Mr Moore’s tips for PRH Surgical CTs

Mr Moore’s tips on how to get the most out of your PRH CT surgical attachment

There is a wonderful amount of surgical experience that you can gain at the Princess Royal Hospital in Haywards Heath but you do need to be pro-active about getting it.

There is an all day general surgery operating list every Monday, Tuesday, Wednesday and Thursday of the week.

You should go to Ansty ward every day at 8.00am.

If the consultant is already on the ward then you should join them and go round with them seeing the pre-op patients.  The most important reason for this is that you will identify any patients who may have difficult medical management issues that you will have to deal with post-operatively.

You should try to complete the consent form on each patient except for the surgeon’s signature.  This will force you to think about the important surgical consent details.  There are ‘4 givens’ for a surgical consent form!  In the important complications and risks section you can always write: 1. Bleeding, 2. Infection, 3. Re-operation and 4. Thrombo-embolic disease.  By the end of your post you should be quite confident to complete the consent form for laparoscopic cholecystectomy, laparoscopic hernia repair, open hernia repair and haemorrhoidectomy even though you should not sign the form yourself until you are able to complete the surgical operation.

If the consultant is not present on Ansty ward straight away then spend your time making sure that any anal operation patients are prescribed a phosphate enema.  This ensures that the operating field is as clean as possible for the surgeon and it also means that the patient does not have to have a painful defaecation following their surgery until usually at least the day after their operation.

Also ensure that there is a printout of the ultrasound scan and the latest Liver Function Tests on the front of the notes for any laparoscopic cholecystectomy patient.

Make sure that you ask about anything that you do not understand on the consent ward round.

After the consent ward round you should go to see any surgical in-patients.  Make sure that you go and talk to the surgical registrar as soon as possible if you identify a problem.

After seeing the in-patients and dealing with jobs you can come to theatres.  Get scrubbed up and get involved!  Make sure that you tell the operating surgeon if you are keen to learn suturing or operating skills.  Make sure that you tell the anaesthetist if you are keen on learing more about anaesthesia.  Please note that this requires you to get in to theatre clothes and to come to theatres.  If you do not do this then it is impossible for the consultants to give you training while they are in theatre.

Mr Moore is departmental audit lead and you should make sure that you let him know if you want to complete an audit project.

If another specialty such as medicine refers you a patient for a surgical opinion you should make sure that you first go and see the patient and you read the hospital notes yourself.  You should formulate your own opinion about any further medical or surgical management no matter how junior or inexperienced you may feel.  You should then find the surgical registrar and discuss the case with them and see if they agree with your opinion.  If you cannot find the surgical registrar then you should talk to the surgical consultant.  If you cannot find the surgical consultant then you should bleep the on-call surgical registrar at RSCH.  If you cannot get hold of the on-call surgical registrar then you should contact the on-call surgical consultant.  If you cannot get hold of the on-call consultant then you should phone theatres to see if they are scrubbed up conducting an emergency operation.  If they are then you can get a message to them.

The PRH CTs are the eyes and ears of the team.  Do not rest if you find that a post-operative surgical patient is not going to plan.  If there is a problem with a post-operative PRH surgical patient then you must contact a surgical registrar or consultant as soon as possible and document the details and the outcome of your discussion in the patient’s hospital notes.  Rarely patients develop post-operative complications and it is very important that these patients are identified as soon as possible and transferred to RSCH if necessary in a timely fashion.  Most post-operative problems are much easier to deal with sooner rather later.  If in doubt ask and clearly document any conversations or medical management decisions.  If the surgeons are scrubbed up in PRH theatres then please get changed in to theatre clothes and go and talk to them in theatres.  Do not wait till they finish their operation or till they come out of theatres.  You are a member of the surgical team and you should be happy to join the rest of the team in theatre.

So best wishes for an enjoyable PRH surgical CT attachment and please get involved and be pro-active.  You are very welcome.