Monday, February 11, 2008

i r surgeon

in a recent post i touched on hierarchy in theater. it is necessary, but unfortunately it also adds to the notorious reputation of surgeons.

i have worked with arrogant bombastic surgeons who have blown their top during operations and shouted at and blamed everyone except themselves. i have even gotten angry with them, but i always held my tongue. you see even if i didn't respect them, i respected the institution that is theater.

in theater there can be only one voice of authority and that is the voice of the surgeon. often surgeons don't understand this. they think they are in charge because it is their right or because they are so cool or some other deficient logic. i always imagine a governator voice saying:
"i r surgeon! you must comply!"

but that is not what it is about. in the end it all boils down to the patient. everything that is done is done for the benefit of the patient. the cleaner in the back who gets the instruments ready does it for the patient. the sister who crisply palms instruments to the surgeon on his demand does it for the patient, not because he is so cool (although if he is a surgeon he is probably cool).

when the surgeon demands silence it is because his knife is poised precariously above the ivc and he needs to focus all his attention. when the surgeon demands silence, it is not for him, but for the patient. and for the patient, he had better get his silence.

there is also the aspect of respect, not so much for who he is but what he is. but once again, many surgeons misunderstand this. respect is a two way street. i believe i as a surgeon can't expect respect from the sister or the anaesthetist unless i respect them for what they are. even the assistant i will always respect.

so in conclusion, i am not the type of surgeon who says "i r surgeon! you must comply!" but when i'm in theater i do expect a very high level of excellence from everyone there. the hierarchy must be maintained.


rlbates said...

Well said. The team that works together is pure pleasure to work with.

Anonymous said...

You needed a Highlander picture: "There can be...only one!"

Sid Schwab said...

It's true: I can be pretty chatty during smooth surgery, and enjoy music most of the time. But when things get tense, I ask, sturdily, for quiet. Sometimes people seem taken aback. The anethesiologist talking on the phone, the circulaters discussing last night. But they quickly recall it's indeed about the patient, and the surgeon needs to get what the surgeon needs.

Jeffrey Parks MD FACS said...

well put. Every once in a while, the surgeon must take an authoritarian stand. But the power trip that some surgeons get into for every aspect of even minor cases is embarassing. Teamwork and respect will make even the toughest cases go smoothly.

Anonymous said...

I like it. I've heard a similar argument from a surgeon friend.

I wish I could get my students to respond and be that respectful in my "theater." ;-)

medstudent101 said...

I've been thinking about this entry a lot today. I'm a third year med student and I'm actually thinking of going into surgery. I agree that surgeons need to be able to hold attention and get things going if need be. But being a complete asshole about it is not necessarily the best for the patient. I think many surgeons cross the line--maybe they're confused about the difference between holding respect, and just pissing people off/terrorizing. I've assissted in surgeries with both types of surgeons and I think it is more effective when the surgeon isn't a jerk.

Cluttered Mind said...

I am a nurse and work in patient safety in Canada. I feel strongly that all members of the team, right down to the cleaning staff, if necessary, must have the authority to speak freely, without the risk of being blasted, when they see a safety issue developing. Reviews of most sentinel events document communication issues as contributing significantly to the problem - how many times have we heard, "...well I saw it happening but didn't feel I could say anything..."? I agree there is (and probably should be) a hierarchy among the team, but it can occur within a respectful and open culture.

I enjoy your blog, having visited your part of the world (White River and the Kruger Park) in 1999, but I have been chewing over this post since I read it.

Bongi said...

cluttered, yes i agree. but in theater this must be structured. you can't just have the floor nurse throwing in an opinion at what may be a crucial part of the operation when full concentration is needed.

usually the floor nurse will speak to the sister and she passes it on to me. however, i usually ask her to tell me directly when i see the whispering to the sister.

the other important point is that, due to the nature of our job, at least in my setting, the surgeon may be the only one who knows what is going on.

but i must add that i insist on my assistants speaking. i say they must ask questions and even challenge me constantly.

white river, as you no doubt know, is very close to nelspruit. kruger is great. hope you enjoyed your time here.

amanzimtoti said...

But you don't like your assistants to help you though hey?

Someonect said...

bongi, i agree with you. i think the important thing is that it is a team effort and we all work together, but in the OR, similar to codes, there can be only 1 leader.

in my or, i am really an easy going guy. when things get serious and i ask the 3 nurses discussing the upcoming weekend, the anesthesiologist talking about politics, and the nurse calling into the room for a tylenol order, to be quiet, i am an asshole. even though i have just osteotomized a childs spine (breaking the back), and things are very tenuous.

i think it is a team effort, but the other members on the team do not have as much at stake as the primary surgeon. if something goes wrong and the child dies, who has to speak with the family?

for me, it is never a power trip. sometimes intensity is seen as being an asshole. let me tell you, if you have to tell a family that there child died during surgery, you will do your best to never have that conversation again.