Last year, I mostly viewed the scutwork the seniors demanded as an exercise of their power, nothing else. I did it, of course, but I couldn’t really see why they didn’t just do it themselves. Why the interns and juniors had to write all of the notes in the morning, write most of the post-op orders for the seniors’ own cases, write the post-op notes on the patients the seniors had just been operating on – it seemed rather pointless; or rather, too pointed: they got the fun of operating, and I got all the busywork.
Now, with a little more experience in the OR, I can see more reason to it (or perhaps, now only a year away from being a senior myself, I’m starting to rationalize giving a lot of the work to the intern). For one thing, the work hour limits hurt the chiefs a lot: simply being present for all their cases takes pretty much all the available time. Being in the hospital a few hours early every day to round would put them way over. Nevertheless, the good ones seem to know more about their patients than I do, for all they spend less time on it. The most fearsome chief I had this year seemed to be able to put me in the wrong every time we sat down to run through the list: despite having been in the OR all day, and me not, there was always some test result, some lab value, some change in the patient’s condition, which he knew about and I didn’t. He wasn’t trying to do anything in particular to me, either; he was just taking care of his service.
For the rest, writing orders and helping to get cases started, I’ve realized that “simply” doing three or four cases in the day can be quite tiring, and it’s only kindness to the seniors to use my energy instead of theirs to move in and out of the OR. (My hospital has an inefficient OR setup; neither the OR staff nor the anesthesia staff has any motivation to move quickly. It doesn’t decrease their workload or their hours, or improve their pay, to turn things around quickly. This leaves the surgery residents as the only people who really care whether it takes twenty minutes or fifty minutes to get the next case started, so the day will move more quickly if there’s one of us turning up to make sure that the patient has in fact arrived in pre-op holding, that their pacemaker is being turned off appropriately, that the CRNA is aware when the scrub tech is ready for them to come back to the room (instead of both parties sitting waiting for the other to call, as I frequently find them doing), that there are enough hands available for transport and to finish setting-up details in the room.)
So, I think my approach has changed since the beginning of internship: instead of figuring out what the chief was going to check to see if I’d done, now I look for any work at all that needs to be done, and take care of it, regardless of exactly whose responsibility it technically is. I wish I knew how to teach this work ethic to the new interns; but luckily, I think it’s primarily transferred by example, so I just need to keep doing my job properly.