Breast Surgery

Attendings

Patricia Greatorex
Patricia S. Greatorex, MD		 Paige Teller, MD
Paige Teller, MD		 Elizabeth S.M. Desjardins, MD
Elizabeth S.M. Desjardins, MD
Patricia Greatorex
Jillian K. Smith, MD, MPH

Expectations

Before / at beginning of rotation

  • Pick 3 goals for your rotation. These can be technical or knowledge goals. They should be realistic for the length of your rotation and your current level of training (e.g. improve deep dermal sutures, perform independent sentinel lymph node biopsy, improved knowledge of HER2 positive management, etc). Please share your goals via email with all 4 surgeons, so we can facilitate reaching those goals.
  • We are continuously developing and updating a rotation quiz, which is transitioning to Survey Monkey. Use the quiz to identify knowledge gaps, direct your reading, and to start discussions with your attendings. Here is the link: https://www.surveymonkey.com/r/X3CXFGW

Reading

You should have received several papers attached to your welcome email. Please work on reading these throughout the rotation as part of your breast education.

Rounding and Communication

On weekdays (including Thursday mornings) you are expected to round on any breast patients that stay overnight at the Scarborough Surgery Center or Bramhall, write a progress note, and communicate your assessment and plan to the attending. All attendings are fine with a text update if things are going well. Please call if there are more complex issues to discuss.

Peri-Op

  • See patient in preop before the case, verify that consent is in the chart, correct operative side is marked, do IPHR, orders, and discharge orders.
  • Order sets:
    • The “ASU Gen Surg Post Op” order set can be used for smaller (non-mastectomy) cases. DesJardin/Teller/Smith patients getting SLNB will all get 5 tablets of oxycodone unless otherwise specified (usually don’t need narcotics if just a lumpectomy alone). Greatorex uses 5-10 tablets of Dilaudid (discuss specifics with her).
    • The “Gen Surg Breast” order set can be used for mastectomy cases without reconstruction. Remember to order home meds as well. These patients may go home same day versus spend one night on a case by case basis. They should generally be offered a prescription for narcotic.
    • If a patient is having reconstruction, plastics will do the orders and discharge instructions and the discharge order next day.
  • Discharge instructions:
    • DesJardin’s discharge instructions all start with “.ESMDDISCHARGE” and there are versions for lumpectomy-type cases, mastectomy w/o reconstruction, mediport, etc
    • Teller’s discharge instructions: “.PT1POINST”
    • Greatorex’s discharge instructions:  “.GTXDCMMC” for most cases, and “.GTXDCMASTNORECON” for mastectomies w/o recon. 
    • Smith’s discharge instructions: “.JKSMMCDCLUMPECTOMY” (for lumpectomy and excisional biopsy) and “.JKSMMCDCMASTECTOMY” (for mastectomy without recon)

OR etiquette

  • Pull up appropriate images on the computer screen in the OR prior to each case.
  • Try to be in the OR as the patient enters the room, and help with transfer and positioning.
  • Prepare for each case (including reading office notes for the patient). The more prepared you are in knowledge of the anatomy and steps of procedure and specifics of that patient, the more you will be allowed to do technically.

Clinic

  • Documentation
    • You may be asked to write the visit note or a portion thereof. This will depend on the attending, your training level, and where you are at in your rotation. Please discuss with attending when you are in clinic.
    • Pend your note when you are done. The attending will edit as needed and sign the note and encounter.
  • Physical Exams
    • Attending will ask patient permission to include you in the physical exam. Attending will direct your participation in the physical exam. This may include performing a portion of the routine exam or repeating the examination of key findings – again with patient permission.
  • Tumor Board
    • The Breast Care Center Tumor Board conference happens every Thursday at noon. We discuss our new cancer cases and post-op cancer cases. Please plan to attend this each week you are on the rotation. If you have seen a new cancer consult in clinic with us that week, we may have you present the patient. We may also have you present one or two post-op patients for whom you were part of the operative team.
    • Tumor Board is on Zoom. Please join each week.