In answer to J.Kb. Why do doctors do rotations?

My family has doctors, nurses, EMTs and other medical professionals in it. I am well aware of the process of medical internships and rotations. I was going to write something about it but then DiveMedic did a much better job.

B.L.U.F.

Unlike engineers, doctors are expected to make diagnosis and medical decisions that require them to have good working knowledge of the human system right now. Engineers can wait till the morning to ask an expert in a different field.

JKB over at gunfreezone asks why medical training requires doctors to do rotations in specialties that are not their own, pointing out that engineers in one field don’t have to also do internships at a civil engineering firm, a mechanical engineering firm, a structural engineering firm, and a chemical engineering firm. He states that it looks like a complete waste of the student’s time. The reason that medicine does that is actually pretty simple, so let me give a simple explanation.

It isn’t likely that a mechanical engineer will do something that will have a direct effect on a chemical engineer’s job. That chemical engineer isn’t likely going to have an issue with avoiding the problems that a structural engineer is having. Imagine if a mechanical engineer tightened a screw a quarter turn, and this caused the hydraulic fluid to become acidic and then the building collapsed. Not so in medicine. Sure, people in medicine tend to specialize, but the human body is a complex system, and changes to one system have profound effects on the others.

Let’s say that I am in cardiology and I have a heart failure patient who is in fluid overload. There are a number of drugs that one could choose from to get rid of those fluids. I could try furosemide, or perhaps bumetanide. Perhaps torsemide, or even hydrochlorothiazide. Any of those medications would likely solve your patient’s issues, but which one of these is going to be detrimental to the patient’s kidneys? Do I want to choose a potassium sparing or a potassium wasting diuretic? How will that react with the patient’s preexisting autoimmune dysfunction? I could consult a nephrologist, an endocrinologist, and an immunologist, but doctors largely don’t stand around most of the time having huge arguments. That only happens on TV shows, not because there are no egos involved, because there are. Medical people are just too pressed for time to keep doing that, so wouldn’t it be easier if I already knew?

So for that reason, most in medicine learns a little about every system and specialty before going on to gain a deep understanding of their specialty. Nurses, doctors, PAs, NPs, all of them.

The first comment on that post complains about sterile fields and how they are “superstition.” Sterile fields are there to prevent post procedure infections. You can’t see infectious agents. Perhaps you didn’t touch anything. Or maybe you bumped into something that was covered in S. aureus and didn’t notice. How do you know? Can you be sure? If you are wrong, you will know in couple of days when your patient goes septic. You can’t bet a patient’s life on “the ten second rule.” Certain behaviors are high risk, so procedures get written in to the process to reduce or eliminate those higher risk behaviors. That includes treating everything that “breaks field” as though it was covered in an infectious agent- because it might be, and there is no way to know for sure. So you toss the offending object aside, and use one that you KNOW is sterile.

As an example, the most common cause of hospital caused infections is a CAUTI (Catheter Associated Urinary Tract Infection). It’s caused by a catheter introducing a pathogen into the urinary tract. That can affect the kidneys. It can cause Acute Kidney Injury. In some cases, that can cause Chronic Kidney Disease and ultimately kidney failure, or it can cause septicemia (a blood infection), which leads to death. Because of this, there are procedures that need to be followed when inserting, caring for, and ordering indwelling catheters. Can you violate that procedure and get away with it? Sure. A few times. Maybe only once. But one thing is sure, you will eventually wind up with a septic patient. So the procedure is there to prevent that.