RE: Ob: staples at C/S
From: Atkinson, Samuel M (ATKINSONS@ECU.EDU)
Sun Jul 30 20:32:54 2006
I h.ad a pseudoaneurysm repaired under local and was given choice of closure..I chose clips and had a first year female resident (gyn) take them out. I had a carotid with US surgical sub cu and extruded it for 5 weeks. Obviously you have not been a pt very often.
sAm
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From: ob-gyn-l@obgyn.net on behalf of Kim E. Goldman
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Sent: Sat 7/29/2006 1:20 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Ob: staples at C/S
FWIW,
Neurosurgeons almost always staple their craniotomy skin incisions. I almost always suture mine. Why? Because it feels nicer to the patient. It is NOT as quick but if you are the one walking around with it, it feels a whole lot better.
Maybe that is why patients and/or midwives are requesting sutures rather than staples?
Just a thought.
Kim
On Jul 29, 2006, at 11:55 AM, DoctorJoe@aol.com wrote:
In a message dated 7/29/06 10:11:03 AM, garrys@mindspring.com writes:
Over the last 3 years since being in a collaborative practice, many of
our CNM patients who seem to be a bit more "natural" (maybe many of them
have taken Bradley classes) are insistent to a fault about having
subcuticular sutures, not staples, for their unplanned C/S closure.
Honestly, it is almost as predictable as the sun rising in the east!
When I tell them that I prefer staples, and haven't sutured skin in
years (and thus am a bit out of practice), well, many seem taken aback.
I have found that I don't want to tell the
mechanic/gardener/plumber/electrician etc. how to do his job, yet this
seems the opposite to me.
What's up with that?
Well, in parsing your post, the first thing I'd think is - what are the CNMs TELLING their patients about staples versus subcuticular stitches? Sounds like educational variation to me. You can always "brainwash" a patient given enough time. Is that what's going on?
As for me, I always liked staples better. They give IMHO a straighter scar. They come out, hence, do not tend to stay in situ and cause (in some cases) more inflammation and sometimes a thicker scar. And I always took them out and places steristrips on Day 2 or 3, and I did it myself. So that meant I actually TOUCHED the patient and rubbed on her belly, so to speak. I think that 'bonding' is worth more than the actual technical question itself. And oohing and ahhing over how nice the incision looks is a positive thing, esp. in a patient with an unplanned C/S (i.e. in a patient who has "failed" in her birthing plan).
And no, you wouldn't argue with a "professional" about his job, e.g. the plumber or electrician. You WOULD argue with the waiter about the way your food was prepared. So does that make you feel like more of a "server" than a "professional?" It should.
And therein lies one of the major problems with medicine today. Patient and doctor? No. Server and consumer? Yep. We've gone beyond the intermediary stage of "client."
Joe P.
