Colorectal Clinic & SurgeryJeff Lee

Colorectal Service• Attendings: Dr. Clark, Dr. Turner• Clinic: 9B or 1K clinic• What it is: Basically it is Dr. Clark and Turner seeing follow ups

or scheduling surgery for patients• Colorectal OR time as well

Clinic on 9B• Take elevator to 9B• Go down the hallway and the clinic will be on your left• Enter the clinic and you will see this:

Go straight ahead through that door and turn to your right

Where Clinic HQ is

Clinic on 1K• Set-up is similar to 9B• Go down to the 1st floor and follow the signs for Surgery Clinic

Clinic Headquarters

What to expect• Dr. Clark• Expect to do H&P’s on new patients• Expect to be rushed (try to keep H & Ps) to 10 minutes• Expect to type up a note (try to find a good template that will

include their PMH, SH, PSH, etc)• Expect to present them quickly to Dr. Clark• Expect to be pimped!!! He is very nice but will keep the questions

flowing! You WILL learn a lot!

What to expect• Dr. Turner• She typically does not expect you to see patients• You follow her around & shadow her• She does not usually ask questions• It be chill but you won’t learn much

Your workstation

OR time• Time in the OR varies among the attendings as well• Clark• Know your anatomy• Be ready to do a rectal exam on the patient while he/she is under

anesthesia• Be confident! Even if you are wrong!• He will say things like:

• “You’re killin’ me doc!”• “Good! We’re learning!”• “You need to read!”• He also likes to joke about pitting partners against each other

• Don’t take anything personally; he says these things to everyone, even chief residents

• Turner• Chill

Questions you will be pimped on

• TMN for anal cancer staging & grading• Most common place where anal cancer occurs

• TMN for colorectal cancer staging & grading• Colorectal cancer screening guidelines• Anal cancer treatment

• When to use NIGRO protocol• Rectal cancer treatment

• When to excise, when to use adjuvant therapy• Blood supply to the gut

• Branches off the Celiac, SMA, IMA• Blood supply to rectum, anus

• Nerve supply to the gut• Congenital based cancers

• Turcot, Gardner, Lynch (know diff btw Lynch 1 & 2)• Grades of hemorrhoids• Goodsall’s rule

• Treatment for fistulas• Hinchey classification of diverticulitis perforations• Different types of Polyps

• Which are malignant, which are benign

Bottom Line• Clark will pimp you a lot, but take it in stride and write

everything down he tells you• Even if you get things right, he will keep asking more and more

specific things until you get something wrong; don’t be offended by this, it’s not personal, it’s just his way

• Look up things he tells you to look up: HE DOES NOT FORGET• Overall, he is a great guy; he may be sarcastic a lot but he

wants you to learn and will push you to learn• Turner is chill