strategy

while i'm on the topic of how to handle consultants i was reminded of another consultant who was somewhat peculiar. also while in prague one of my old colleagues from the old days who actually reads this blog asked why i never wrote about this very interesting individual. so here goes. lets just call him doctor d.

doctor d had dogmatic views on pretty much everything and his views were usually fairly odd. he had developed a way of discussing one or other of his views during operations. he could time a discussion about a given topic to last just long enough that as he placed the last stitch he would wrap up his talk. so with a short operation he would just launch into his theories, but with a longer operation he would start by asking each person in theater what they thought of whatever topic he had chosen for that specific operation. i used to enjoy listening to him during operations and sometimes even felt disappointment when the last stitch would be placed while he said,
"and that is why you should not send your children to school but should home school them." or "and that is why you should always wear long sleeved shirts" or "and that is why cremation is wrong" or some such statement.

but on ward rounds my feelings about these discussions were completely different. an operation had a predetermined end, but ward rounds could go on indefinitely. with this in mind i'd instructed the students how to respond to doctor d so as to shorten the discussion as much as possible. i explained to them that if he asks their opinion about anything not related to surgery he is not asking because he wants to know their opinion, but rather that he wants to expound his own theories. if they gave their opinions he would first take time, a lot of time, to debunk their theories before explaining his own. they were under strict instructions to make sure they didn't give their opinion but rather just immediately ask doctor d what he thought. and then after he had expounded his often bizarre theories the students were not permitted to question him on the rounds. if they wanted to argue some point they could do it in their own time when the rest of us would not be forced to stand there, often post call, and listen too.

generally this approach worked quite well and ward rounds usually didn't drag on more than a half hour after seeing the last patient while we heard why a contraception was wrong etc. that was until one day.

we had just seen the last patient on our post call rounds and ward rounds were as good as over. the students were a new group but i had already orientated them about what to do when asked questions unrelated to surgery. so i didn't worry too much when doctor d started.
"what do you think of rugby?" he asked each student. they dutifully were non committal and quickly turned the question back on him. i was smiling inwardly. we could wrap this up in about 5 minutes if no one questioned him afterwards and he still would be none the wiser i was sabotaging his beloved so called philosophical discussions. he continued.
"rugby is a homosexual game and anyone that plays it must be homosexual." i could almost hear my bed calling. we just had to nod and soon we'd be on our way. and then things went south.

one of the students seemed to be turning slightly red. he also seemed to be bouncing up and down on the spot.he seemed disturbed. i realised he was going to go against my instructions and ask something or worse, challenge doctor d. i started recalculating how long it would take for the rounds to end. but what happened then i hadn't expected.

suddenly the student jumped forward with index finger extended, first towards me;
"i know you forbade us from questioning doctor d about any of his crazy theories, but this i just can't take!" and then towards doctor d:
"doctor d how the hell can you say rugby is for homosexuals? do you really think all the springboks are homosexual?"

i wanted to cry. not only were we forced to endure the full length explanation of doctor d as to why rugby was indeed a homosexual sport, but afterwards i was personally taken to task for instructing the students as to how they were to ensure the good doctor d's talks did not go on for quite as long as he liked them to. worse still, the good doctor d adjusted his way of discussing his theories on ward rounds to bypass my influence on the students. never again did we have a short discussion after rounds, whether the students asked questions or not. doctor d also i think trusted me much less after that episode.

eccentric

sometimes eccentricity is excused by brilliance. the old prof of thorax in my humble opinion fell into this category. i quite enjoyed his lackadaisical approach to training, especially because i was not required to know thoracic surgery to the depth that a thorax surgeon was required to know it. i could sit back and observe.

during my rotation in thoracic surgery i enjoyed the morning meetings. the prof was very knowledgeable in all things. truth be told i never heard him teach any thoracics. he taught pretty much everything else. he would walk into the thorax lounge, sit back, light a cigarette and drink coffee. as long as you kept his cup of coffee full he would just keep on talking about all sorts of topics (except thorax surgery. he reasoned the registrars were supposed to be reading current articles and therefore were supposed to be more up to date than he was. if that were the case then how could he be so audacious to assume he had something to teach them?).
he also had what i considered a sort of inappropriate giggle. after almost every sentence he spoke he would slightly lift his shoulders and let out an almost inaudible giggle. no one else dared laugh unless it was clearly a joke. he was, after all the prof.

finally one day i witnessed him giving a thoracic surgery opinion on a thoracic surgery patient. as usual he was sipping and puffing away waxing lyrical about some or other topic which he seemed to be an expert on (i think he was explaining how he had written the program that his department used for patient records or how the cities electric supply was wired). one of the thorax registrars stood up with a ct scan. he placed it on the x-ray board and waited for a gap to ask the prof's opinion. sure enough, after the next giggle, the prof turned to see what he was doing.
"excuse me prof but could i ask you for an opinion on this patient please?" the prof put down his cigarette and coffee mug (which i duly quickly refilled). he then reached into his top pocket where he kept his fold up reading glasses. all eyes were on him as he clumsily unfolded them and placed them precariously on the tip of his nose. he then threw his head back in order to be able to look through the said glasses. everything went silent. then spake he.
"hierdie pasient is gefok!*" followed by a gentle lifting of the shoulders and the usual giggle. he whipped the glasses off his face, folded them up and returned them to his pocket in one smooth movement. i laughed. it seemed i still couldn't tell the difference between the prof trying to be funny and being deadly serious because everyone in the room stopped what they were doing and stared at me as if i had disrespected the great man. i swallowed hard and shut up. after all the prof was exactly right.

*this patient is f#@ked