Worst Doctors in the Hospital

[placebo_B12]

Just curious if you had to go out into a 3rd world country with no infrastructure, and you were asked to save the lives of the war torn people in the vicinity. People beaten, starving, infections, traumatic wounds, heart failure, sepsis, gangrene. What 5 doctors would you bring?

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[Tired]

The best way to answer this is to look at who the military deploys to war zones.

And why the hell is this thread titled, "Worst Doctors in the Hospital"?

 

[placebo_B12]

And who do they deploy?

It is probably skewd towards penetrating trauma (thus, an abnormally high deployment of trauma surgeons, vascular surgeons, CT surgeons, orthopedics, and anesthesiologists, EM).

If we were going to take over a hospital in India, we would have an entirely different patient population, and may need to deploy EM, IM, Card, CCM, ID, Gsurg docs to optimize patient care.

 

[Tired]

And who do they deploy?

It is probably skewd towards penetrating trauma (thus, an abnormally high deployment of trauma surgeons, vascular surgeons, CT surgeons, orthopedics, and anesthesiologists, EM).

Yeah, that's what I understand. Although I know they will deploy other specialties and put them into these roles (ie - the Army will deploy Ob/Gyn as General Surgeons).

If we were going to take over a hospital in India, we would have an entirely different patient population, and may need to deploy EM, IM, Card, CCM, ID, Gsurg docs to optimize patient care.

I can't imagine what the medicine subspecialties would be able to do in these circumstances. The care, while intense, is necessarily at a lower level due to inadequate facilities and limited followup. You don't need a cardiologist, because they're not going to be doing caths, and you don't need Cardiology to prescribe HCTZ. No point taking critical care if you don't have ventillators and pressors, or an ICU. No reason for ID, since basic antibiotics will be in short supply, to say nothing on linezolid or meropenem.

You need surgery to correct basic things (Ortho for DDH, Gen Surg for hernias and tumors, trauma surg for bleeding). You need anesthesia to run the cases. And you need primary care to do basic medicine. Everything beyond that is pointless. War zones and extreme circumstances (I would imagine) have a strong triage component, and lot of people die because they lack basic care, not subspecialized care.

 

[southerndoc]

Most relief organizations use emergency medicine physicians not only because of their schedules (and ease with getting time off to rotate overseas), but also because of their broad training. Emergency physicians are trained in adult and pediatric medicine, although not as in-depth as internists and pediatricians. Nonetheless, the training is sufficient and well served in underdeveloped countries.

 

[swpm]

Lack of medical infrastructure and a lack of followup care are going to be bigger problems than which residency a US-trained doctor went to.

Of course, orthopedic surgeons really aren't even doctors any more, so I picked them in the poll.

 

[Tired]

Of course, orthopedic surgeons really aren't even doctors any more, so I picked them in the poll.

How so?

 

[Miami_med]

You left Family Medicine off of the poll. Most of the rural guys who operate in the US without any real infrastructure are in FM. They'd probably be most prepared to take the broadest patient base (along with EM).

 

[Faebinder]

You left psychiatrists off the poll too. Some seriously ill patients with them

 

[lateness]

it's a kind of a silly poll bc you cant assume to bring any 5 doctors to an area that is severely depleted and lacking in resources in a third world, ravished by war which doesn't have the same amenities, or infracstructure and expect them to function as they would in the US.. war torn areas are so completely different and broad, some lacking more resources than others . that being said, obviously if someone has been injured as a result of an ongoing war, then the surgeons to stop and control bleeding issues, would be important, you can also help with burying the bodies..

 

[Faebinder]

This poll is F-ed up... the title of the thread says worst doctors in the hospital yet the poll asks who are the best to take care of seriously ill patients...

Not to mention the heavy ER docs trafficing the forums of course will claim they are the best... My first reaction..... opened the thread "Worse doctors in the hospital...." and saw that people picked ER docs... didn't read the poll question..

So I guess ER docs were the worse... then Istarted reading the threads and the poll question and cracked up.

 

[lateness]

This poll is F-ed up... the title of the thread says worst doctors in the hospital yet the poll asks who are the best to take care of seriously ill patients...

Not to mention the heavy ER docs trafficing the forums of course will claim they are the best... My first reaction..... opened the thread "Worse doctors in the hospital...." and saw that people picked ER docs... didn't read the poll question..

So I guess ER docs were the worse... then Istarted reading the threads and the poll question and cracked up.

 

[cdql]

I'd send House and his crew.

If they were unable to go, maybe the Scrubs crew.

 

[Miami_med]

I'd send House and his crew.

If they were unable to go, maybe the Scrubs crew.

Since House is in Critical Care, Internal Medicine, Neurosurgery, Neurology, Pediatrics, and Pathology simultaneously, all specialties would be covered.

 

[Llenroc]

I vote for option "Z", your thread is ******ed, because you ask who the worst doctors are, then in your poll you want the best doctor.

 

[swpm]

Of course, orthopedic surgeons really aren't even doctors any more, so I picked them in the poll.

How so?

I was being facetious. Having had many less-than-inspiring encounters with orthopedic surgeons attempting to manage medical problems ("uh, yeah, let's give him a daily aspirin to treat that DVT" or "whoa, if Ancef won't kill it we'd better consult ID") ... I wasn't being 100% facetious. Maybe only 73%.

Sure, they're great at carpentry and can really wield those power tools, but my God, holy Christ, wow if many of them don't just revel in the atrophy of their general medical knowledge once they hit residency. It's as if they take pride in their inability to read ECGs, write orders for insulin, etc.

I vote for option "Z", your thread is ******ed, because you ask who the worst doctors are, then in your poll you want the best doctor.

Heh. That's great. Guess my vote for ortho went down in the "best in the hospital" poll because I too just read the thread title.

 

[Tired]

Since House is in Critical Care, Internal Medicine, Neurosurgery, Neurology, Pediatrics, and Pathology simultaneously, all specialties would be covered.

Don't forget Neurosurgery, Interventional Radiology, Diagnostic Radiology, Vascular Surgery, and Nursing. Only things I've never seen them do are transplants, Ortho, and mop the rooms.

 

[cdql]

Got it then

House, his crew, and Janitor from Scrubs

I think we covered all bases

 

[Tired]

Got it then

House, his crew, and Janitor from Scrubs

I think we covered all bases

And the chicks from Grey's Anatomy, for a little sexual healing . . .

 

[Mman]

Sure, they're great at carpentry and can really wield those power tools, but my God, holy Christ, wow if many of them don't just revel in the atrophy of their general medical knowledge once they hit residency. It's as if they take pride in their inability to read ECGs, write orders for insulin, etc.

Man, when I'm in the OR with them they can't get over how much stuff they can get a medicine consult to do for them. All they have to do is plead ignorance and the medicine folks will swoop in and save the patient which makes less work for them.

Now you tell me who is smart, the one doing the work or the one getting somebody else to do it for them?

 

[Jejton]

Yeah, that's what I understand. Although I know they will deploy other specialties and put them into these roles (ie - the Army will deploy Ob/Gyn as General Surgeons).




I can't imagine what the medicine subspecialties would be able to do in these circumstances. The care, while intense, is necessarily at a lower level due to inadequate facilities and limited followup. You don't need a cardiologist, because they're not going to be doing caths, and you don't need Cardiology to prescribe HCTZ. No point taking critical care if you don't have ventillators and pressors, or an ICU. No reason for ID, since basic antibiotics will be in short supply, to say nothing on linezolid or meropenem.

You need surgery to correct basic things (sOrtho for DDH, Gen Surg for hernias and tumors, trauma surg for bleeding). You need anesthesia to run the cases. And you need primary care to do basic medicine. Everything beyond that is pointless. War zones and extreme circumstances (I would imagine) have a strong triage component, and lot of people die because they lack basic care, not subspecialized care.

I would a ped because these situations ( 3rd world and/or war torn ) always contain large amounts of children with hosts of problems - malnutrition, injuries, disease, etc. I also voted for ob/gyn because women in general have a whole host of medical issues that are peculiar to them ( duh! ) and they usually, even more so in non-western cultures, dont feel comfortable having a male doctor examine them. In some cultures its absolutely forbidden. I only voted for a general surgeon for some of the above reasons. Basically, since you are triaging, you wont be doing too many advanced specialized surgeries and ( speaking from lack of experience ) I imagine that most of the surgeries can adequately be handled by a general surgeon with good training and experience.

 

[toothless rufus]

Don't forget Neurosurgery, Interventional Radiology, Diagnostic Radiology, Vascular Surgery, and Nursing. Only things I've never seen them do are transplants, Ortho, and mop the rooms.

 

[cdql]

And the chicks from Grey's Anatomy, for a little sexual healing . . .

hahaha

now we've got the spiritual side of medicine covered too

 

[swpm]

All they have to do is plead ignorance and the medicine folks will swoop in and save the patient which makes less work for them.

Now you tell me who is smart, the one doing the work or the one getting somebody else to do it for them?

They may plead ignorance, but it's just a cover for their genuine ignorance. Yes, I'm being facetious again, but at best, years of "tricking" other doctors into doing your medical management inevitably results in atrophy of knowledge.

Obviously there are exceptions, and the competitive nature of ortho means they get some of the most highly qualified applicants these days. But the ortho culture sure doesn't seem to value non-operative management of patients the way other surgeons do.

And even if you're right and they're a bunch of clever dudes fooling gullible internists and anesthesiologists into doing their scut work ... that's contemptible, not smart.

 

[Tired]

Obviously there are exceptions, and the competitive nature of ortho means they get some of the most highly qualified applicants these days. But the ortho culture sure doesn't seem to value non-operative management of patients the way other surgeons do.

Although I'm not starting my Ortho internship until June, my few months on Ortho service makes me disagree with a little. I think there is strong value for non-op treatment in Ortho. There does seem to be, however, a lack of value placed on management of non-Orthopedic conditions during the perioperative period. I have to admit, I was a little suprised at how willing Ortho was to turf things like abdominal pain, diabetes, etc to medicine or General Surg.

As one Gen Surg PD put it to me: "Those Orthopods. They always want the smartest students, but then the moment they're accepted they teach them to forget how to use a stethoscope or do an abdominal exam."

 

[EctopicFetus]

oh guys.. the stories I can fill you with from 4 weeks as an intern on the ortho service. Truth is the attendings dont know how to manage the conditions so how would you expect the residents to know.

 

[outofhere]

This is a strange question and lots of strange postings, and even more strange that I am writing a reply...

I think, when people head out to 3rd world/war torn countries to provide medical care, there a handful of diagnoses/treatments that are needed most of the time. Regardless what one's training is, you can get a crash course on what is frequently seen, and then you see one, do one, and teach one. I think as docs, we have all learned enough basic skills, and know when to ask questions and get help. So it isn't so much who would be better at these situations, as to who is a quick learner. Especially because supplies are limited, it is unlikely to be a sophisticated situation.

For active battle situations, of course, surgeons are a must, so there is no argument there.

I am a psychiatrist, and I had considered doing some humanitarian work for Africa, in my previous, single, child-free life, I was told that in those places, you learn how to manage what you see freq: complications of AIDS, infectious stuff, malnutrition...etc, and since supplies are so limited, there is no rocket science.

Alright, enough rambling from me.

 

[VentdependenT]

Just remember folks: no anesthesiologist, no surgery.

 

[VentdependenT]

I'd bring an orthopod who specializes in total knees, an occupational medicinist (i dont think thats a word but wtf), a pathologist, a PM&R doc, and an allergist.

 

[cdql]

Not exactly physician material

But it never hurts to being a team of these along if we're diving into 3rd world nations

 

[CatsandCradles]

Just curious, but what made you leave FP out of the poll.

I guess they're not good nuff for this stuff even though they are primary care....I did not know that a radiologist is better suited at taking care of rural health issues.

 

[edmadison]

And who do they deploy?

It is probably skewd towards penetrating trauma (thus, an abnormally high deployment of trauma surgeons, vascular surgeons, CT surgeons, orthopedics, and anesthesiologists, EM).

If we were going to take over a hospital in India, we would have an entirely different patient population, and may need to deploy EM, IM, Card, CCM, ID, Gsurg docs to optimize patient care.

Its interesting to look at the actual deployment rates from the Army, top 3: Gen Surg, FM and Pediatrics. Great for me as a soon to graduate army pediatrician!

Ed

 

[Winged Scapula]

Just remember folks: no anesthesiologist, no surgery.

Not necessarily...but its a lot less fun for the patient and requires industrial strength tape to strap down those arms!

J/K...anesthesia...one of the greatest advanced in medicine and surgery.