Shadow an orthopaedic surgeon (for the next 5 minutes)
How much of an insight can one possibly gain into what working as a doctor is really like through a few weeks of work experience?
Most applicants will have had a glimpse into one or two areas of medicine and at most gained a general idea of the job. Of course at interview one must spin this experience for all it’s worth and really expand upon any insights gained.
This series of articles will add to your work experience so far by looking in a little more detail at different specialities.
It will hopefully add some flesh to the brief glimpses you may have had during work experience.
For current medical students and juniors that are deciding on their speciality this should also be a useful guide to what might be expected working in each speciality beyond the glamorous descriptions.
In this piece I hope to give you some more of an idea into a week in the life of an orthopaedic surgeon. We all know these chaps are difficult to get hold of as they’re usually too busy trying to read an ECG backwards or driving around in their Ferraris, but we’ve managed to catch one.
What follows is written by a current registrar on one of the training rotations. Now, because trauma and orthopaedics can be a bit bit cloak and dagger (!) we’ll have to keep his identity under wraps.
I arrive 5 minutes late for the daily trauma meeting and the on-call consultant decides that this is a good reason to let all the other registrars off the hook today and targets the entireity of this mornings grilling session at me. X-ray meetings are always like this so I know what to expect.
Unfortunately the weekends take has been busy, so the consultant is in a malicious mood. He shoots me down on the classification of periprosthetic fractures, brachial plexus anatomy, and asks me to draw the attachments of the structures of the posterolateral corner of the knee following a discussion about knee dislocation. Each topic seems perfectly targetted to expose a gap in my knowledge. There then follows a lecture about how I will ‘get fried’ in the FRCS exam, (which is two years away). I nod obediently as I’m told to read up the topics whilst dreaming up revenge for such a ruthless Monday morning ambush.
There follows a ward round where a few weekend problems are dealt with. Two of our hip fracture patients have died and need post mortems due to having had recent surgery. Usual stuff.
The afternoon is a relaxed session of daycase surgery. We have a knee arthroscopy and my consultant is happy to watch me excise a torn meniscus without needing to scrub in to assist. Such cases are good confidence builders at my stage in training.
I escape any major upsets at the x-ray meeting. The cases are all routine but one of the staff grade doctors on-call overnight failed to deal with one of the infective emergencies (a child with a possible septic hip) to the satisfaction of the on-call consultant. It doesn’t sound like a true infection from the story, but this particular consultant likes to be phoned at home in such instances and the poor on-call doctor didn’t think it was worth disturbing him in the middle of the night.
The rest of my morning is spent going through disability claim forms and signing letters from last weeks clinics. Yawn.
After an unusually long luch break it’s straight into longest clinic of the week. A follow up fracture clinic with over 70 patients! Many are quick and easy cases that need final check x-rays and physiotherapy. Despite rushing through we finish over an hour late after waiting for the x-ray department to catch up with us.
A long day of surgery begins with seeing our pre-operative patients who have come starved and ready by 7.30am. I have a chat to the anaesthetist who has concerns about one elderly patient who is diabetic and has some heart disease. We agree to re-order the list and put this patient first.
This list begins with a hip replacement which I am able to confidently complete, ably assisted by my consultant. It always feels easier when your assistant is also your teacher. I’m aware that i’m much slower and have more difficulties when my assistant is more junior and when any intra-operative decisions cannot be checked and corrected by my boss.
The second case is a difficult revision knee replacement. I retract whilst my consultant slowly and meticulously removes the original implant and begins to replace it with a complex long stem revision implant. The surgery is long, tiring and actually quite tedious. I make a mental note to write off revision joint replacement from my list of potential subspecialty options.
We start the last case, a simple shoulder decompression, very late, after negotiating with the theatre management staff for some extra time. The hospital is keen to avoid cancellations and so we’re able to carry on. We finish after 7pm.
The X-ray meeting is interesting today. We have a complex case to discuss with the radiologists who are also in attendance. A 50 year old woman has presented with sudden difficulty walking and opening her bowels -features of spinal cord compression. She previously had a gyneacological cancer that was thought to be cured but has now clearly reappeared as a spinal metastasis. We decide that she needs a full abdominal, chest and pelvic CT scan to work out how far the recurrent cancer has actually spread. If the situation isn’t too bad and her life expectancy reasonable, we can at least operate to stabilise her spine and allow her to remain on her feet. If she isn’t fit for surgery or her life expectency is very short indeed surgery will be futile and she will almost certainly become paraplegic and incontinent within a few days.
The sober discussion is followed by a hectic day on-call, attending trauma emergencies in casualty. One road traffic accident involves a young man who has come off a motorbike at high speed. He has major open upper limb injuries and we take him to theatre as soon as he is stable enough to be anaesthetised.
The afternoon is spent in theatre debriding our motorcyclists forearm and hand. He has multiple fractures that require plating and some nerve and tendon injuries that require repair under the microscope. We are unable to close all of his wounds but hopefully should be able to do so at his next theatre visit. If his skin loss is too severe to close everything nicely next time he will require skin grafts or perhaps a flap.
He will certainly require at least one further visit to theatre in the coming days.
The evening is spent seeing more emergencies in A&E. I supervise one of the F2s to aspirate a knee joint, pull a broken wrist into position, and stitch a nasty elbow wound together. By midnight I am finished and retire home to bed. I am still on-call however, and expect to be called by the F2 doctor if there is anything she needs help with.
It’s my teams turn to lead the X-ray meeting and we go through the previous 24 hours admissions one by one. There is much discussion of the open arm injury that we operated on yesterday and one of the juniors gets quizzed extensively about the different types of nerve injury. There are a number of elderly patients with hip fractures that need urgent surgery to get them out of bed and back to their nursing homes before they add to our mortality figures.
The ward round and fracture clinic that follow are fast and efficient. My consultant and I make quick decisions about who needs further investigation, who needs surgery and when, as well as who can be discharged. I enjoy the quick diagnosis and management that is an integral part of this job.
Lunch is free today, provided courtesy of one of the large device manufacturers. It’s the orthopaedic equivalent of a drug lunch except that we’re shown the new intramedullary nailing system being sold to the hospital over salmon and cucumber sandwiches.
This is followed by an elective clinc full of arthritic patients with knee and hip pain. The clinic is overbooked as usual and a late finish is pretty much guaranteed. After yesterdays late on-call finish and the heavy (free) lunch, I’m feeling pretty drowsy and struggle through the clinic. The post-operative patients are all happy, the older arthritic patients can often be listed for joint replacement surgery but the younger patients with severe early joint disease are as ever, a dilemma. I offer long explanations and a variety of conservative treatment options. It’s always difficult to explain that there is no easy answer.
By some quirk of fate we finish only half an hour late and the clinic nurses congratulate us on running such an efficient clinic. My consultant, however wants to discuss some ‘interesting’ cases with me before we depart. Looks like I’ll be home late after all.
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