Types of patients you found challenging in this rotation and what you learned about dealing with them

The most challenging patients in this rotation I found are the ones that refuse treatment. For example, there was a patient with post status laparoscopic appendectomy who refused to put a NG tube in. Even he allowed us to insert the NG tube in the morning, he pulled it out after the nursing left the room. He told the medical staff that he felt uncomfortable with the tube in his nose. Patients who refused treatment are the ones that always require a lot of time and patience for explanation. In this case, we tried to figure out the reason that why patient refuse the NG tube. Then we had to explained to him how important the NG tube is and how is can help him to improve the symptoms after the surgery. I learn that for the patients that refuse treatment, providers should always try to convince the patient by explaining the risks and benefits of the treatment. Patients should fully understand the reason for the treatment and the consequences without treatment before leaving the hospital against medical advice.

How could the knowledge I’ve gained here be applicable in other rotations/disciplines?

At beginning, it was challenging to identify anatomy and follow what the surgical vernacular is in terms of tools used during the procedure and techniques employed throughout the entire surgery. However, as I scrubbed into more cases, it naturally became easier to understand what those terms meant. I also learned how to tie multiple knots via one hand or two hands with the help of other students. Because I enjoy using my hands, I learned a lot of technical skills that will help me during my ER rotation and for the future. In this rotation, I also got the opportunity to practice a lot of the clinical skills, such as place NG tube, I&D, putting in a Foley, and suture placement. These are the clinical skills that I might not have the chance to practice in previous rotation. The knowledge and clinical skills that I’ve gained in this rotation will help me with future surgical patients and performing the appropriate clinical skill when needed.

How your perspective may have changed as a result of this rotation (e.g. elderly patients, kids, IV drug users, etc).

Dealing with elderly patients with multiple comorbidities for surgery is not easy. Surgery in this age group requires special considerations. The preoperative preparation is important because, when preparation is suboptimal, the perioperative risk increases. In addition to organs having a steady decline of the functional reserve, the presence of chronic diseases such as hypertension, diabetes, and coronary and cerebrovascular disease are more likely to be present. It is important for patients to understand the preoperative process and ask questions in order to remain informed, understand their risks, and make appropriate decisions that meet their needs and align with their wishes. Before the surgery, it is also important to give patients instructions on their medication schedule for the days prior to the surgery and on the morning of the procedure. For example, certain types of blood pressure medications such as ACEIs or diuretics, blood thinners or oral diabetes medications are often stopped before surgery.

What do you want to improve on for the following rotations? What is your action plan to accomplish that?

In the surgery rotation, I saw a lot of patients are admitted for surgical procedures, for examples, appendectomy, cholecystectomy, mastectomy, and breast lumpectomy. For my next emergency medicine rotation, I would like to continue to work on my procedure logbook. There are still a lot of other clinical skills that I would like to practice, such as practice on foreign body removal from the nose, ear, or other sites, practice IV placement, arterial line placement, or drawing ABG. If I have a chance, I also want to practice more suturing skill and splinting.