242. Nepal Day 9

Without the pressure of a fee-for-service or a strong continuity of care theme give the see-one-day, operate-the-next, and home-the third (or fourth), the lead gynecologists scheduled patients without feeling this need to have the doctor who made the initial recommendation actually do the surgery. 

The concern is what if I am scheduled to operate when if I had first seen the pt I would have chosen a different procedure or non-surgical management. 

And that's what happened. While I was finishing rounds, I patient I had scheduled for a vaginal hysterectomy was instead prepared for an abdominal approach, based on    findings from an exam under anesthesia, an admittedly more informative exam. Scarring was suggested which would make the vaginal approach at risk for significant complications. However, an abdominal has a higher risk of complications and certainly a longer recovery. No scarring was found and the patient experienced more bleeding. 
But who knows, even more bleeding may have occurred with the exposure-challenged vaginal procedure. At some point, you take your colleagues' decisions at face value, stop the second-guessing, and move on.