her uterus or kidneys, and thus ordered a lower abdominal ultrasound.  They saw the small fibroid and went with, "me have mass, me operate".  For a mere $1,000.00 or so!  Which she clearly didn't have, so now was in our office asking for a more discounted surgery.  This is usually where us Southerners throw in a "bless her heart"!

So after hearing the sad news that removing her post-menopausal uterus would NOT help with her foot pain, she went away with some ibuprofen and likely a bit of disappointment.  With low levels of professional accountability, however, this is unfortunately quite common here.  And not even the worst we've seen.

But on to happier news~  Things went quite well in the OR today!  Four cases (one was a minor case, but still!)- all went well, Adele got some great experience, Heidi even got to get some blood on her gloves once or twice (It's more and more exciting when you get to do it less and less, it seems...), and Chris just loves to operate so she pretty much rocked the whole thing out while I sat one or two cases out to finish up in clinic.  It's a great team effort, as usual.

We saw another 11 patients in clinic, and 2 will likely be surgical cases for May (my next trip)-- who wants to come with me?!  The rest were a usual mix of infertility, menstrual complaints, and incontinence or other concerns.

We are now at dinner tonight, and one patient that I operated on in 2013 or so just came in a recognized me~  #feelingfamous -- Good thing she looks like she is doing well...

I'll try to get some pictures up in a little bit-- Chris was nice enough to take some today since I usually forget anymore!

Until then, good night to all~