Latest news with #otolaryngology
Medscape
4 days ago
- Health
- Medscape
When Junior Residents Challenge Chief Attendings
Life as a medical student is far from easy. Every day, you grapple with a vast course load, erratic shifts during clinical rotations, stress, anxiety, and burnout. Yet, once you've reached the summit of that academic journey and are conferred with your medical degree, you start your residency, shiny new objects surrounded by much more experienced people. As a young resident or medical student, the mere idea of disagreeing with an attending physician in a position of power may raise hairs. After all, junior residents and students often look up to attendings, seeing them as versatile healers who can seemingly fix any ailment as they attend to the wards they lead. As a third-year medical student on call late at night, Suresh Mohan, MD, found himself in disagreement with a senior physician — the chief resident — over the treatment of a patient, which then escalated into an acute emergency. 'I quickly realized [about this senior physician] 'I think you're letting your ego get in the way of doing the right thing for the patient.' That was the first time I disagreed with the way that I watched this person manage something…I realized it was a very human emotion that got in the way of them doing the right thing,' said Mohan. Bleeding Trachea, Bold Dissent Mohan is now an otolaryngologist and surgeon at Yale Medicine, New Haven, Connecticut, with a specialty in reconstructive and cosmetic surgery for the face, head, and neck. But the experience he had as a third-year student still resonates with him. With few people around to help, Mohan found himself relatively alone. 'Sometimes, you're the only trainee in the hospital…the only doctor in the hospital that's responsible for all the patients that need ENT [ear, nose, and throat] care,' he said. While on call late that night, Mohan and his chief resident were called in on a consult for a patient's bleeding trachea after the patient had undergone a tracheotomy earlier that morning. During a tracheotomy, a surgical opening is made in the neck and a tube is inserted directly into the trachea. It is usually performed by an otolaryngologist. Bleeding from tracheotomies can range from minor oozing due to irritation or suction trauma to life-threatening hemorrhages if a major vessel is involved. Upon seeing the patient, the chief resident said there was nothing to worry about and they will continue to monitor the patient. An hour later, Mohan was called again, but his chief maintained that everything was fine. 'Of course, in the back of my head, I'm wondering if it's bleeding more,' said Mohan. Within the next few minutes, they were called two more times to see the patient, and yet his chief was adamant that no further action needed to be taken at that time. 'Eventually a code was called…we were rushing over there…and it turns out the trach was not fully in the airway,' Mohan said. 'The patient was having trouble breathing and causing more to happen from that…it escalated quickly into a much more acute emergent situation.' Mohan and the team started yelling for instruments, trying to get the trach tube back in place in the patient's trachea. Fortunately, they were able to secure the airway. One of Mohan's biggest takeaways from the experience: 'It doesn't matter if they call you three times, you still need to do the right thing.' Post-Bariatric Bleeding Incident As a third-year general surgery resident, Joshua Rarick, MD, found himself on call and alone at Covenant Hospital in Saginaw, Michigan. In the late evening during a 24-hour shift, a patient's vitals began to drop following a Roux-en-Y gastric bypass. Rarick had not personally performed the initial surgery, but as the resident on call, he had to respond to nurses messaging him with concerns about the patient's blood pressure dropping. 'To me, it looked like the patient was probably bleeding, so I had called the attending to update them,' he said. Rarick tried to temporize the bleeding, but his attending didn't agree. After a few hours of fluids, during which the patient would transiently respond, eventually the patient's vitals and pressure came back down because she was still bleeding. '[My attending] disagreed with my plan to go back to the OR [operating room], but eventually we had to go back to the OR because there was a bleeder that we needed to clip,' Rarick said. Rarick is now a fourth-year general surgery resident. He said these types of interactions aren't uncommon, and not all disagreements end with tempers flaring. 'Sometimes, attendings disagree with you, and they say, 'No, let's do this instead,' which is normal,' Rarick said. 'But that was one of the first times that there was an actual disagreement with what I thought the plan should be.' Advocating for Optimal Patient Care As a medical student or junior resident, if you truly feel a patient's case isn't being properly handled, don't be afraid to speak up in a conciliatory manner. 'There are many situations where seasoned attendings are so specialized, their knowledge in other areas of the field might be lacking or just not up to date,' said Mohan. 'So especially as residents who are on top of all the latest info, you have an opportunity to educate, but doing so in a way that's palatable is really important.' But what if an attending disagrees with a junior resident's or student's concerns, and the latter still feels strongly about the mishandling of a patient's case? In extreme cases where all other resources are exhausted, you'd want to contact a hospital ombudsman, clerkship director, site director, or even faculty mentor, said Mohan. 'If there's something egregious happening, and the resident or student doesn't feel comfortable approaching in a direct format, ombuds people are able to report a concern,' he said. Mohan listed an order of resources to consult before this, however. 'First, look it up to understand if your question is reasonable. Two, talk to a resident to try to get some more knowledge. Then, if you're still not feeling comfortable, and gently assuming that the attending is not receptive, I think finding other faculty mentors is probably the next place to go. And if you're really feeling lost, then contact an ombudsperson.'
CNA
24-05-2025
- Health
- CNA
Your hearing can get worse as you age – here's how to protect it
For most people, your hearing gradually deteriorates with age, and about half of the time it's caused by genetics that are out of your control. But years of regularly attending room-rumbling concerts, for instance, can exacerbate hearing loss, and you might find yourself straining to hear movies or struggling to follow group conversations. 'When we're young, we think nothing can ever threaten us,' said Dr Howard W Francis, a professor of otolaryngology at the Duke University School of Medicine. But 55 per cent of US adults have disabling hearing loss when they're 75 and older. And if hearing loss goes untreated, it can raise your risk of developing conditions like dementia and depression. Fortunately, there are steps you can take to protect your ears. Here's what experts suggest you do – and what you should avoid. DO: BE MINDFUL OF LOUD SOUNDS Other than ageing, exposure to loud noises is the most common cause of hearing loss. And the longer you're exposed, the more likely it is that your hearing will be damaged, said Dr Dunia Abdul-Aziz, a board-certified otolaryngologist at Harvard Medical School. Hearing an extremely loud sound, such as an explosion, even once can cause permanent hearing damage. But hearing loss is more often the result of 'cumulative exposure that you'll notice later on in life,' Dr Abdul-Aziz added. Concerts are an obvious culprit, but you can also lose hearing after years of watching fireworks, operating loud machinery, attending music-blasting exercise classes or using your headphones at full volume. Repeated exposure to sounds around 85 decibels (like the sound of a power tool) can potentially damage your hearing, according to the O ccupational Safety and Health Administration. Loud sounds can damage the tiny hair cells in the inner ear that translate sound into electrical signals the brain can understand. Once those hairs are damaged, they won't grow back, experts said. It can be difficult to tell whether your environment is noisy enough to cause damage, but there are signs to watch for: If you need to shout to speak to someone a few feet away, your hearing is probably at risk, according to OSHA. Many smartphones and watches can also alert you if your surroundings reach potentially harmful volumes, said Patricia Gaffney, president of the American Academy of Audiology. The same goes for the volume of music in your headphones. If noisy environments contribute to the ambience of a space, you don't necessarily need to avoid them altogether. Instead, wear earplugs, Dr Abdul-Aziz said. 'It's the best thing you can do' to protect yourself, said Dr Nandini Govil, a paediatric otolaryngologist at Children's Healthcare of Atlanta and Emory University. DON'T: USE COTTON BUDS You may be tempted to use cotton buds to scratch an itch or remove earwax. But resist the urge. Skin cells in the ear are 'almost like a conveyor belt,' Dr Francis said; when new skin cells grow, dead cells migrate outward and carry earwax with them, he said. So cleaning your ears yourself usually isn't necessary, and using a cotton swab comes with risks. These small wads of cotton can push wax into the ear and cause buildup, Dr Francis said. If a swab goes too far into your ear, it can puncture the eardrum and cause hearing loss, Dr Govil said. And in rare cases, the force from pushing the swab inside your ear can dislocate the tiny bones behind the eardrum that help transmit sound through the ear, Dr Abdul-Aziz said. Pieces of cotton can also get stuck inside the ear and obstruct hearing, Dr Govil added. If you still want to clean your ears, consider rubbing a warm washcloth along the outside without entering your ear canal, said Dr Frank Lin, a professor of otolaryngology at Johns Hopkins University. If you have buildup in your canal and don't have other ear problems, you can purchase over-the-counter earwax softener drops and flush the ear with warm water using a rubber bulb syringe, Dr Francis added. DO: TEST YOUR HEARING Just as you might get your blood pressure checked annually, consider testing your hearing at home or with a doctor regularly, too, Dr Lin said. It's easy to feel blase about your hearing when it's a 'black box' you don't know anything about, he explained. But hearing tests give you a score. And when you crystallise your hearing into a number, 'it's very truth-telling,' he said. 'Numbers don't lie.' The World Health Organization recommends adults ages 50 and older test every five years until they turn 64. Then, testing can increase to every one to three years. DON'T: BRUSH OFF HEARING CHANGES If you experience sudden hearing loss in one or both ears, treat it as a medical emergency and visit an otolaryngologist or audiologist within 72 hours, Dr Gaffney said. Sudden hearing loss is often treated by administering 'a bunch of steroids,' she explained, but the longer you wait, the less effective they'll be. 'Some people think when they have a sudden hearing loss, 'Oh, I'll just wait it out and see if it gets better,'' Dr Gaffney said. But 'you're under a time clock.'
