Dr. Santell's Rounds: Don't Be Common

During an intern year rotation in Surgery I saw a patient with a large abdominal wall abscess. My progress note looked something like this:

S: Pt reports moderate pain at the site of the abscess. Pain is under better control with PO Vicodin and morphine IV prior to dressing changes.

O: Tmax 100.2, Tnow 98.8 BP 144/88 HR 86 RR 14 SaO2 99% on RA
BGs: 99-262
Gen: Alert, NAD
Cor: RRR S1S2 No M/R/G
Chest: CTAB
Abd: Soft, nondistended with moderate tenderness around I&D site. NABS
Wound: 12cm in length, maximum depth is 4cm, granulating well, some tan-colored necrotic areas at the angles
Labs: None today

A: 46 obese diabetic man with abdominal wall abcess. POD #3 after I&D. Wound healing well with routine wet to dry dressing. Blood glucose only in moderate control.

P: Continue current antibiotics and daily dressing changes. Add basal insulin and increase sliding scale coverage.

It was a busy day and I moved on to the other patients on the service. At the time, such a post-op note was considered a literary masterpiece. A lot of the interns were falling into the habit of writing 3-line post-op notes, in imitation of their attending physicians.

I didn't know Dr. Santell made a habit of reading the charts of all the patients on Med-Surg, whether the patient was on his service or not. He had a particularly curious mind and I think he took a proprietary pride in the care patients received on "his" hospital unit. He also liked to keep an eye on the work the residents were doing and give us feedback, whether he was our attending of record or not.

The next morning, I entered the charting room at 6:15am. Dr. Santell was already seated at one of the tables and reading charts. He looked up at me sternly.

"Theresa, how do you spell abscess?" he asked me, bypassing all greeting and small talk.

This is not the kind of question a drowsy intern answers with confidence. "Um," I said. "A-B-C-E-S-S?"

He shook his head emphatically. "A-B-S-C-E-S-S," he corrected  "It's a common mistake, but I don't want you to be common."

This was a theme in Dr. Santell's teaching style. He wanted you to be good at your job, not merely competent, and he didn't want you to pick up bad habits, even small ones, because small mistakes underlie big ones, and those were the ones you had to avoid at all costs.

Dr. Santell corrected my spelling on a number of occasions. Tip for students and residents: ophthalmology is spelled with two Hs, not one. So is diphtheroids. Don't even get me started about diphtheroids.

Comments

[Mayhem]

"i wonder how well those comments would be received by today's students/residents?"

Poorly. One of our ophthalmologists asked a group of us how to spell ophthalmology. Everybody got it wrong (she skipped me because she saw when I glanced down at the embroidery on her white coat) and she told us off. They mocked her for the rest of the day but I felt stupid, given I had spent the last month reading a textbook named ophthalmology.

[MWAS]

I'm so glad I can say diphtheroids better than I can spell it. You inspire me to not be common!

[anonymous]

i wonder how well those comments would be received by today's students/residents?

[purplesque]

Great post. I greatly admire teachers who do not restrict the range of their teaching, and to do that without embarrassing your student is an art.

[Peggikaye]

and you get on to me for over thinking!