Are the stereotypes true? Doctor Rich reacts to Dr. Glaucomflecken’s “Easy Going Surgeon”
Why are you handing me this? [Doctor Rich and Iliana laugh] Yeah… I wanted it five minutes ago. It’s useless to me now. Throw it away.
Doctor Rich:
Welcome back to the Doctor Rich channel! We’re back in the studio to do another “Doctor Rich reacts to Dr. Glaucomflecken.” Today, we have nurse practitioner student Iliana Ye.
Iliana:
Hi, thank you for having me!
Doctor Rich:
And we’re gonna watch and react to OR videos by Dr. Glaucomflecken (aka Dr. Will Flannery). Iliana — has anybody ever told you that they keep the operating room very cold to minimize infections?
Iliana:
I’ve heard that…
Doctor Rich:
Is that true? [Iliana looks at the camera and shrugs knowingly] Stick around to the end to find out!
[Video of Dr. Glaucomflecken’s “Easy Going Surgeon” skit, with Dr. Glaucomflecken playing all parts]
Kind Nurse:
Good morning, doctor. We have a new med student working with us today.
Newbie:
Hi, I’m excited to be here.
Kind Nurse:
We’re happy to have you! [To the surgeon] Please be nice!
“Easy Going” Surgeon [rolling his eyes]:
Of course I’ll be nice! Look, don’t let them scare you — I’m not like the other surgeons, alright? I’m really easy going.
Iliana:
I’ve heard that one lots of times…
Doctor Rich:
So I think this is a great video because there are certain personalities that are attracted to surgery, general surgery, and sub-specialties of surgery that are… uh… very — how should we say — aggressive? Maybe they can be demanding? They want what they want — and they want it ten minutes ago! There’s a process of education where you train medical students. Well, not all medical students end up going into surgery — so you might get timid students that are just a bad match. So what Iliana, what’s your experience with surgeons — or your perception based on your rotations in nursing school?
Iliana [laughing]:
Intimidating! Intimidating to go into the OR, and pressure not to mess up or make any mistakes.
Doctor Rich:
Yeah. Okay. Let’s see. [continues with the video]
“Easy Going” Surgeon [sternly and impatiently]:
What’s the blood pressure doing? Okay — make it better, please! Can we check the blood pressure, please?! The patient’s moving. Why is the patient moving? Look — I only get paid to do my job. Don’t expect me to do yours too!
Doctor Rich [laughing] :
So you tell Anesthesia… You know, they induce anesthesia, the patient goes to sleep, [sarcastically] and at no time should they move or breathe or have any kind of movement at all… It’s not as if (again), there’s just an anesthesia button! (I think he’s done a video on that where you flip the switch and anesthesia comes on and switches it, and the patient wakes up!)
I mean — it’s a complex, constant process of monitoring the patient’s vital signs. And (particularly if they have morbidities) it can be very challenging not to let their blood pressure go too high or too low. Every patient metabolizes medications at a different rate. But certainly there ARE times when maybe things aren’t being followed as closely and the patient does start to move when they shouldn’t. And you know, we’ll say, “Why are you checking stock prices?! You should be managing the patient!” So this is kind of a look at that interaction and kind of the flaws in thinking on both sides.
“Easy Going” Surgeon:
Bed up! Bed down! Put the bed exactly where I want it, please. Reverse Trendelenberg! [shaking his head] That’s regular Trendelenburg — I need reverse Trendelenberg! Dr. Trendelenberg is rolling over in his grave right now. It’s way too hot in here…
Iliana [throwing up her hands in mock exasperation]:
How do I know where you want the bed?
Doctor Rich:
We have a great video on the “battle” that goes on over Trendelenberg — or the head down position. But the bed positions up and down… Again, as if the surgeon is this high and mighty individual who thinks of the anesthesiologist as someone that just kind of raises and lowers the bed (and that’s their role in the OR) that we’re making fun of. Perhaps some people kind of feel that way. But obviously, this is a collaborative team effort with anesthesiologist, nursing, scrub techs, housekeeping… everybody! We all are there for the patients to give them the best outcome.
“Easy Going” Surgeon:
Turn the temp down, please. It’s not as low as it can go — make it colder. Well, then call HVAC and tell THEM to make it colder. [complaining] I’ll tell you where the money went — right into hospital administrators’ pockets!
Doctor Rich:
There’s like so much stuff here!
Iliana:
Right!
Doctor Rich:
So I don’t know — do you find that it’s really cold in the OR?
Iliana:
Very!
Doctor Rich:
Yeah… So historically, they’ve always said that this lowers the infection rate, right? In fact, that’s a total myth. Lowering the temperature has nothing to do with patient safety. Doctors are under layers of gowns, and masks, and hats — and we’re being cooked under the OR lights. It’s very hot, and the room is cool for one reason: the doctor or the surgeon! But I don’t know — if someone’s operating on me, I want them to be comfortable! How do the nurses feel about that?
Iliana [laughing]:
The nurses don’t like that. We’re the only ones with a blanket around our waists — shivering there!
Doctor Rich [laughing]:
All surgeons should just be robotic surgeons — and then they don’t have to be under the lights, and they don’t have to cozy up to the table and wear all these layers!
So the fact of the matter is that keeping the room cold does not prevent infections. In fact, your immune system doesn’t function as well in colder temperatures as it does in your normal body temperature range. There’s now an entire field of study called ERAS (or enhanced recovery after surgery) that looks at maintaining the patient’s normal physiology. That’s temperature regulation and fluid balance throughout the entire surgery — before surgery, during surgery, and after surgery. There’s entire companies whose sole purpose is to create warmers to keep the patient warm in the operating room. So the fact of the matter is you want your normal body temperature, and we have warming devices and blankets that can compensate for the cold temperature for the operators (not just the surgeon, the assistant, and the scrubs) that are right there layered up — and get hot during the surgery.
“Easy Going” Surgeon:
Hey, where’s the music? Let’s get some music playing. Oh, turn it up — I love this song. Music’s way too loud — I can’t hear myself think! Okay… I’ll uh… I’ll take that instrument I like. I don’t know — just hand it to me, please! [complaining] Yeah, and they just keep hiring more administrators… Why are you handing me this?! Yeah, I wanted it five minutes ago. It’s useless to me now. Throw it away!
Doctor Rich:
Give me what I want — not what I ask for! [sarcastically] That NEVER happens! [sheepishly] Yeah… So I’ve, I’ve definitely had where I’ve been frustrated — something wasn’t there exactly when I wanted it — and I sent somebody to Albuquerque to get it… and then they get back and I’m like, “Yeah, I don’t want that. That’s useless — throw it away.”
Cameraman [offscreen]:
Oh my gosh…
Doctor Rich [laughing]:
That’s the OLD Doctor Rich. The NEW Doctor Rich would NEVER do that.
“Easy Going” Surgeon:
Why isn’t my equipment working? Why isn’t this working? Okay — find someone to EXPLAIN to me why this isn’t working. Listen, I CARE about social issues — you’ll understand when you start paying taxes. Who are you? [to someone offscreen, apparently answering his question about why something doesn’t work] Why what doesn’t work? I don’t even care — I don’t even care!
Doctor Rich:
And again — I’m trying to look at that from both sides. So as the surgeon, you’re in the case, you’re dissecting around vital structures (organs, blood vessels) and if you don’t have your full attention — you’ve LITERALLY got someone’s life in your hands! So it can be frustrating when you have equipment that doesn’t work! I mean, it’s supposed to work — and if it doesn’t work for a silly reason (like it wasn’t switched on!), there *could* be some frustration there! But then it’s like, “I don’t know why it’s not working, find somebody!” — and then they come twenty minutes later and the surgeon’s like, “I don’t care.”
Iliana [laughing]:
It doesn’t matter!
Doctor Rich [sarcastically making a “shooing” motion with his hand]:
Be gone. I’m done with you.
“Easy Going” Surgeon:
Hey, why are the drapes like this? No, the drapes were better last time. What do you mean they’re different drapes. Why… Why are we using different drapes? [angrily] Is it the hospital administrators? Did the administrators get to…
Doctor Rich:
So this is as if he made this video for me. So we have a robotic drape we use every time. And then supply chain issues happen (when things are back-ordered) — and it’s like, “I think the surgeon’s back-ordered, just gimme what I want!” So we have the new drape — that’s NOT the robotic drape — and you’re quick to go in your mind to, “Ugh, it’s the administrators trying to save two cents and giving me a bad drape!” Which again, there is some truth in that — but there needs to be balance like we talked about earlier.
“Easy Going” Surgeon:
Anesthesia? Hey, Anesthesia! Oh, Ane-STHE-sia… [tauntingly] I drove the BMW in today…
Doctor Rich:
All right. So — as I’ve grown wiser, you know, this is a collaborative effort. Everybody deserves your respect. Anesthesia has a NAME! You’ve got to learn Anesthesia’s name — as you should for all the scrub techs, and the nurses and, and everybody! And you know — I’ve had to learn over time. Because as I said, you kind of learn to act and be a certain way in training, and then you get out and you have a life journey and you learn that collaboration’s always better.
“Easy Going” Surgeon:
Something’s wrong with the Porsche. I dunno — I gotta take it in.
Doctor Rich [joking]:
That’s why you go to nurse practitioner school… You want the Porsche!
Iliana [sarcastically]:
Right…
Doctor Rich [to Iliana, laughing]:
Making the big bucks!
Iliana:
Someday…
Doctor Rich:
So… I don’t usually talk about cars in the OR. How do you feel about doctors bragging about their stuff?
Iliana [noncommittally]:
You know, I don’t really hear anything about CARS necessarily, but… Um… You know…
Are the stereotypes true? Doctor Rich reacts to Dr. Glaucomflecken’s “Easy Going Surgeon”
Why are you handing me this? [Doctor Rich and Iliana laugh] Yeah… I wanted it five minutes ago. It’s useless to me now. Throw it away.
Doctor Rich:
Welcome back to the Doctor Rich channel! We’re back in the studio to do another “Doctor Rich reacts to Dr. Glaucomflecken.” Today, we have nurse practitioner student Iliana Ye.
Iliana:
Hi, thank you for having me!
Doctor Rich:
And we’re gonna watch and react to OR videos by Dr. Glaucomflecken (aka Dr. Will Flannery). Iliana — has anybody ever told you that they keep the operating room very cold to minimize infections?
Iliana:
I’ve heard that…
Doctor Rich:
Is that true? [Iliana looks at the camera and shrugs knowingly] Stick around to the end to find out!
Don’t have time to read this post? Watch the video here instead!
[Video of Dr. Glaucomflecken’s “Easy Going Surgeon” skit, with Dr. Glaucomflecken playing all parts]
Kind Nurse:
Good morning, doctor. We have a new med student working with us today.
Newbie:
Hi, I’m excited to be here.
Kind Nurse:
We’re happy to have you! [To the surgeon] Please be nice!
“Easy Going” Surgeon [rolling his eyes]:
Of course I’ll be nice! Look, don’t let them scare you — I’m not like the other surgeons, alright? I’m really easy going.
Iliana:
I’ve heard that one lots of times…
Doctor Rich:
So I think this is a great video because there are certain personalities that are attracted to surgery, general surgery, and sub-specialties of surgery that are… uh… very — how should we say — aggressive? Maybe they can be demanding? They want what they want — and they want it ten minutes ago! There’s a process of education where you train medical students. Well, not all medical students end up going into surgery — so you might get timid students that are just a bad match. So what Iliana, what’s your experience with surgeons — or your perception based on your rotations in nursing school?
Iliana [laughing]:
Intimidating! Intimidating to go into the OR, and pressure not to mess up or make any mistakes.
Doctor Rich:
Yeah. Okay. Let’s see. [continues with the video]
“Easy Going” Surgeon [sternly and impatiently]:
What’s the blood pressure doing? Okay — make it better, please! Can we check the blood pressure, please?! The patient’s moving. Why is the patient moving? Look — I only get paid to do my job. Don’t expect me to do yours too!
Doctor Rich [laughing] :
So you tell Anesthesia… You know, they induce anesthesia, the patient goes to sleep, [sarcastically] and at no time should they move or breathe or have any kind of movement at all… It’s not as if (again), there’s just an anesthesia button! (I think he’s done a video on that where you flip the switch and anesthesia comes on and switches it, and the patient wakes up!)
I mean — it’s a complex, constant process of monitoring the patient’s vital signs. And (particularly if they have morbidities) it can be very challenging not to let their blood pressure go too high or too low. Every patient metabolizes medications at a different rate. But certainly there ARE times when maybe things aren’t being followed as closely and the patient does start to move when they shouldn’t. And you know, we’ll say, “Why are you checking stock prices?! You should be managing the patient!” So this is kind of a look at that interaction and kind of the flaws in thinking on both sides.
“Easy Going” Surgeon:
Bed up! Bed down! Put the bed exactly where I want it, please. Reverse Trendelenberg! [shaking his head] That’s regular Trendelenburg — I need reverse Trendelenberg! Dr. Trendelenberg is rolling over in his grave right now. It’s way too hot in here…
Iliana [throwing up her hands in mock exasperation]:
How do I know where you want the bed?
Doctor Rich:
We have a great video on the “battle” that goes on over Trendelenberg — or the head down position. But the bed positions up and down… Again, as if the surgeon is this high and mighty individual who thinks of the anesthesiologist as someone that just kind of raises and lowers the bed (and that’s their role in the OR) that we’re making fun of. Perhaps some people kind of feel that way. But obviously, this is a collaborative team effort with anesthesiologist, nursing, scrub techs, housekeeping… everybody! We all are there for the patients to give them the best outcome.
“Easy Going” Surgeon:
Turn the temp down, please. It’s not as low as it can go — make it colder. Well, then call HVAC and tell THEM to make it colder. [complaining] I’ll tell you where the money went — right into hospital administrators’ pockets!
Doctor Rich:
There’s like so much stuff here!
Iliana:
Right!
Doctor Rich:
So I don’t know — do you find that it’s really cold in the OR?
Iliana:
Very!
Doctor Rich:
Yeah… So historically, they’ve always said that this lowers the infection rate, right? In fact, that’s a total myth. Lowering the temperature has nothing to do with patient safety. Doctors are under layers of gowns, and masks, and hats — and we’re being cooked under the OR lights. It’s very hot, and the room is cool for one reason: the doctor or the surgeon! But I don’t know — if someone’s operating on me, I want them to be comfortable! How do the nurses feel about that?
Iliana [laughing]:
The nurses don’t like that. We’re the only ones with a blanket around our waists — shivering there!
Doctor Rich [laughing]:
All surgeons should just be robotic surgeons — and then they don’t have to be under the lights, and they don’t have to cozy up to the table and wear all these layers!
So the fact of the matter is that keeping the room cold does not prevent infections. In fact, your immune system doesn’t function as well in colder temperatures as it does in your normal body temperature range. There’s now an entire field of study called ERAS (or enhanced recovery after surgery) that looks at maintaining the patient’s normal physiology. That’s temperature regulation and fluid balance throughout the entire surgery — before surgery, during surgery, and after surgery. There’s entire companies whose sole purpose is to create warmers to keep the patient warm in the operating room. So the fact of the matter is you want your normal body temperature, and we have warming devices and blankets that can compensate for the cold temperature for the operators (not just the surgeon, the assistant, and the scrubs) that are right there layered up — and get hot during the surgery.
“Easy Going” Surgeon:
Hey, where’s the music? Let’s get some music playing. Oh, turn it up — I love this song. Music’s way too loud — I can’t hear myself think! Okay… I’ll uh… I’ll take that instrument I like. I don’t know — just hand it to me, please! [complaining] Yeah, and they just keep hiring more administrators… Why are you handing me this?! Yeah, I wanted it five minutes ago. It’s useless to me now. Throw it away!
Doctor Rich:
Give me what I want — not what I ask for! [sarcastically] That NEVER happens! [sheepishly] Yeah… So I’ve, I’ve definitely had where I’ve been frustrated — something wasn’t there exactly when I wanted it — and I sent somebody to Albuquerque to get it… and then they get back and I’m like, “Yeah, I don’t want that. That’s useless — throw it away.”
Cameraman [offscreen]:
Oh my gosh…
Doctor Rich [laughing]:
That’s the OLD Doctor Rich. The NEW Doctor Rich would NEVER do that.
“Easy Going” Surgeon:
Why isn’t my equipment working? Why isn’t this working? Okay — find someone to EXPLAIN to me why this isn’t working. Listen, I CARE about social issues — you’ll understand when you start paying taxes. Who are you? [to someone offscreen, apparently answering his question about why something doesn’t work] Why what doesn’t work? I don’t even care — I don’t even care!
Doctor Rich:
And again — I’m trying to look at that from both sides. So as the surgeon, you’re in the case, you’re dissecting around vital structures (organs, blood vessels) and if you don’t have your full attention — you’ve LITERALLY got someone’s life in your hands! So it can be frustrating when you have equipment that doesn’t work! I mean, it’s supposed to work — and if it doesn’t work for a silly reason (like it wasn’t switched on!), there *could* be some frustration there! But then it’s like, “I don’t know why it’s not working, find somebody!” — and then they come twenty minutes later and the surgeon’s like, “I don’t care.”
Iliana [laughing]:
It doesn’t matter!
Doctor Rich [sarcastically making a “shooing” motion with his hand]:
Be gone. I’m done with you.
“Easy Going” Surgeon:
Hey, why are the drapes like this? No, the drapes were better last time. What do you mean they’re different drapes. Why… Why are we using different drapes? [angrily] Is it the hospital administrators? Did the administrators get to…
Doctor Rich:
So this is as if he made this video for me. So we have a robotic drape we use every time. And then supply chain issues happen (when things are back-ordered) — and it’s like, “I think the surgeon’s back-ordered, just gimme what I want!” So we have the new drape — that’s NOT the robotic drape — and you’re quick to go in your mind to, “Ugh, it’s the administrators trying to save two cents and giving me a bad drape!” Which again, there is some truth in that — but there needs to be balance like we talked about earlier.
“Easy Going” Surgeon:
Anesthesia? Hey, Anesthesia! Oh, Ane-STHE-sia… [tauntingly] I drove the BMW in today…
Doctor Rich:
All right. So — as I’ve grown wiser, you know, this is a collaborative effort. Everybody deserves your respect. Anesthesia has a NAME! You’ve got to learn Anesthesia’s name — as you should for all the scrub techs, and the nurses and, and everybody! And you know — I’ve had to learn over time. Because as I said, you kind of learn to act and be a certain way in training, and then you get out and you have a life journey and you learn that collaboration’s always better.
“Easy Going” Surgeon:
Something’s wrong with the Porsche. I dunno — I gotta take it in.
Doctor Rich [joking]:
That’s why you go to nurse practitioner school… You want the Porsche!
Iliana [sarcastically]:
Right…
Doctor Rich [to Iliana, laughing]:
Making the big bucks!
Iliana:
Someday…
Doctor Rich:
So… I don’t usually talk about cars in the OR. How do you feel about doctors bragging about their stuff?
Iliana [noncommittally]:
You know, I don’t really hear anything about CARS necessarily, but… Um… You know…
Doctor Rich:
She’s being too nice.
Cameraman [offscreen]:
She’s very nice.
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