Wednesday, August 13, 2008

A Surgeon's Outburst

 Updated 3/2017--all links removed as many are no longer active and it was easier than checking each one.

I'd like to comment on the recent Boston Globe article on surgeons' outbursts and also on Maggie Mahar's post, Surgeons and Other Physicians: A Cultural Divide.  Both seem to be painting surgeons as the ogres or bullies of the medical community.  I'd like to think that I am neither.  There are better examples of surgeons than the Alex Baldwin character in the movie Malice. 
I agree it is not good form or good for the patient for these outbursts to occur, but generalizing to the point that most of your readers would think that 90% or more of surgeons behave this way is wrong. I have never thrown any equipment and rarely gotten angry to point of raising my voice or screaming in the OR. Each time I did, the nurse told me I was right.
I have witnessed some of the examples given in the article. Yes, those surgeons should be counseled and most likely should even be required to go to anger management classes. BUT maybe the reason for their anger should also be sought.
Was the faulty equipment putting the patient at risk? It is very frustrating to try three pair of scissors before you get one that will cut tissue or to have the electrocautery machine not work so the circulating nurse (bless her) has to go find one that does. Perhaps the hospital is at fault for not updating and replacing defective instruments and equipment.
Did the surgeon have to finally say "no more" to extraneous people entering the room? I have done that a few times. Someone comes in looking for a piece of equipment stored in the room you are working in (why wasn't it taken to the other room before my surgery got started?). Someone comes in to ask where such and such is (usually a new person who hasn't been properly oriented). My tolerance is such that I can take several (justified) interruptions in one case, but there is always a tipping point. Raising my voice to get the crew who is supposed to be helping me with my case refocused is my way of dealing with it, not throwing things. Still I would prefer to not have the issue.
Did the surgeon have to ask the nurse (or another crew person) to make their personal calls later? I have had to do this a few times, especially now that everyone has a cell phone. I try to be considerate when that person has a loved one in the hospital and are trying to get updates. Still, if they can't focus on their work (someone else's loved one) then maybe they should have taken the day off.
Those are just a few examples. I agree that we should never throw anything in the OR, but I do expect the equipment the hospital provides to work. I do expect the personnel they use to be professional and properly trained. I think of myself as part of the team, but that means we ALL have to put the patient first and work together.

Now let me give you some better examples of surgeons
  • Dr. Eli Blumfield (played by Alan Arkin) from the movie The Doctor.  The one that William Hurt's character picked to do his surgery.   He was not only a great surgeon, but a good person.
  • Benjamin Franklin "Hawkeye" Pierce (Alan Alda) from MASH, don't recall ever seeing him throw anything in the OR.  He mostly directed his anger at the policy makers, not the OR staff or patients.
  • BJ Hunnicutt (Mike Farrell) from MASH, a gentle soul who missed his wife and daughter.  He didn't disrupt the OR with temper tantrums either.
  • Sherman T Potter (Harry Morgan) from MASH, who kept Hawkeye and the others in line.  A good surgeon and administrator.
  • Dr Richard McCarthy (real-life orthopedic spine surgeon) who was featured in an episode of Extreme Surgery back in 2004.  I was a medical student when I first meet him at Arkansas Children's Hospital.  He is a very good surgeon and a gentle man.  He is very highly regarded by all -- administration, nursing staff, colleagues, patients, etc.  I tried to find the episode link so you could see him in action, but failed.
  • Dr. Sanjay Gupta, neurosurgeon and CNN correspondent.  Though I have never been in an OR with him, he doesn't seem as if he would be the type to throw tantrums.
  • Dr Bruce Campbell, ENT and fellow blogger.  I have not been in the OR with him either, but you get the sense of a someone who is respectful and civil when reading his posts.
  • David A. Kappel, MD, a plastic surgeon in Wheeling, WV.  I was influenced by him as a general surgery resident.  Someone who is very good at what his does, treats his OR crew well, and is a wonderful human being.
  • Dr Dale Morris who was a general surgeon here in Little Rock, AR for years.  He has retired and is missed.  He was/is a very kind and skilled surgeon who always treated everyone well.
Let me also say that I am blessed to have had several good nurses and OR scrubs over the years teach me how to work as a team.    To name a few -- Jeannette Murphy, Vivian Mitchell, Joe Roe, Becky Bennett, and on and on.

You may also want to read this article from the WSJ and it's comments from last month on "Better Hospital Manners by Mandate".


Anonymous said...

You might want to go back to HealthBeat today (
where you will find a surgeon's very thoughtful response to the original post as well as a comment by the husband of a patient who found himself in the OR recently.

I agree with most of what you say. Of course not all surgeons are shouters. I also suspect that OR culture varies with overall hospital culture . . . And that perhaps in some hospitals no one would even consider using their cell phone while in the OR. (This would make me completely nuts!)

purplesque said...

Very interesting post. I'd like to nominate my husband for that list, not just because I love M.A.S.H., but because several nurses have told me he's a 'saint'. I suspect the issue of overbearing paternalistic physicians extends to all specialties of medicine, but the OR-surgeon scenario gets talked about more.

mark's tails said...

Nice post and I enjoyed reading the links as well. I've come into contact with many excellent and kind surgeons during my training and also have had run-ins with vicious, inconsiderate oofs on both sides of medicine. Our Institution has always had a physician 'behavior' reporting system in place. But it is now being aggressively 'activated' and advertised throughout the system. In addition, strong consequences, including job termination, are being imposed on repeat offenders regardless of their status or hierarchy. I'm interested to see how all this pans out in the near future.

Bongi said...

i have never shouted in theater. i have spoken sternly, once to my junior for shouting at someone in theater. in fact i have been considering touching on my surgical principles in a series of posts, one of which deals with this in detail.

Bongi said...

actually i have already touched on it from a different angle.

hdhindsa said...

Great post. I agree that there can be so many distractions in the OR. I find this a much more common phenomenon in the States for some reason. When I work overseas there seems to be a bit more seriousness and a bit less levity during the case. It also seems that perhaps that in other countries it would be considered poor form to distract the surgeon--not so much here.

Anonymous said...

To generalized that surgeon's are the nemesis of healthcare is clearly the wrong vision to unfold. There are many healthcare providers that are able to maintain their professionalism at all times which is what they should be doing - MD or RN.

The fact remains though that healthcare does have in my opinion a great deal of "bullies" in it. I don't know the percentages but many of them are physicians and there are plenty of nurses too.

Unfortunately my facility has several MDs that fall into the category of being obnoxious and rude. Even in the ED which I work other ED physicians don't want to call these Docs when they are on duty because of their caustic nature.

The problem is that healthcare leaders are for what ever reason not mitigating the behavior of bullies. I have written a couple posts on my site regarding this bully problem in healthcare and despite any loss in revenue MDs that are out of line need to be shown the door permanently just like the nurses are. There is no need to be belittling or rude, or otherwise curt at work to fellow providers - MD or RN.

That being said, to make generalizations about healthcare providers is clearly myopic as you point out. It seems obvious the media is just trying to get some mileage out of the article and the new Joint Commission stance on bad behavior in healthcare.

Anonymous said...

I have been frequenting operating theatres for a couple of years now, and I have never witnessed a yeller. I think this behaviour is increasingly rare as we all get more grown up.

Frustrating things happen in surgery. I have seen faulty instruments thrown at the wall by pleasant, lovely, polite surgeons, and I can understand that.

However, I have also been insulted and shamed by softly spoken surgeons, which caused much more distress to all the staff present. Yelling in frustration is over in a second. Manipulation and nastiness (which is about a person, not about surgeons in general) is much worse and deserves to be stamped out.

It is easy to drop into cliches when you can't think of anything to say. Surgeons: uncaring, uncommunicative, soulless and unintelligent. And I want to be one.

Donna B. said...

I'm having a hernia repaired in a few weeks and I've got to say this post makes me nervous.

I cannot imagine the surgeon I met today throwing anything, yelling at anyone, or being other than the kind, cheerful, and (to me) exceptionally honest guy that impressed me and acquired my trust today.

However, I can imagine someone in the OR on a cell phone or equipment not working, but it would never have crossed my mind that "visitors" would drop in and distract the team working on me.

Now I'm nervous again.