The gown card reads “Dear Doctors, JUST MAKE THE INCISION BIGGER!!!”
Mic drop.
I don’t know who needs to hear this but, yeah, struggling for 20 minutes because you made the incision a quarter inch smaller than normal.
What do you get out of it? Bragging rights in the doctor’s lounge? A free all-expense paid golf trip at the next conference? The love and devotion of your patients?
The push in the OR is toward smaller and smaller. Smaller incisions, smaller case times, smaller.
Just smaller.
And, yeah, that should be shorter case times but it didn’t fit the theme, you know?
I see you struggling with the smaller incisions that you make.
Yeah, patients may like a smaller incision, but how much smaller can you go? And still have the proper exposure to have to do what you are operating to do? Patients probably will be happier with a regular-sized incision and a smaller hospital bill. Because you ramp up their time under anesthesia and therefore the cost of the procedure while you struggle with exposure
I know that you know the incision is smaller. But the patient is not going to know. The incision can only stretch so much.
We were doing a case in the middle of the night. Of course, it was the middle of the night, you work nights, Kate! But the surgeon was struggling with taking out the specimen from the incision size and I mean, struggling! Thirty minutes they struggled and sweated and fought to get the specimen out, me watching from the sidelines, the sterile scrub tech helping them. Finally, they gave up and started pulling the specimen out in pieces. I asked gently if a slightly bigger incision would’ve been helpful. They sighed and said it would’ve been easier. I asked if the patient was going to notice that their incision was mm longer if they had gone for the bigger incision. They said no.
I said nothing else. I think the point had been made.
Two weeks later we had a nearly identical case, same team, same surgeon. When they had localized the specimen they asked for the knife and said to me “See, I can learn.” They made the incision slightly bigger and were able to only work on getting the specimen out for 6 minutes.
Sometimes you just need to make the incision bigger.
It isn’t a slight on the surgeon; just the facts.
Dispatches from the Evening Shift 