Surgery vs. Medicine: Presenting a Patient

They are different worlds...

[@TheMiddleAgeWeeb]

You forgot the "He lives in a rented flat with his wife and his three daughters and their dog" during the medical presentation.

[@dipset4016]

Is there a joke I’m missing here? Sorry not a med school insider

[@ragamuffinm2834]

Yea, you see more demographic information about patients from medicine (and t's basically essential when it's psych). Also the joke is kind of a nod to the fact that medicine reports are rife with information that surgeons often find non-relevent. Living with nurse had worked in the OR for ages-- he's always like-- it's great when patients are honest-- but they're almost always stretching the truth or just flat out lying (under reporting or not report substance use, or lying fasting, forgetting to mention they took NSAIDs yesterday) and they have wing-it or end the case & reschedule. What is considered essential info is different. You'll notice both said a lot of the same stuff but in a different order (different priorities) and the medicine report had way more additional info, recommendations about where the what direction plan of care was heading

[@S_Carol]

To be fair, the rented flat could have hidden mold issues, having a dog puts him at risk of several infectious diseases, living with a wife and 3 daughters means he might be able to head home before he's 100% functional (as with 4 other people in the house they can likely work it out so that there's always at least 1 around). All relevant.

[@karolagarcia216]

Shut up!! 🤣🤣😂 I'm literally in that year of med school and the memes of the living situation with patients have me like 🤡 but tbh semio is really important 😅

[@younggouda6764]

Thats the med students job 🤣🤣

[@anboo2seven]

Some kind of abdominal surgery, yeah...and we don't want to touch that bandage!!! Nailed it!!!

[@itzelr3514]

lol agreed !

[@yelenarotar2307]

Lol agreed!!!!!

[@diane9247]

Yeah, and no shower until next week! Unless his bowel movement backs up to his bandage!

[@Christina-xx2mv]

I was just about to write this but saw u did it first 😂

[@purplepeople623]

agrees

[@folumb]

the surgical presentation was 10 seconds too long

[@user-hm8hv1tn3c]

Agreed

[@samsonchan1488]

Passing flatus and had a bowel movement? Ok advance diet. Surgically stable for discharge 🙂

[@pixpusha]

I came here to say that.

[@caramelpeacock5250]

Me presenting a patient: That's Johnes. He's sick.

[@clouds0103]

Lmao

[@Meatwad787]

Lol same

[@sidragulzar7081]

you are ortho?

[@dfeuer]

​@@sidragulzar7081Sounds likely. Could be ophthalmology, dermatology, or psychiatry though.

[@vcnap]

Internal Medicine turned me into an overly analytical detail oriented talkative and reflects in even my style of conversing with anyone and even my text messages which are paragraphs long. 🤦🏾‍♂️

[@aceventura9075]

Nice to know I'm not alone!😂

[@stephani9223]

Lmao same!

[@screwedsarc138]

even your comments are paragraph long

[@walkz007]

It shows🤣🤣🤣

[@veronicasarabia3821]

This is my personality. 😂 I thought I was a weirdo. But I haven’t yet studied medicine,I can’t imagine when I do.

[@ButtcheekOnaStick]

I like how they both cover the patients conditions, both doing what they know best, and well, and still miss that an anemic patient who is normally hypertensive is now hypotensive after a surgery and noone is addressing it...

[@aijiading5168]

let along he has ESRD

[@AkaiAzul]

Isn't that what the IV fluids and blood transfusion is for?

[@ButtcheekOnaStick]

@@AkaiAzul that only fixes the symptoms, it does not treat the underlying condition causing them. EG, an internal bleed.

[@AkaiAzul]

@@ButtcheekOnaStick That is a good point. I suppose that's why they ordered lab work and rectal exam to confirm a GI bleed.

[@bennettbrown5605]

@@AkaiAzul lol they would've confirmed the GI bleed and chucked them back to surgery AGAIN after giving them more units if they were still even stable at that point.

[@AumJi13]

Yup! This happened before I transitioned from surgery to ICU. The best response I had from a surgeon for his post-op patient’s known HTN. He said, “medicine consult for High BP. I am surgeon I don’t know how to fix BP.” True story!

[@itzelr3514]

lol lol lol

[@Alalalalala11]

Oh, but it’s true. We surgeons treat high BP like medicine treat the surgical dressing. We don’t want to mess with that.

[@johannageisel5390]

@@Alalalalala11 But you could simply open a vein, let some blood out and then sew it up again! There, done.

[@migjordanpayawal7856]

Where's anesthesia when you need them

[@helenamcginty4920]

​@@johannageisel5390thats what they did in the good old days. Of course you had to bleed very sick folk so many times the died from blood loss. You cant win 'em all. 😅

[@palmspirit1833]

Ah, the joy of being a med student and giving a med-type presentation on your first day in surgery.

[@morgangrosdidier1654]

Yea my surg attending would have interrupted me less than halfway through that

[@MK-oj6hd]

@@morgangrosdidier1654same

[@user-sb1ku5hq7h]

😂

[@meretsegar7130]

And between them no one is investigating his potential post op bleed - hypotension in a normally hypertensive pt with resistant anaemia.

[@pochopmartin]

Possibly the most accurate part 🤣

[@breezy30153]

I agree

[@daramyers]

Thats what nurses are for. We are the ones who usually notice vital sign trends and differences from baseline.

[@GeminiCattle]

And neither team wants to deal with it. They say "call the other doctor"

[@KristenRowenPliske]

Well, the surgeon ordered a blood transfusion & the medical doc ordered all the lab work to check for another reason outside of surgery. They’ll try everything else & run every test they can think of before taking the patient back to surgery & cut him open again to look for a possible bleed. Not cuz they don’t want to surgery again but they don’t want to do an unnecessary surgery & put the patient under even more risk for complications.

[@sobel4511]

Surg: I hope it's not a bleed! IM: It could be so many other things! Radiologist: Maybe we could... you know... check?

[@NilaR93]

Literally had this happen during my nightshift yesterday 😂😂

[@samsonchan1488]

Correlate clinically.

[@berndhaft]

@@samsonchan1488 lmfao

[@deepikachaudhary9366]

Never have I witnessed Radiology volunteering any checking 🤣🤣🤣

[@ianlondon2888]

LOL. Fantastic!

[@whobeyou5342]

I have No training in medicine- but i enjoy listening and watching your videos. It's Like listening to a person speak in an interestingly foreign tongue.

[@imbored4615]

I have training in medicine and I watch them for the same reason

[@hesbonkiproticharapkirwa9097]

😂😂😂 we once had a patient who was disturbing us somewhat, it was during a medical round, then the registrar presented the case in high medical lingo, and suddenly "what are you guys talking about? What language are you speaking?" So, I understand, during our first days at the wards, that's our general experience too😂

[@lilbatz]

I'm howling. 😆 Love how surgical blows pass the ESRD and the uncontrolled diabetes.

[@whatup4340]

Medicine and surgery are two completely different worlds, aren't they?😂😂

[@thomism1016]

More like two different professions 😂

[@Cookie-mg8im]

Yes

[@henk-3098]

It's like yin and yang. Two complete opposites that are both vital in caring for the patient.

[@littlesecretion4586]

urologist: HA!

[@vivek27789]

@@littlesecretion4586 😂😂👍

[@kianna4954]

I love how neither of their presentations were wrong.. just different ☺️☺️

[@sarahcrain8083]

I am seven weeks post opt from left TKR and Achilles tendon release. Knee scar looks great. Achilles incision not closing and requiring wound care. Long story short. The ankle surgeon was out of the office week before last. When my wound took a turn for the worst. During a phone consult with ortho nurse, she suggested that I see my primary care physician. I was like are you serious...my PCP is not about to attempt to treat a infected surgical wound. This video was spot on.

[@catlinboy]

That's really interesting, because whilst I agree that GPs in the UK would be hesitant of doing too much with surgical post op care that should be got from a specialist, here district nurses and treatment room nurses often redress and assess surgical wounds in patients after leaving the hospital. So if there was evidence of infection it would be the GP they would refer their concerns to for further investigation, rather than the surgeon. It's also the community nurses (district or treatment room) who would remove staples or stitches post surgery in many cases, so it's them who would identify delayed wound healing or make decisions about leaving stitches in for longer, etc. Just interesting how it's different in different countries.

[@tanyad7894]

I hope you are healing well now!

[@sarahcrain8083]

@@tanyad7894 Thank you.

[@kayade5305]

@catlinboy Spot on. I've worked for years as a practice manager and lost count of the amount of times a frazzled doctor runs into the nurses office, asking what to do with a wound. I trust nurses with wound healing over doctors.

[@pochopmartin]

Good god this may be your best yet 😂

[@glueball214]

DITTO!!

[@GeminiCattle]

Gosh I miss working in the hospital! RN for 25 years and I had to retire early to take care of my mother. I really miss it! This video is awesome!

[@itzelr3514]

i know what you mean - hospital can be pretty entertaining :) - fellow RN here :)

[@aformula4198]

Your mum is lucky she has a child like you🤗

[@itzelr3514]

@@aformula4198 lol, true :)

[@n.n.8423]

Lmao, those medicine workups and “fungal coverage” after one night of fever😂😂😂😂😂 I can’t

[@ohyeah1067]

😂

[@dietitianmama]

Meanwhile the dietitian is like “how do you want me to feed this patient?!”

[@mt_v96]

The fact there is no mention of nutrition seems pretty accurate

[@Ray-md9nr]

One main principle of medicine. Don't open can of worms you don't want to smell.

[@itzelr3514]

lol

[@samadrahman9902]

Doc Schmidt is GOATed! I’m a med student and love watching these!

[@ensuingm.d.studyjunkiee8514]

"Some kind of abdominal surgery earlier this week", I felt that one.

[@catlinboy]

They gave Iv fluids to a patient on dialysis, as well as a whole unit of blood. Like, i'd assume it was a well thought our best of two bad options except they didn't even mention he was a dialysis patient!!

[@TheMCFARTPANTS]

I mean considering his surgery he was most likely bowel rest so perhaps NPO or cl liquids at most. Patient probably had a fluid volume deficit. Patient was probably also anemic at baseline being a dialysis patient and if he were going to dialysis they could give him the blood there.

[@ekekekekk]

@@TheMCFARTPANTS we can do some fluid removal in dialysis and give epo, but we need to stabilize that low BP first, but did we try the leg raise trick, give their scheduled midodrine at 0600, and used an appropriate sized cuff to ensure the most accurate BP? also the bed wasn’t zeroed so Mr Jones’ wet weight is completely inaccurate. Don’t worry; I can always get Jones on the scale before a treatment ;)

[@TheMCFARTPANTS]

@@ekekekekk doc stated that after the iv fluids were given the blood pressure stabilized. Pull off necessary fluid during dialysis with the administration of blood and perhaps erythropoietin.

[@TheMCFARTPANTS]

@@ekekekekk possibly could have done blood cultures, but abx have already been started for fever

[@KristenRowenPliske]

Yeah. It’s not a surgeon’s area. Usually they’d have a renal doc

[@thomism1016]

This guy is just absolutely awesome. Quite right! Everyone stick to what they do best 😂🌶😂

[@Doc_Schmidt]

thanks!

[@thomism1016]

@@Doc_Schmidt I am a urologist🇬🇧. Absolutely tremendous material. Just goes to show how universal our practice is no matter where you work in the world. Please keep producing your incredible material. Always instantly relatable to every doctor. Joys, rewards, frustrations the works. Insuperable, ineffable, irrecusable. I am all out of superlatives. 🎉🍾🌶🤓🛍🥂💐🎊🎶👍🏾🤗😎😂

[@matthewzheng6188]

As an intensivist this patient seems sick as balls

[@swethakannadhasan3224]

Nailed it. Especially with the medical consultant wearing glasses

[@Lvmykidos2]

So Doc, what you’re trying to tell me is you just fluid overloaded my dialysis patient that now nephrology is going to call me in to do emergent dialysis because he can’t breathe!

[@britanynoel8345]

Respiratory will bring the bipap 🤗

[@itzelr3514]

lol

[@lilbatz]

At 3 am with a leaky portable. Don't ask me how I know. Lol

[@greganthony6577]

Hello beautiful

[@queenmacaron2882]

And that’s why I like medicine so much better than surgery. We cover so much more and I like being super thorough.

[@nnalifunmilayobobai2504]

Funny how me being a law student and not understanding more than half of what is being said here yet I love watching him😂😂😂

[@lovespamming1282]

"Yeah, English is my first language. Why? Did you need me to translate something?"

[@mariella2884]

Me a nurse in the corner watching this like: “can someone please put in a diet order it’s POD4” 👀

[@purplepixie274]

I love it when different depts argue for a couple of days on which scan is best, wait a couple days till they're in coma that they didn't even notice, then do a scan anyway, give results of scan that it's end stage cancer, not a 6 month chest infection that 5 lots of antibiotics didn't fix, and the patient dies in about an hour. But you can't sue for negligence because they were going to die anyway!!! Love it.

[@KristenRowenPliske]

Very true. All of the surgeons I used to work with, when presented with a medical problem, would consult a medical doctor & wash their hands of the problem. Wasn’t their area of expertise, so they did not chime in. And vice versa, unless it was ID. The most they’d do was order their home meds. Patients with lots of issues usually came with a medical consult anyway.

[@joywebster2678]

If the patient is over 65, call geriatric medicine. As the CNS for the gerictric team I'd be chasing the surgeon or internal medicine saying...but if you look at their lab values u can filter sudden post op confusion, he wasn't demented pre op, and he likely isn't now. Sigh.

[@Odracir1911]

I'm a nurse and this is what I hear from doctors. Very accurate! 😅

[@noodlepoodlegirl]

I am just so impressed! Beyond words.

[@amaliawilde8978]

I SWEAR on my first loop it sounded like you said "7 year old gentleman" and the mental picture I got was of a child with a monocle and top hat so thanks for that.

[@aliciascott3176]

Yes again brilliant. I read both prospectives daily. Fun stuff.

[@paulagraham8464]

Brother, who was in internal medicine, spent quality time grumbling that surgeons just know how to cut 😆

[@GeminiCattle]

I was working in ICU here in okc. I had a patient that I called the on-call for. It was a teaching hospital. I told the doctor pt needed Lasix. He said "ok give 20mg iv" I said "really?" He said "I don't know, I'm OB/Gyn, that's how much we normally give. How much do you think?" I said "like 80mg, this guy is drowning!" He goes, "give him what you think, I'll sign the order" ..... lol. He was scared to death!

[@Onestep2atime]

Omg!!!!! This is awful.

[@tejoned]

20mg? That's practically a homeopathic dose.

[@kelseybergen6095]

Wait, how come a male patient needed an OB GYN? Lol!! But yes that’s as bad as when you have a confused/delirious agitated pt who is starting to swing and the doctor says to give them 6.25mg lo seroquel….ummm good luck getting that in them and it has legit no effect

[@starkeclipse]

Good team work.

[@amylynn3821]

Back in the days before hospitalists I was on call and got a call from the Ob/Gyn on call who said he had a 20 year old patient who had just had a septic miscarriage. Her pressure was 60/0 and her temperature was 102 and he was like, I gave her some fluids. Can you consult and help? I basically told him to call the ICU to get her transferred ASAP and I would call them from my car. She actually did great. We had her intubated on a couple of pressors and broad spectrum antibiotics for about 24 hours and then she bounced right back and was out of the ICU within 48 hours. (Just to note-I am a general internist, and not critical care but it was 3 AM and pulmonary/critical care wasn't going to be there before 7). Come to think of it, I had another patient call a couple of days ago saying she was pregnant and had Covid and she called her Ob/Gyn who told her to call me to deal with it. Pregnant patients are like post-op wounds. I try not to deal with them if possible.Every prescription comes with a message to ask their Ob if they can take it. Finally, in my favorite moment from training, a past-cardiac cath patient went into atrial fibrillation. We called his cardiologist who had done the cath and he asked "Why are you calling me? You need to consult arrythmia. I am a coronary flow specialist!"

[@timmytallskinny1362]

Surgery didn’t talk about the incision site 😂

[@starkeclipse]

As a surgical nurse, this feels spot on.

[@adi4305]

I never have any idea what he says or what jokes he says, but I still like his content

[@McGorak]

When you are so ill this is all understandable without a day of schooling

[@birdsnestfern5635]

I like your funky words, magic man

[@priscillahussain1722]

Hahahahahah yes pass on that buck back and forth!!!! 😂😂😂 so real!

[@tigerheaddude]

Very interesting distribution of work. Here in the UK, surgical patients stay under the surgeons until they are discharged, regardless of the medical problems. They would just get a medical consult or "shared care" sometimes, but even is unusual.

[@catlinboy]

Right! Unless the patient needed to be medically stabilised beforehand, and would be under medicine for a wee while before being transferred to surgeons for an op.

[@tanyad7894]

That makes so much sense!

[@graham2631]

I believe it's the same in Canada but I'm a patient not a doctor. Medicine for profit in the states is a strange concept.

[@drewmartin9148]

For the most part, general surgeons in the US manage their patients post operatively. Maybe somewhat different in private practice.

[@starkeclipse]

In my hospital in the US, surgery keeps the patient and med consults as well. Unless they are very far post-op. But service transfers are very rare.

[@wendy5116]

I’m a CDI (clinical documentation integrity) nurse and this is accurate. ESPECIALLY the “some kind of abdominal surgery” from the hospitalist…you can’t count on their notes for accuracy about the exact procedure. Meanwhile, query a surgeon about any chronic medical condition and they are never sure. However, their pre-op H&P always mentions the chronic dxs…go figure. God bless the PAs…😂

[@SummerClarke2005]

Doc. . . I have just imagined you as Dr. Owen Hunt from Grey's Anatomy and now I cannot unsee it

[@stephanienikols9831]

You’re very thorough! Great doctor . I can tell

[@pewperclipped3709]

I need this guy as my caregiver. Would solve all the anxiety of going to appointments lol

[@utahimeiori8739]

Me, a first year med student: ah yes, sick person who recently had surgery and is being treated for... stuff

[@AJG854]

I understood all of this 😂 thanks IBS!

[@Onestep2atime]

Unfortunately I understand most of what he said. My husband has been in ICU for over 2 months. I love watching his videos bc I need to find laughter during this crisis.

[@hollyfisher8811]

@@Onestep2atime I am truly sorry for all your Husband is going through, Yun💝~ Can only imagine how difficult a time this is for you, while supporting his recovery...Sending many PRAYers today from Arizona to you BOTH🙏🌠!!

[@greganthony6577]

Hello

[@user-gt2mi2wq4e]

'A surgeons knowledge ends at the tip of his scalpel'

[@JustUdoro]

The “some kind of” THREW ME ALL THE WAY OFF!! Um…there is so much truth…thank you for revealing what is really behind this Medical System curtain. 😮🤭🤦🏾‍♀️

[@berina7887]

I Looooove thiiis hahahaha so relatable hahah and then, in my country as a family doctor, I get complete medical records after patient's check out from hospital, and have to take care of both those - surgical and internal medicine things

[@mt_v96]

No mention of nutrition. **Pretty accurate*

[@hunterjones3528]

Can I just say like 3 years ago I would've had no idea what they were talking about but now I can keep up

[@Sinflair]

You are speaking big words magic man.

[@iudvomberg8448]

A surgeon: knows nothing, can do everything. A internal doctor: knows everything, can do nothing. A orthopedist: knows nothing, can do nothing.

[@bethrose4920]

Yep....sounds like a typical report on my usually 2 pts in ICU...... ICU RN....40yrs

[@TheFullmastee]

Amazingly accurate! Well done!

[@winnmarc1266]

SOOOOO TRUE!!! Surgery notes 8 lines, Medical notes 4 pages

[@eggr17ify]

Man I run all those tests. Scarry how short staff we are so no one is getting their results in a timely manner

[@rachelgammill7868]

No One: ... CC: He was hypothesize lastnight.

[@teripenny3335]

I continue to learn from your videos!! Thank you!!! Very informative, interesting and funny lol

[@a20inchfork18]

Im glad that I understand the videos without knowing anything about health

[@Pastran222]

Sooo True! You nailed it!

[@juliegreen9000]

Oh my gosh this is so accurate

[@illegalopinions4082]

I cannot get over the fact that they don't actually have to look after their patients until they leave

[@paulwilhelmsen6586]

I totally understood all of those…..word things.

[@northsouth252]

You're wonderful

[@VVSKO504]

Damn this sound like my actual report! 😳😳I had my g-tube place and had a fever, 2 blood transfusions, started antibiotics and the next day woke up with Conversion disorder!

[@jilltownsend2123]

This is why I love surgery ❤️

[@japanime555]

I too have my moments where I’m a bit “hypothesize”

[@OmarAbdulMalikDHEdMPASPACPAPro]

Yep, THIS is how it is!😅❤️👍🏾👋🏽👨🏽‍⚕️

[@bouchrasub]

Omg this is so accurate! Lol

[@norht161]

I like your funny words magic man

[@hasithasenevirathne647]

all in a day's work. so relatable 😁😁

[@MichiganCrimeTime]

CHECKING FOR CORTISOL DEFICIENCY!👏🏼thank you from the adrenal insufficiency folks!

[@Puglover130]

I’ve never felt more important than when in the MICU and there would be a team there every morning consulting on ME! 😊 and the pre-consult run through , but that only had like 2 people

[@user-wu7ug4ly3v]

This reminds me how much I don’t miss my hospital years. 😂

[@rebbecachunn]

As a former transcriptionist I was sobbing

[@carleighrousseau4226]

This is perfect ! 🤣🔥

[@casssidyy711]

vet med pretty similar during rounds except we get to say things like “patient does NOT like chicken. we have tried pilling with peanut butter and that seems to work”

[@rc4780]

Lab: Haha he’s getting R1R2 K+k+

[@cosmicredfield]

The fact that I'm so chronically ill that I fully understood all the medical verbiage.😂

[@brasschick4214]

Bullseye!! Nailed it!!

[@luckyfisher8635]

You nailed it!

[@katiestime7273]

Accurate! 💯💯💯

[@madeinitalyasmrofficial8340]

Have you medicine guys ever thought that he may be anemic because he just had surgery and lost 2L of blood vs got 5L of crystalloids in the OR? No need for haptoglobin bro

[@Doc_Schmidt]

There's always need for haptoglobin

[@K33176]

Not to mention that after the transfusions, the A1C is useless

[@ganesaponraja7963]

Have seen post-op bleed patients come back in 1 month after a transfusion with haemolysis and antibodies. There's a need for hapto if there's no bleeding yet there's anaemia

[@mayissalty6279]

I’ve been watching these videos for the past few days and thinking “god, I’m so glad I’m not studying to be a doctor” only to realise now that I’m studying to be a lab worker..... in a hospital

[@vincentr2465]

The accuracy is kind of scary ☠️

[@Alalalalala11]

No, we surgeons would mention his electrolytes, bowel sounds, NGT output. Also, our orders would be to ask IM to follow his blood sugar and nephro to ask how much fluids to give and whether we need to adjust any doses. Come on! We are not that stupid.

[@starkeclipse]

As a surgical nurse, I'd say it depends on how many years you've got under your belt. Some of the fresh residents running the show overnight....ehh...

[@josephdahdouh2725]

@@starkeclipse ughh. As a premed hoping to become a surgeon someday, I hope I get down with good quality care earlier than those residents.

[@starkeclipse]

@@josephdahdouh2725 You've got this! Keep your ears open to what your nurses say. We often catch a lot of the errors that slip thru. 🙂

[@ashleyfai8386]

HAHAHAHAHAHAHAHAHAHA THIS WAS SOO ON POINT. Cracked me up!

[@TeaWithTheAuthor]

LMAO then there’s the one nurse with a report that sounds like the first when I’m like, there’s nothing going on because the medicine team already nailed it.

[@doc_anke]

I so recognize myself as the surgeon. That could so - word by word - have been my presentation...😂😂😂

[@communicationbreakdown256]

Cortisol deficiency , so glad to hear he will be checking the hormones. I have Cortisol deficiency and therefore I am on Cortisol dependent meds. Also, it is very dangerous to be Cortisol dependent.

[@Whyinem]

Greatness

[@kimeverhart6253]

Wow!

[@annmarieday6371]

Brilliant as always 😂