Getting Blotto with Otto

At the risk of turning my blog into a "Dear Abby" column for disaffected medicos, I am replying to Anonymous who writes:

Dear Sheepish,

A question for you: I asked my HMO3 today why he thinks women are more likely to develop a femoral hernia. He said that it is because the process of childbirth weakens the posterior wall of the femoral canal. I asked him to tell me an examination feature that would distinguish an incarcerated femoral hernia from a tender groin lymph node. He said that a patient with an incarcerated femoral hernia would have signs of a bowel obstruction and that a hernia is reducible.

I am not on call tonight.

My question is: How many alcoholic beverages should I consume tonight?

Unfortunately for you, Anonymous, however many drinks you have tonight, your poor HMO will still be there on Monday, oblivious to his ignorance and not having learnt a thing. You, however, will be hung over and barely functioning, and very much the worse for wear for your alcohol-fuelled binge.

If you plan on pursuing your surgical career, you need to decide on one of two paths.

1. Work out how much you can drink on a regular basis without anyone knowing the difference. This may take a fair bit of trial and error.
2. Realise that one-in-two or one-in-one on-call, will make frequent Toga Parties or Bond Nights a near impossibility, so perhaps it is time to give up or cut down now.

Personally, I have made it a point that I don't drink when I'm on-call, and at other times I'm limited to one drink at night with dinner. If I'm on holiday, then no restrictions apply. In reality, though, not being in the habit of drinking regularly I often just go without. There is not much point opening a bottle of wine when I know I'll be unlikely to finish it before it goes off - but that is just me.

I don't think that I am any more authoritative on this issue than anyone else - is it OK to drink when you are on call? Given that sleep deprivation for 24 hours is said to be as bad as having a blood alcohol level of 0.05, perhaps it's OK to have a few drinks if you get plenty of sleep? Stories abound about surgeons who operate while inebriated. Is an impaired surgeon better than no surgeon at all? Is an incompetent surgeon better than no surgeon at all? The Bundaberg experience would say no, and so would my MDO.

Perhaps next time, you should ask your HMO3 if he knows what a torsion of the testicle feels like. Or intermittent claudication of the arm. If not, you can always provide a demonstration.