Monday, October 19, 2009

Garbage In, Garbage Out

Sometimes when I go down to get specimens from the ORs for frozen sections, I feel like there is a huge disconnect between us and the surgeons regarding how we do our job. I guess it must seem that we appear, pick up the piece of tissue, disappear for awhile, and come back later with the results. It's magic: tissue in, diagnosis out.

Let me tell you, it is not quite that easy. And to make the magic work there are a few things that can help the spell along. Unfortunately, we sometimes do not have much help in this regard. Here are just a few examples.

1. Adequate specimens. Okay, you gave me a huge container with a piece of Telfa in it that I race back up to the gross toom. Is there anything here? Maybe if I hold the Telfa up to the light... oh, wait, there is a tiny fragment of soft tissue that is maybe 0.2 cm? On a good day? Hmmm... now you are angry because because we need to "defer to permanent" to really call what it is? Let's think about this for a minute...

2. Bovie-licious. In the same vein... I return to the gross room with another container and open it. What is that smell? Is that a new BBQ dish in the cafeteria? Or the smell of the fast food from across the street? Wait... that is wafting off of the specimen. Singed flesh smell. The specimen is charred, black ball. Guess what we see under the scope? Bovie artifact! And maybe not much else.

3. Clinical history. Believe it or not, we do play a role in the patient's care. Yes, the patient's care. We're not just looking at tissue in a vacuum. It helps to have some clue of why we are even looking. That box on the specimen requisition sheet about clinical history? Just one legible sentence with the patient's presumed diagnosis or presentation and the surgery they are undergoing can be a big help. Oh, and when I ask for history in the OR, speaking clearly and not being rude is really helpful too.

4. Orientation. I am not a mind reader. And, unfortunately, I was not there when you pulled that tissue margin out of Mrs. Jones' pelvis. So there is really no way for me to know which side of the specimen is anterior. Putting in a suture to orient the specimen and telling us what it is can go a long way. Oh, and about those sutures, please just keep it simple. If I see a rainbow of different lengths of various suture material sticking out of the tissue from every possible angle, it's just a hot mess.

4 comments:

brocasarea said...

thts the reason i always make it a point to write clin history proeprly while sending any specimen to lab...

Resident Anesthesiologist Guy (RAG) said...

I get to see this interaction a lot. I've seen surgeons be quite nice, but more often than not they're rude and malicious. One surgeon went off on the path resident for asking about the patient - stating if she was interested then she should have gone into a patient-oriented field and could look her info up on the chart in the computer. The path resident didn't know what to say, but the quick response declined considerably in that room the rest of the day. I think surgeons and the OR staff (sometimes) are arrogant assholes. At least in my main OR area they are.

The Lone Coyote said...

Re: quick response time... my mother always said you get more bees with honey than vinegar.

broca--thank you, it is helpful.

Dragonfly said...

Bovied specimens. Hilarious. But also not.
I just finished surgery and my registrar kept telling me not to write any clinical information on the path forms so they could be sent out already. (Except that I always did them while the surgeon was dictating his notes or during the case if I was not assisting so it didn't make any difference). I have been trained by every other specialty and friends who work in path to always write the details (and the GP name so they can be sent the findings as well).