A recent collaborative article between Kaiser Health News and The Washington Post discusses doctors losing their temper, repeatedly, and eventually being sent to anger management classes. If you’ve ever worked in a hospital or visited the Emergency Department for a problem that wasn’t really an emergency, you may have met that angry doctor! Where are all the happy doctors and surgeons?
Ill-tempered physicians are nothing new in hospitals. This isn’t to suggest all doctors have repeated problems with acting out but in the office or hospital setting, it does occur. The historical background to this phenomenon is this: doctors have typically been the most trained person in the patient-care setting, directing the care of the patient. So they would write orders and those orders were followed without question. This sort of relationship with nurses would psychologically and naturally lead to a feeling of omnipotence on the part of the doctor (however erroneous this feeling is). With this “power”, the doctor would become accustomed to making a decision, expecting it to be followed without argument and if it was questioned, would lead to anger and retribution towards those that did not follow their “word”.
The other element to this, and I still find to be unequivocally true, is that because the doctor is the most-trained health care professional on the healthcare team, they are at the greatest risk of being sued for malpractice because they are the ultimate decision maker when it comes to patient care. If you don’t think this is an accurate assumption, look at the malpractice rates of the physician vs the nurse or the anesthesiologist vs the nurse anesthetist…the physician has the highest malpractice insurance premiums because 1) their pockets are considered the deepest and 2) they typically are providing the final decision on patient care. The fear and risk of complications due to the disruption of their plan of care leads to anger.
The article in Kaiser Health News mostly discusses doctors that perform procedures, such as surgeons. Many have heard of infrequent, but headline-grabbing stories about surgeons throwing instruments or berating nurses in the operating room. The surgeon loses their temper and self-excuses their actions because of the stress in the OR. While this isn’t a good excuse, it’s definitely a reason they lose their temper. Everyone has a bad day and while that doesn’t excuse bad behavior, the old saying of, “Walk a mile in someone else’s shoes before you try to judge their journey” holds true. When was the last time you were operating on someone, performing a procedure abounding in risks and complications? Your fuse may be short as well. That being said, surgeons chose to go into a stressful field like surgery, so they should prepare themselves for these situations and be as even-keeled as possible. So how can surgeons put themselves in an environment that sets them up for success?
If you consider a CEO, they surround themselves with an executive management team with which they are cohesive and can accomplish great things together. If a CEO was assigned a random team of executives for which they had no previous knowledge of their capabilities or strengths, you wouldn’t expect that team to lead the company to a successful fiscal quarter. Continuing with that analogy, take a surgeon, the leader of the operating room for which he/she is performing a procedure, being thrown together with a scrub technician or OR nurse that aren’t familiar with the surgeon’s specific instrumentation needs or routine. In other words, the surgeon may not be familiar with his/her “executive team”. If you were the patient on the OR table, wouldn’t this make you nervous? Well, you’re not alone, it makes the surgeon nervous too! Rather than concentrating on the procedure they are expected to perform, their concentration is diverted to bringing the scrub tech and OR nurse “up to speed” on what the surgeon needs to perform the procedure to the best of their ability. This leads to an unhappy surgeon.
Therefore, when a surgeon has a team in the OR that they know and are familiar with, and conversely the OR crew is familiar with the surgeon, it makes for a more streamlined OR environment and a happier OR crew and surgeon. Thus, setting everyone up for success. This is why, when you are searching out a surgeon for plastic surgery, you want a board certified plastic surgeon that has a consistent OR crew with whom they work. Why? Because a plastic surgeon with the the same OR crew to perform their cosmetic surgery, will inevitably have all of the instruments they need at arms length, handed to him/her by a scrub tech that works with the doctor everyday and assisted by the OR nurse that is also attuned to what “their surgeon” wants and needs. All this consistency leads to a happy surgeon, resulting in the best possible circumstances for your surgery. So don’t dismiss this blog post as, “those surgeons should be happy because they’re rich!” because a truly happy surgeon with a cohesive OR staff will be in a position to deliver the best possible results…and isn’t that what you want?!