Preparation for (Trauma) Elective-Minority Recommendation

[KMATTOX at aol.com]

Dr. Nicolson:   
 
I have a somewhat different recommendation.   You can even  consider this a 
minority report.   
 
1.    I would read the textbook and source material  recommended to you by 
the staff at the site of your trauma elective WHILE you  are there.   Prior to 
your going, I would review non-surgical texts  and articles as they pertain to:
 
    Cardiology, Renal Failure, ARDS, Rehabilitation and  physical medicine, 
Quality management, Nosocomial infections, infection control,  EMS, Anesthesia, 
Pain Management.     I would read about  equipoise, ethics, risk/benefit 
ratios, end of life issues, futility, and how to  talk to people about complex 
futility problems.      
 
2.    Have a base of information on the medicine and  non-surgical 
disciplines regarding their views of disease diagnosis and  treatment.    Then build on 
this base from your experience and  readings DURING the rotation.   
 
3.    On ANY elective rotation, read the BIG HARD BACK  book on the subject 
of that rotation, be it Pediatrics, OB/Gyn, Psychiatry,  or Molecular Genetics. 
  You will never again force yourself to read  the big hard back book on a 
discipline other than the one you eventually choose,  after you leave the 
elective.  Seize this opportunity to master their  subjects and fully understand 
that discipline's approach to problem  solving.   
 
4.    Understand that there are often two, three, or  even many appropriate 
ways to solve the same problem.  There is almost  NEVER a single practice 
guideline or best practice approach to any alteration in  a biologic system (in 
medicine that is called a disease).   Engineers,  politicians, economists, and 
lawyers tend to see the world in black and  white, pluses and minuses, and 
binary monotony.  Physicians recognize that  there is a bell shaped curve of 
variable treatments and responses.   
 
5.    Surgeons must also recognize that other  disciplines have a library of 
approaches for the problems seen by the  surgeon.   .   
 
k    



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