I have entered my second half of
my surgical residency and I think I am mature enough to make my own opinion
about the well-known issues of a resident in surgery. In my knowledge, the
working environment of residents in any of the surgical speciality is similar.
The striking difference between a surgical and non-surgical speciality is the
fact that, the surgeons has to perform a well-planned, time consuming
procedure on the patient as the part of
treatment while, the treatment by latter specialities mainly comprise of
brainstorming, discussions and logical conclusions.
Time consuming is the word that I
like to stress here. The usual routine of a surgery unit includes two or three
operation days in a week in addition to whatever common things like outpatient
day, grand rounds day and special clinics. In a teaching institution the
responsibility of working up the patients for surgery naturally lies on the
resident, starting from the lowest line of hierarchy. I will never criticize
this working model, because it is an inevitable part of surgical training. In
my personnel experience, I have found out that the more we talk with the
patients, the more beneficial it is.
Most of the time the residents will not be
able to cover the academic topics in a fruitful manner along with the stressful
working hours resulting in some mistakes her and there and eventually scolding
during operation theatre proceedings or ward rounds. The residents get
intimidated by the patients as well. Some patients may consider them
inefficient, inexperienced young doctors experimenting on them, while some
others over bear them with disrespectful dialogues. The nursing and supporting
staff may also sometimes act like residents are invisible.
Getting into a resident ship in a
reputable institution under merit is the fruit of long focussed hard training.
The UG course itself is a long journey of five and half years. The fresh pass
out from a medical school is considered naïve and the chance for a rewarding
permanent job is minimal. The same time the friends from precollege times who
chose a nonmedical field would have started earning.
Anyway my point is that the result of these
inevitable pressure put on the residents in surgical specialty has a major
influence on their character development as a doctor. The main change is that
the threshold for anger come down. But the vent for frustration release is
often small. Most of the time the ignorant patient or a newly joined nursing
staff will be the prey for unexpected anger venting. The senior staff are
usually experienced enough and seen so many residents grow up in front of them.
So most of them are resistant to it. From one bad experience the resident will
also understand that going into a bull fight with a senior nursing staff is not
healthy.
Numerous times I have regretted
for getting enraged with patients or patient attendants. The stimulating issue
will be something silly. The patient might have forgot to bring an
investigation report, might not have responded to my call etc. I get furious
when such negligent acts occur before me when I am frustrated, especially after
some scolding from consultant or senior, or during a long busy duty. ‘This doctor
is talking to us as if we are animals’- I have heard one bystander of a patient
make a comment about me in ED. It is not actually true from my point of view, and
it is a well-known fact that the patient bystanders try to provoke staff with
all kinds of offending remarks when they don’t get what they expect.
What can be done to prevent
clumsy conversations and keep ourselves under control? The first point is that
one should voluntarily train and keep some artificiality in conversation and
action in front of patients and their attenders. This comes from practice. Speaking
with true emotions out of heart may not be advantageous to patient or doctor
either. I have seen senior consultants managing difficult situations with versatility
of language. This is also known as ‘Soft skills’. Some may have this innate quality.
But most of has to develop it.
Dramatization is the key word in learning
communication. Start with a facial expression that might communicate the situation
beforehand. Spending two minutes on a CAT film as if you are studying it
thoroughly, running through the referral letters even if they have written
blunders, pulling your lips apart laterally creating a smiling face before
conveying a normal result or good result will help more than telling it
plainly. Make a sad face or face of desperation before conveying a bad report
or death. Try to look at the face of person while talking and get the feedback.
Try to be clear and loud enough. Be a good actor.
Try to think for a second before
raising the voice. Get the help of nursing staff or guard to raise the voice
than getting our own pressure high. If something wrong has been found with the
nursing staff never ever raise the voice, smile and make a joke of it. Politely
make them know that you will convey the mistakes to the consultant or their
seniors if they keep on repeating it. The permanent staff is afraid only of
their own superiors and consultants. Better idea is to keep a friendly
relationship with all supporting staff and never go on to a straight fight with
them.
There are so many surgeons who do
not drink. But an equal number of them take alcoholic beverages. From my
experience, having a Beer party once or twice a month with resident colleagues is
a great reliever of stress. Sharing the experiences, feeling loose and free and
good food is actually a necessity for healthy survival in this profession. Not only
drinking, having a coffee break with a colleague is also refreshing. Actually it
is usual that one get addicted to coffee in residency. Anyone who has done residency
cannot forget the freshness of after rounds coffee. It is lucky to have non
egoistic down to earth, freely communicable colleague to share the work and
fun.
