The Sum of Four Years
I got the summary of my procedure logs from residency in the mail the other day. It's kind of funny to think, "this is the sum of four years of victory and defeat, immense joy, and some of the most unimaginable pain you could ever think of", which all sounds melodramatic, but really is true. I can truthfully say that my residency was the best time of my life and the worst time of my life. I'm like Mowgli, but instead of being raised by the jungle creatures, I feel like I was raised by obstetricians, and my childhood can be summarized as follows:
Surgery on antenatal patients:
Appendectomy 1
Laparoscopy 17
Cerclage 9
Abdominal Hysterectomy:
Total/subtotal hysterectomy with/without removal of tubes/ovaries: 78
Radical hysterectomy (for cervical cancer) 2
Hysterectomy after Cesarean delivery 1
Other abdominal hysterectomy 13
Vaginal Hysterectomy:
Vaginal hysterectomy with or without removal of tubes/ovaries: 23
Laparoscopic assisted vaginal hysterectomy: 9
Laparotomy:
Removal of ovaries: 7
Laparotomy for ectopic pregnancy: 4
Removal of Mass: 16
Myomectomy: 10
Other laparotomy* 98
Incontinence and Pelvic floor:
Urethral suspension: 1
Paravaginal repair : 5
Anterior/post repair: 32
Other incontinence repair: 24
Spontaneous Vaginal Delivery: 437**
Forceps Deliveries
Low/outlet forceps: 27
Mid/rotational forceps: 1
Vacuum Deliveries: 49
Cesarean deliveries: 226
Breech presentation delivered vaginally: 12***
Multifetal deliveries:
Twins: 18
Triplets+: 2
Low birth weight:
500-1000: 18
1000-1500: 23
1500-2500: 34
Operative laparoscopy: 91
Hysteroscopy/operative: 32
Hysteroscopy/diagnostic: 47
Other hysteroscopy****: 38
Conization of the Cervix: 35
Induced abortion (Medical or surgical): 88
Surgical sterilization: 117
Vaginal Ultrasound: 118
Miscellaneous: 353^
Endocrine/Infertility Surgery: 118
Uro-gynecology: 49
Surgery for invasive cancer: 76
Outpatient/primary care visits:
hypertension: 353
Diabetes: 173
Thyroid disease: 82
Dermatologic: 38
Gastrointestinal: 156
Respiratory: 46
Breast probs: 89
Geriatrics^^: 147
Behavioral medicine:292
Immunization: 45
Peds/adolescent: 59
Preventative care: 329
Other ambulatory: 277
For a total of 2086 outpatient visits in 4 years.
Wow. It's really weird to see the most formative years of my life summed up in numbers like that (some of which I suspect weren't documented quite right, like the 98 "other" laparotomies). I remember every single forceps, every single breech presentation delivered vaginally, and every single surgery for invasive cancer I did (half to 3/4's of the cancer patients I operated on as a resident have now died of their disease).
* I don't remember what other laparotomy really means... maybe exploratory laparotomy/lysis of adhesions?
** Um... I probably did more like 600-700, but I stopped counting after 2 years of residency
*** My favorite!!
**** I can't imagine a hysteroscopy that's not either diagnostic or operative, those are the only kinds there are!
^ Um.. what 353 cases did I do that don't belong into those catagories above?
posted by Midwife with a Knife @ 10/27/2006 07:53:00 PM
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I am trying to conceptualize how this accounting could be done in psychiatry. Take just one flavor of, for example, Major Depression, Recurrent, Severe, With Psychotic Features: factor in the possible short visit, medium visit, long visit, full diagnostic assessment visit, medication management, consultation, individual psychotherapy, group psychotherapy, crisis intervention, hospital admission AND the ever-popular concomitant substance-abuse (and let's play poly for the hell of it). I don't have enough fingers for the first patient!
Nevertheless, a very impressive list of procedures. If I had a mass, I might even consider a lap with you.
So you have a blog =D
Thanks. I'll remove your mass any time. ;)
I think they track the procedures for hospital privilaging purposes. For example, it is possible to do an Ob-gyn residency some places and never deliver a vaginal breech. That person obviously should not have hospital privilages for vaginal breech delivery.
Are there things that psychiatrists have privilages or not to do? I'm sure you could do something similar (although I recommend you not.. it seemed like a lot of busy work in residency, although I'm finding it oddly satisfying and simultaneously kind of sad now). We have like ~20 procedures and ~12 outpt catagories. Could psychiatry be summed up in 20 inpatient and 12 outpatient catagories? OK, probably not.
I do indeed have a blog. Exactly what I needed to prevent me from making any progress on my research project! Thanks for being my first commenter. :)
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I am in the UK and we manage pregnancy and labour v. differently. But even here vaginal breech delivery is so rare (assuming we know in advance the breech presentation) - depends on the level of training and experience of the midwives. 12 successes, I hope? Do your privileges also include cephalic inversion and water births?
PS: You didn't explain your ^^ annotation to "geriatrics"?
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