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Docs Outside The Box
A Recap Of Our Wonderful Trip To Ghana. #471 Part 1
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In this episode, we share our experiences from our recent medical mission trip to Ghana. We also discussed a medical resident who was caught performing unauthorized genital ultrasounds in his apartment and concluded with giving career advice to residents who are transitioning to work as attending physicians.
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Bizarre Medical News: Unauthorized Ultrasounds
Speaker 1You didn't hear about this? The resident who was doing ultrasounds on men on their genitals in his apartment.
Speaker 2I beg your pardon.
Speaker 1Oh my god, this sounds nefarious. An ex-UC health doctor guilty for genital ultrasounds in his apartment, rudell Saunders, was found guilty of practicing medicine without a license. Saunders, a resident at the time, told the men that he needed a certain number of ultrasounds for his training. One of the men testified that he was interested in the ultrasound because of a family history with heart problems. I'm like you're a little far south for some heart problems.
Speaker 2One recruiting someone. Two telling them to come to your house. Like residents who are listening right now. Don't do that.
Speaker 1Attendings listening right now. Don't do that.
Speaker 2Attendings listening right now. Don't do that. What's good, everybody. Welcome to another episode of Docs Outside the Box, our first episode since recording since we got back in Ghana. Yeah, we did one episode in Ghana. Go back and check that one out. That's the last episode and we covered a lot of topics on that episode and yeah, it's been like four weeks, babe. We haven't recorded since.
Speaker 1Lazy lima beans.
Back From Ghana: Reflecting on Break
Speaker 2Yo, guys, when I tell you we needed a break. I didn't want to record, guys, we needed a break my brain. Just I had so much to say. But I think the really interesting thing for everybody who's listening is like I constantly have something to say about a lot of things that are going on. It's just that there's a lot of times where I have to govern, I have to really rethink what I want to say and say, okay, well, listen, is this something that you guys want to listen to? And also, at the same time, would I get canceled for saying it? After a while I was just like look, man, I'm working, and then we're also taking care of the kids, and then we're also seeing family. It was just like, yeah, I didn't feel like recording, that's it. I just didn't feel like recording at all.
Speaker 1Yeah, it was a lot. We needed a break, I think. I think you were ready to go?
Speaker 2You were ready to go, you were ready to go. I just didn't want to.
Speaker 1No, I mean for me it could have gone either way. I was actually kind of fine not recording, yeah, because I did feel like we needed a break, Having the kids with us 24-7, right, Like usually the kids are in school or they're in camp Like they are, so having them with us 24 7 definitely made me more tired than usual, you know, made me more fatigued mentally and physically than usual. Um, but the trip was great, great I love, I was.
Speaker 2I was very briefly y'all. So in August we spent a significant amount of time doing the medical mission and we split duties. The significant part of time I'm there operating seeing patients, and then we reverse. Renee will do the same thing.
Speaker 1I'll be kind of like what we do at home with locums.
Speaker 2Yeah, it started off with me running a clinic out of my apartment.
Speaker 1Yeah, it started off with me running a clinic out of my apartment. Basically, I hear a knock on the door Tick tick, tick, tick tick. Yes, hi, I'm here to see Dr Ani. I'm like?
Speaker 2OK, hold on a second you start to realize, dr Ani. Dr Ani, I don't have the patience to examine people, but yes, this actually happened three times.
Speaker 1Yes, you had three patients, yeah.
Speaker 2This happened three times, so we saw people no actually ended up.
Speaker 1Yes, you did end up with three patients.
Speaker 2Yeah, it was three total, yeah, and then we said, ok, you look, ok, can you make the trip up to Kumasi, which is four hours away. So I saw them, did the pre-evaluation on them from a surgical standpoint and then, hey, go up to Kumasi and, you know, get surgery. So that's what we do. I, my family's from Accra um, my mom is Ewe, my dad is Ga, so we're mainly in the Accra region and then when the team comes, we go up there, toasi, to Kwame Nkrumah University of Science and Technology. We set up with the team and then we're there for several weeks operating, seeing patients. Renee, you did a bunch of COPLOS, or at least you did a lot of education around COPLOS. You even did a virtual presentation while you were in a KRA with the kids to folks in Kumasi. What did you talk about?
International Healthcare Volunteers: Sustainable Medical Missions
Speaker 1specifically. So you know we are pushing more for education with international healthcare volunteers. We're really moving, trying to move forward in the realm of education, and so this time around we did essentially a copal clinic. But before we did the copal clinic we did a series of didactics In Ghana. You'll find that a lot of the colposcopies you know cervical cancer screenings actually done by midwives, and so there were quite a few midwife students there and we presented to them on colposcopy, on cervical cancer screening, and you know we just had a live audience, so we wanted to take advantage of that.
Speaker 2Yeah, that's one thing we talked about a couple years ago, but we, you know, it's really important for us to kind of talk about it over and over again, which?
Speaker 2is okay, you can't just go there. Go to a different country, go to a place that has low resources and just I going to be able to do procedures, that someone who's still going to remain there going to be able to take care of the complications from these procedures, right? So I think one of that came up when we interviewed a pediatric surgeon who went to Haiti, and I think she went to some other places in Asia.
Speaker 1Yeah.
Speaker 2And I remember we were. I was asking. I was like OK, there are certain procedures that you do that maybe they can't do or replicate. How do you justify that? I forgot what her answer was, but that's a really serious thing to talk about. It's like, well, if you're doing cases that you do in America, but you do them in a different country, but there's nobody there to follow up on these patients and they don't have a way to get to America, then what are we doing to get to America? Then what are we doing? So I think one of the things that I'm really proud of with our organization, which everybody will put in the show notes, is International Healthcare Volunteers. We really focus on sustainability and obviously the foundation of sustainability is education, education.
Speaker 1Yeah.
Speaker 2Education, so doing lectures, and it's not just from us Receiving education from them, so that it's bi-directional. So they learn from us and we learn from them, they learn from them, oh yeah yeah, yeah. So I think about go ahead. You were going to say something.
Speaker 1No, I was going to say, you know, last, this past year, international healthcare volunteers announced that we are building a simulation center out in Cape Coast. So you know, if there are doctors out there who are interested in volunteering with the International Healthcare Volunteers, I would really urge you to do that because, again, we are an organization that is really really serious about sustainability. It's not, you know, it's not volunteerism, as people say, right where you go and you volunteer, but you're really just going to see what it's like. You just want to visit a country, which is fine if you want to do that, but if you're really into sustainability and wanting to see something through, international health care volunteers is the way to go. So Alfred will put that information on YouTube and we'll put their information down in the show notes if you guys want to volunteer.
Speaker 2Yeah, so we, from a general surgery perspective, what did I do? So my days usually started I was up by like 645. I was at the hospital by 715. And usually we're operating by around 815, 830. I'm gonna be very honest with y'all guys. One thing that travels very well well, whether it's the United States, whether it's on our mission trip, whether it's in other countries is anesthesia. You know F around time. So that is one thing.
Surgical Experiences in Ghana
Speaker 1So wait, did you actually start operating at 815?
Speaker 2Sometimes even later than that.
Speaker 1What do you mean? Sometimes even later? Yeah, yes, later much later.
Speaker 2No, yeah, yeah, and then that will cause us to operate late into the night, you know, but it is what it is. So for you anesthesiologists out there who think that man, like, if I go to another country, like, will things be different? No, everything will be the same, right.
Speaker 1Anesthesia is the rate limiting step.
Speaker 2Oh my goodness, damn um, but we did everything can we get the patient in the room?
Speaker 2we did everything from hernias. So we talk about ventral hernias, right. We're talking about hernias that people like, particularly with women. A lot of the ventral hernias that we're seeing are women who've had phantastial incisions from C-sections. And then we're also seeing just ventral hernias, like umbilical hernias or like Swiss cheese type ventral hernias, and then we see the normal, like inguinal hernias, right, and then they have like regular hernias that you see in the United States. Then they have what we call Ghana hernias, which are the hernias that are like all the way down to like literally their thigh.
Speaker 1Yeah, fishermen.
Speaker 2Yeah, then we did a couple of thyroids. Now the thyroid surgeries. I'll be honest with y'all, we have a theme and we've been doing this since I've got there. I haven't seen anything different. Whatever we do in the United States, we don't do excuse me, what we don't do in the United States we don't do in Ghana, right? So me as a trauma surgeon, acute care, general surgeon, I don't do thyroids. I did that in residency, maybe once or twice as an attending, but I don't do that as part of my practice. So the thyroids are usually done with. We assist the local surgeons there. Now I'm gonna tell you something right now, the local surgeons there are cold. They are really good. They can operate those them there. I'd leave it to like they're probably better trained than we are. They just don't. Some of them, a lot of them, just don't have the access to the technology that we have. But in terms of, like, raw operating surgical skill, they're great because, like they're here in the United States, you know, the big thing is okay. Well, like yeah, like.
Speaker 2I don't do thyroids because there's somebody who's specially trained to do thyroids, or there's someone who does uh, you know the adrenals. So they're really good at doing adrenals there. They have specialization, even in general surgery, but it's really few and far between you know.
Speaker 2So if you nick something and you have a vascular injury, like that's on you. If you have a urologic emergency, that's on you. Like there's. There's nobody who's going to come and save the day and be like, hey, like can you come in the next 15 minutes? I'm going to hold my finger on this.
Speaker 1They're like fix it, fix it.
Speaker 2You know. So these surgeons, they, they are very well trained and, like I said in the beginning, I learned a lot from them. One thing that we didn't bring we didn't bring mesh. So my partner, dr Kinnard, he went and purchased mesh in Ghana and we sparingly used it during cases, particularly for the larger hernias right, the inguinal hernias that were like the gana hernias and then like the ventral hernias. We use that also. And then for the others we just did a you know suture repair and then one thing we didn't anticipate.
Speaker 2one thing we didn't is I don't know what was in the fufu. I don't know what was in the chita. I don't know what was in the gari. I don't know what was in a Cheetaw. I don't know what was in a Gary. I don't know what was in the light soup in the Fufu. I don't know what was in the Comey. I don't know what was in the. I don't know what was in any of that stuff. But appendicitis was like rampant during this time. The amount of appendixes we did, compared to the appendixes that I like, the appendixes that we did this month were way more than the total amount of appendixes that I've done over the last 10 years. Okay, me, I think, probably in Ghana, realistically, seriously, not overall, but I'm talking about in Ghana. Like the appendixes that we did over the past 10 years, I probably did like three.
Speaker 1Yeah, yeah.
Speaker 2Right, yeah, and this month we did like close to 15, which is highly like abnormal. Yeah, that's unusual. Yeah, every day there was at least two or three students who came in saying that they have appendicitis and you would go in there and it's like perforated, or you know the appendicitis is inflamed Like it's real, or you know the appendicitis Like it's real. It's real appendicitis.
Speaker 1But you know, I want to say something, so it's funny.
Speaker 2What do you want to say to me?
Speaker 1First of all, let me just back up a little bit, because you did talk about doing the clinic outside of our apartment and I just want people to know that we are not like that resident who was doing ultrasounds on what happened. You didn't hear about this. No, the resident who was doing ultrasounds on men, he was doing ultrasounds on their genitals in his apartment. I beg your pardon, oh my God.
Speaker 2Here in the United States.
OB/GYN Procedures and Education
Speaker 1In the United States. Yeah, it was a resident. He was. Yeah, he was having men come to his apartment and he was doing ultrasounds on their testicles. This sounds nefarious.
Speaker 2Ultrasound.
Speaker 1So we were not doing that For what reason we? Were not doing that, so I want to go back. I just wanted to go back so that people understood exactly what was happening there. Hold on a second.
Speaker 2Hold on.
Speaker 1Hold on, Hold on and to say that one of the docs one of the docs who is also on the mission trip was made aware that this gentleman was, you know, in a lot of pain and she didn't know whether or not he needed surgery. So she asked you to evaluate him so that he could know if he should take the four-hour trip to Kumasi in order to get his surgery. Why, you gotta clarify that for her man.
Speaker 1No, I need to clarify it, Otherwise people are gonna be like, oh, I see what's going on over there.
Speaker 2All right, let's get back to this. Let's get back to this resident.
Speaker 1So that's one but number two, wait, number two is that so over the last couple of years cause you talked about having, you know, appendicitis or people having appendicitis. It's true, though, like every every year, or I should say almost every year, we meet somebody who has appendicitis. So one of the surgeons that you operate with remember the first year that we met him. He had appendicitis, remember, yes, and then I think that either that same year or the following year, I don't know if you remember Gonza, remember Gonza? Remember he was a house officer.
Speaker 2We treated him with oral antibiotics right.
Speaker 1He treated himself with oral antibiotics and we kept telling him Gonza, you cannot keep taking oral antibiotics. If you keep flaring up, you have to have surgery. But he also had appendicitis. So I'm like what is going on that all these people around us are having appendicitis?
Speaker 1OK, so you've stalled enough, let's talk about this guy doing ultrasounds on testicles yeah, you didn't hear about that In his apartment. So he's an ex-UC health doctor guilty for genital ultrasounds in his apartment. Rudell Saunders was found guilty of practicing medicine without a license yeah, but why was he doing ultrasounds? I don't know, I don't know, I don't know, I don't know. So he was found guilty of felony charges and that was released. That was the decision that came down.
Speaker 2August 5th. Hold on, hold on. He's a radiologist, or what was he? No?
Speaker 1he. I don't know what kind of resident he is. I'm not sure what kind of residency resident he is, what residency he was in Yo. This is highly abnormal yo Highly abnormal.
Speaker 2I think he was a resident.
Speaker 1Was he a resident? Yeah, Saunders, a resident at the time, told the men that he needed a certain number of ultrasounds for his training. One of the men testified that he was interested in the ultrasound because of a family history with heart problems. I'm like well, I'm like you're a little far south for some heart problems.
Speaker 2Where was he finding these people from?
Speaker 1so this is a he, so he let's see a doctor who teaches at the University of Cincinnati's medical school testified that the school did not require a certain number of ultrasounds for the credentialing procedure. Yeah, so I'm not quite sure. Sounds for the credentialing procedure? Yeah, so I'm not quite sure. Yeah, I'm not quite sure. See, I like this. When did this come out?
Speaker 2This came out in August, the fact that he was found guilty. So this has been going on for at least.
Speaker 1Yeah, this has been going on for several months.
Speaker 2Yeah, yo, you got to show, I got to read. Yo, you got to let me know, I got to read about this. You got to let me know about this, because this is one, recruiting someone. Two, telling them to come to your house, Like. Three, what did you say afterwards? What's the follow-up?
Speaker 1Four did you get money from them? I'm not sure I think he was. Was he a resident or you know them? I'm not sure. I think he was a resident or you know what. I'm not sure. We'll have to delve a little bit deeper into this. On another episode.
Speaker 2Residents who are listening right now. Don't do that. Don't do that.
Speaker 1Attendings listening right now. Don't do that Like don't, that's what he called it. Don't do that Attending's listening right now. Don't do that Like don't.
Speaker 2That's what he called it. Don't.
Speaker 1Unless you have your practice set up and everything. When did it occur? This is University of Cincinnati, so I'm assuming it was somewhere in Cincinnati.
Speaker 2I like that, though I like what he did, but I didn't have that on my radar at all, so I'm glad that you brought that up yeah, see, gotta be careful what you say.
Speaker 1Now here, remember you, the one said that you were afraid of being canceled well, yeah, I mean.
Speaker 2so let me just clarify, guys. Like the patient was already pre-screened, the doctor sent them to my place to say, hey, can this person take the trip, or should they take the trip up? Right, right Went up there and then we operated he did?
Speaker 1He did get his surgery. He got his surgery in a medical facility. So I just wanted to make that clear. We're not out in Ghana just randomly picking people in Ghana, just randomly picking people. So yeah, so as for my own experience, I only went for about three, four days, so you went a little bit longer than me. I actually only really went for three days, but when I got there there was a continuation of the Copal Clinic that we had started, and so I got to see a couple of patients. There weren't as many patients as we would have liked to have seen. There was a continuation of the Copal Clinic that we had started, and so I got to see a couple of patients from there. There weren't as many patients as we would have liked to have seen.
Speaker 1Again, that's, you know, kind of logistical and resource kind of those things come into play. But what was nice about that time was that, even though we didn't have that many patients time was that, even though we didn't have that many patients, we did have the resident as well as two house officers who I worked with a little bit more closely, so I was able to give them kind of education on colposcopy. You know what the colposcopy is, for what you're looking for, doing the screening, when to take a biopsy, when not to take a biopsy, what happens after you get the results from the biopsy. So that was really really good. We ended up using a really, I guess, highly digitalized camera, colposcopy, which you know, which is, I guess it was donated by someone at some point, so it wasn't equipment that we actually had come with. The problem was that there just wasn't enough resource in order for the residents and the house officers to be trained on it. So we contributed to that, to their training on it, and then I did a couple of.
Speaker 1I did three open cases and one was one was a lot of fibroids. So I did a myomectomy and thank goodness for my training because, man, let me tell you, she had a lot of fibroids, a whole lot of fibroids, and I think that you know, in the United States a lot of people would have taken her uterus. A lot of people would not have taken the time to do the myomectomy. So we did the myomectomy. She had very little blood loss, thankfully, and it was a really good case. It was a really good case. So, you know, I did the myomectomy because I was trying. Really good case. It was a really good case. So, you know, I did the myomectomy because I was trying to give her a chance. She's 36 years old and she never conceived, so I was just trying to give her a chance to be able to have a baby. So we'll, you know, we'll see, we'll see what happens.
Speaker 2Hopefully in a year you get some good news from her.
Speaker 1Yeah, we'll see.
Speaker 2Yeah, now one thing, um, I do want to mention so. At in the evening time we would go back to there's a dorm or like a, a hostel that we would stay at and we would eat dinner there, and that was the time where we had. We would just talk like it's like, it's me, another surgeon, there's ob, another surgeon, there's OB there, there's an OB fellow there, ob, what is it?
Speaker 1Yeah.
Speaker 2Gainonk Gainonk fellow that was with us. We had a pediatrician that was with us, we had a nurse practitioner that was with us. Our team is very diverse and like during those times we would just go and eat dinner and you know we'd eat and have fun and talk and stuff. And you know, one thing that I noticed that I do is, um, particularly for the residents, the residents who are leaving um or people who are just about to become attendings. You know, one of them was asking me like advice, um, as to like what they should do when they first start working and stuff, and like I don't know why, but I just didn't feel like talking about like the financial stuff. But I was really kind of talking about like okay, when you first get to a hospital, like you got to be really careful about the politics and I'm like slow down. No, actually, the smaller the town, the worse the politics and at least the more exposed you can be. People get really bad consequences from like not learning how to read the room, not understanding the geopolitical stuff that's going on in a hospital. You coming in as a new hotshot X, y and Z and you know people in these small towns like yo, this is their, this their bread and butter. Right, everybody knows everybody, everybody knows everybody. You got to be careful what you say, and so forth. Um, you know.
Medical Training and Work Hours Debate
Speaker 2And then one thing that we were talking about also was like training right, like, um, somebody had asked me, like man, like, do you think that surgery training should be longer? Um, like, general surgery training should be longer than five years, and I was like that's a really good question. It's a really good question. I went off on a little bit of a tangent, but I do think that one of the things that we struggle with with general surgery training is okay, you have an 80-hour work week, right, are we getting enough training? Are the residents getting enough training? And also, at the same time, abiding by a work week? You know my thoughts already and I know me and you differ just a little bit, but I understand, I actually don't know your thoughts on that.
Speaker 2Well, so we both agree that this is because you're in an academic situation, right, whether you're at a community-based hospital or you're at a you know, at a large hospital, it's an educational experience, even though you're a PGY1, postgraduate person. Right, the training is just what it is. It's training, it's education. But I feel like making them focus on a really adhering to an 80-hour work week, you're not really preparing them for the real world, because the real world, there is no 80-hour work week. Right, you just work.
Speaker 2Right, it's like, you know, being a pilot. It's, you know, like they train and then when they go and they work, there are strict work. You know work hours for them when they work, when they're done, training and so forth. That doesn't exist in medicine, right, but I think you are of the standpoint of, well, if they're in training, then yeah, there should be restrictions on how long and how often they're training, how many hours they're working for, and so forth. I just feel like I'm like, well, I get it, but you put them out there in a field and it's like, well, sorry, sis, well, there's no 80 hour work week here, so hold on, let me. Let me finish.
Speaker 2Yeah, go ahead, go ahead. So that's that's one thing that I brought up. I was like, well, the amount of cases, the amount of exposure, the variety of things that you see, that's really limited, right, because if you are, if your shift ends, you know, during the day shift, at four o'clock, five o'clock or six o'clock, and all of these great cases come in at nighttime. You know the old school ways you lived at the hospital, hence why it was called residency. You resided at the damn hospital. So there's a whole bunch of different, a whole bunch of cases that you would be normally doing are gone. And I'm not just saying that from a get off a lawn standpoint. I was also a product of the eight hour work week. But I remember like, yeah, you know I would do a day shift and then I come back the next morning it's like, yo, you missed this case, you missed this X lap, you missed this gunshot wound. You're like, damn man, I missed all this stuff.
Speaker 2But then you know, I said, well, you know there's a lot of my attendings who you know they they brag about like the stuff that they were, they were able to get away with when they were in training in the seventies and the eighties and I'm like, well, probably a lot of the reason why we have a lot of these regulations is because y'all messed it up. You know, like I remember a lot of my attendings who were they would brag about how they would go to the VA and they were doing like these crazy cases as chief residents by themselves, like you know, like esophagectomies, and I'm like yo, like this is a big deal. These cases like you're removing someone's esophagus, right, and you're reconnecting because it's cancer and so forth, to be doing that without an actual attending, to be doing that as a chief resident, I think it's nuts Right, and it's no wonder you're seeing a lot of these complications Could be experimental. So a lot of stuff that was happening, you know, particularly at the VAs and so forth, you know in their 70s and 80s, maybe even in the early 90s, and you know these attendings saying, oh yeah, it was just me as a chief or as a third year doing X, y and Z, all these major things. It and oh yeah, it was just me as a chief or as a third year doing X, y and Z, all these major things. It's like you telling yourself, you telling yourself, I don't know if that was the right thing to be doing, you know. So you know, the pendulum has swung.
Speaker 2No-transcript. We're going to have to change the way how we train folks a little bit.
Speaker 1Well, they didn't want to hear that answer. I'm sure they didn't want to hear that answer. So I mean, listen, you know, I do think that there needs to be some sort of protection for learners, and you're absolutely right, like the, you don't have the protection of the 80 hour work week. But let's also talk about the environment that you are going to be working in as an attending, versus what you're going to be working. You know how you work as a resident, right? So, as let's just take night shift, for example, because it really is all about the call, right, it's not about the shift, right, it's not. It's not about the day shift, right, because usually on day shift, right, usually on day shift, you are in charge of a service. Usually, on day shift, you are in charge of a service. You're in charge of a service.
Speaker 1So if you're on ICU, you're probably not on general surgery. If you're on trauma, you're probably not in clinic. You're probably not doing all these things as an OB resident. If I'm day shift, if I'm on OB, I'm not on Gynonc. If I'm on OB, I'm not on antepartum, right, like I am on that service. But night shift, that's where things change. Why don't you just say after bed. No On night shifts or on night call. However, your residency does it okay. When you are on call at night, you are over all of the services, right? So your team you have a smaller team that is now taking care of all of the services. At least, that's how it was in my residency.
Speaker 2That's how it was in my residency. I think that's how it is everywhere, man Right. I think that's how it was in my residency. That's how it was in my residency. I think that's how it is everywhere, man Right. I think that's how it is everywhere, right? Okay?
Speaker 1Exactly, Nobody has. Oh, you have the night shift OB and the night shift GYN-ONC, and the night that's not how that happens. It's like it's three of us and we take, you know, antepartum, gynec, ER, everything.
Speaker 2The best at night is the super subspecialty surgeries like opto, derm and plastics. I don't know how it was at your place, but at my place it was an intern would cover like plastics, opto and like, like. I forgot what was the other one. I mentioned plastic derm and no, not derm, didn't have anybody in house exactly opto and I forgot who.
Speaker 2But either way, it's like people will come into the hospital like, yeah, I need a plastic surgeon. It's like, okay, an intern comes in and it's like I'm covering all of these services, like what you need? Like, yeah, they, they want a plastic surgeon to fix this. It's like, all right, you know now you got an intern fixing it, but go ahead. Do you get a coalescent of services?
Speaker 1right. So you get a coalescence of services. The thing is, as an attending, I'm never covering Gynonc, right. If I'm covering the ER, it's like, yeah, but for the most part the ER docs, right, are expected to do a lot of the triaging, right, and you know I'm not covering the same number of services, right, for the most part, that I would be covering, or the same number of patients that I would be covering. You know, when I was in residency as an attending, I'm just not right. So my OB service alone as a resident, I mean, you can have 20 patients, you know, on the ward. It's like that's a lot of people. You know the aunt service huh.
Speaker 2That's a lot for OB.
Speaker 1Yeah, but I'm just talking about the OB service. I'm just talking about people who delivered, right, like that's all I'm talking about. I'm not even talking about the people who are delivering, who are laboring, right. I'm not even talking about the people who are on antepartum, people who are pregnant, who are not ready to have their babies for potentially days or weeks from now, right, like. So I'm just talking about, really, I should say postpartum, right, so, people who have delivered, right, that's the postpartum service, right. And then you have the people who are actually laboring. So that could be like four or five more people laboring as you walk in the door, but it certainly could be more as the day goes on. Then you have your antepartum service, which could have another 10, 12 people. Then you have, you know, so you're covering a lot of people.
Speaker 1But my point is that my point is that, right, it as as residents. Okay, you're covering a lot. Right, you are covering a lot of people, you're seeing a lot of patients, but you are also expected to study as an attending. You're not expected to study, you're just not expected to. Now you want to go and you want to read a little article here and there, to then have to take an in-service exam, you know, or to be evaluated, you know, for the knowledge that you had on this particular month.
Speaker 1You are not expected to perform academically as an attending, and so that's the. I think that's the difference, right. And so even for those attendings who are like, no, but I work at an academic center, I'm like, yeah, but you still don't have the same burden of being evaluated in the same way that residents do, right, and you have your residents doing most of the work, you know you're probably not doing half the documentation that you would be doing as an attending if you didn't have your residents there, which is why attendings get pissed off on graduation day when they have to be the ones who are on call, because they're like who's going to do all the documentation?
Speaker 2So I say all that to say, most of the medical care is probably not at academic centers, though, right Right, most of the things are at either community hospitals or suburban hospitals, places that may if they have residents. It's a small amount, but I get what you're saying. I think you make really good points. It's just I don't know what the answer a problem. You know me.
The Reality of Attending Life After Residency
Speaker 1I think I've told this story on the on the podcast. Before that, when I graduated from residency, right, I'd done a ton of C-sections, so I knew how to do C-sections, but you never feel ready to do it by yourself. You just don't right, which is why I went straight panic the first time I had to do a C-section by myself. I was like, oh my God. And you were like what's wrong with you? You haven't done C-sections. I'm like no, I've done plenty of C-sections. You're like so what's the issue? I'm like I don't know. I was just panicked that for the first time, I didn't have an attending standing in the corner or standing across from me basically just telling me yeah, you're doing a good job, right, I had to be that person to do that.
Speaker 1And so I think every resident probably goes through that. When they get to the finish line, they feel like I'm not ready, I don't know enough. Maybe if I did like five more, maybe if I. And it's like listen, this is why it's called medical practice, because this is what we do and we are going to encounter things that we never encountered before. No matter how much time we spend in residency, there are going to be things that we never encounter until the 15th year of practice. I mean you can't stay in residency 15 years before you go and encounter that thing. Sorry, I'll tell you right now, you're never going to feel prepared.
Speaker 2There are times when I stay a little bit extra because I need to see some cases that I haven't done in a long time, because it's just part of my medical practice. I need to know how to do these things and that's practice.
Speaker 2You know, whether it's colonoscopy, egds or even doing some type of colon resection, I'm like, okay, I just got to make sure I'm staying on top of that. That's just the way how medical practice works. It's just. It's a very interesting thing to think about. You know where you know most other places, they keep track of your hours, whatever. It may be not so much in medicine afterwards, and I don't know if that's a good thing or if that's a bad thing, but we're not going to answer that question.
Speaker 1Yeah, I think we're not going to answer that question. Yeah, but I also think it's not about the hours. I think it's. I think it's not, or I should say it's not just about the hours. It's also about the environment and the other responsibilities that residents are essentially supposed to be doing. Right, they have other responsibilities that attending don't have. Let's see. Oh, so you just want to move on. That's what you want to do, all right. So up next, we're going to be talking about whether or not you can or cannot do locums. As a busy mom, I think I know the answer to that, and I think all you guys know what the answer is out there. So stay tuned.
