Wednesday, June 17, 2009

Happy Time-Out Day!

So said the signs posted about the doc's lounge in the OR.


I had a pre-op nurse ask me today if I wanted to mark the patient. "No" was my answer...I was doing a D&C and didn't think marking the cervix would be a good idea in the pre-op area. Hell, I probably couldn't SEE it in the pre-op area!

One of these days, I'm going to mark an abdomen (pre-laparoscopy) with the words : Camera here, dipshit. I told this to our hospital's risk manager and after her laughter died down, she told me to stop being difficult.

Now, I think timeouts are a good idea to remind us what we are doing. However, the new craze of MARKING every single incision is insane. Every surgery is unique. I should be able to reserve the right to THINK and ACT on the basis of my skills, knowledge, and unique factors any patient may bring to the table. The majority of my cases are laparoscopies. Sometimes I need 2 incisions. Sometimes 3. Bad cases get 4. I've done tubal ligations where I couldn't place the usual suprapubic ended up being a left-sided port due to her uterus being scarred to the anterior abdominal wall. I changed my surgery intraoperatively from my usual way to something unusual.

Now, I'm not against marking incisions in cases where laterality/location is important. When I choose to get my knee fixed, I damn well want the RIGHT knee (literally and figuratively) operated upon. Neuro better operate on the correct level. But in cases like laparoscopies, c-sections, or where you're doing the same thing to both sides (ie, bilateral tubal ligation, tubes in ears, tonsilectomies...) does it truly help to mark? Or is it yet another blip on the computer to mark off?

I'm threatening a true temper tantrum if they start requiring marking the incision site for c-sections...

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