Have you ever come across problems with rage and temperament issues in the OR. I have been an operating room tech for many years and have been in a variety of surgical settings.
A certain surgeon brings in a lot of money to the hospital, but he is terrible. I have been called things no one has ever called me. He throws instruments on my table and mayo stand, screams, and implies that I and my colleagues have no idea what we are doing. I have reported him to my manager and the OR director, but nothing ever comes of it.
Other surgeons have witnessed his behavior and have said something, but nothing was ever done. I understand the OR is a beast of its own, but the culture has to change with these newer guys coming out of residency. The mindset of the surgeon being our 'customer,' which is being rolled out to us now, is not reason for us to put up with abuse. What have you encountered on a peer-to-peer level on how to handle such demeaning behavior? I trained and worked at a level 1 trauma center with emotions that constantly ran high, and still it was less stressful than this particular surgeon. Thank you for your advice.
A recent paper in the American Journal of Surgery addressed this topic. The authors interviewed 19 OR personnel including nurses, medical students, surgical residents, anesthesiologists, and 2 scrub technicians. Dr. Amalia Cochran, the paper's lead author, told me the reason there weren't more scrub techs was that they were reluctant to participate.
This figure, modified slightly from the paper, describes the harm that disruptive surgeons can do and suggests some coping strategies.
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| Italicized items are discussed in the paper |
I suggest you read the entire paper. Your hospital's medical librarian should be able to obtain a copy for you without difficulty.
It's a tough situation. When I was a surgical chairman, I had some experience with surgeons behaving badly. I always had trouble getting the nurses and techs to go on the record with their complaints.
If your immediate boss can't help, maybe you could try your hospital's risk management department. A surgeon who bullies the staff is a patient safety risk. Some hospitals have anonymous hotlines where complaints can be lodged.
The only other thing I can suggest is to get several other staff to join in the complaints. Administration can ignore one or two people but not eight or ten.
Can anyone else comment?
27 comments:
As an anesthesiologist, and sometime medical-staff committee member, I have had to deal with this problem a number of times over the years. Thankfully, it seems to be getting better, but there are still a few dinosaurs out there.
You have to have a hospital admin and medical-staff structure dedicated to dealing with the problem, and mistreated employees have to be willing to go on record. Without a paper trail, no action will be taken for fear of lawsuit by the offender. Employees rightfully fear retaliation, either by the surgeon or by their own admin, who fears losing a revenue stream.
In extreme cases, it wouldn't be unreasonable to record the behavior, perhaps even announce that you're recording it, and present that evidence to the admin. In one case I know of, the surgeon was such a rain- and publicity-maker for the hospital it took a veiled threat to send the recording to local news media to get something done. In the era of patient satisfaction, admins hate adverse publicity. Be aware, though, that retaliation by the hospital, or even job action, against a recording employee, could be the result, as it was in another case I know of; and recording could be illegal in your state.
I think what will ultimately solve this problem is for hospitals to lose a few multimillion-dollar judgments for allowing a "hostile working environment".
It's disheartening that the OR tech who wrote in feels as if his or her concerns have not be appropriately addressed. That is, frankly, unacceptable.
As a junior resident, I can safely say that I've seen my fair share of unacceptable behavior in the few years that I've been a resident and student in the OR. I doubt my experience is unique.
We must wonder where we stand as a profession when this sort of behavior is tolerated in 2015. When scrub techs aren't even willing to participate in an anonymous academic study of operating room behavior. When--as a trainee--I've had the feeling on more than one occasion that I'd rather be anywhere else in the world rather than scrubbed into a case while witnessing or being subjected to similar behavior.
How would this be tolerated in other industries? How would this be addressed in other countries? One fellow I worked with who trained in Europe said that surgeons would never have been allowed to treat trainees the way he was treated when he started his fellowship in the US. Why is it that this is an ongoing problem in American surgery?
One troubling metric I see applied to this (and other aspects of surgical education, such as resident education) is that "well, it's better than it used to be". Our goal shouldn't just be to make things better than how they were in the past in surgery. Our goal should be to create a culture and environment reflective of where we are in 2015 elsewhere in society. And that surely does not include any room for behavior such as that highlighted here.
There is no room in the surgery today for this kind of behavior. Yelling and cursing at people only serve to make them more uncomfortably and more prone to mistakes.
If the tech's supervisors, risk managers, and administration are unwilling to look into this, I would recommend filing a complaint with the state medical board. Depending on the state, this could be more trouble for the problem child than anything else.
Unfortunately, I would also suggest having a new job lined up prior to fling the complaint.
Thank all of you for your comments. I share the concern that you have expressed about the victim of this type of abuse possibly risking loss of employment if continued complaints are made. That is why I suggested that there might be safety in numbers.
My experience is similar in that busy surgeons are granted a lot of leeway especially if they practice in areas where many hospitals are available and willing to tolerate bad behavior in return for increased patient and surgical volume.
Anonyomous Europe: Wow guys... this is serious. As a trainee I have also had to do with a lot of different types of senior surgeons, but I consider myself lucky as I only had a very very few bad experience.... Do not worry, in Europe, especially in adult surgery there are a lot of psychopaths like that, or so I hear from the anaesthesiologists....In the surgical path that I took we also have our "special ones", but they tend to be rare, thank God (the Christian one, this is important where I live:)).
John C Hall writes in his book "Advice for a Young Surgeon", that as the role of the surgeon you need to ease the tension in the OR and elevate the mood as well as providing the operation.
As a "Generation Y" surgical trainee I would say that if we have to spend most of our lives working, then maybe we should do this in a good and relaxed atmosphere where we help each other. Of course you need to adhere to the rules of surgery but having fun while working is not a crime. Besides, the "old ones" need to train us so that we can take over some time. If the atmosphere is bad, then no one wants to work there and there will be no reinforcements.
Besides: I am a trainee. If I operate I need a fully relaxed atmosphere with nice people around me. If I get yelled at I will lose control after a time and screw up inevitably...
I'd like to suggest you compare the problem and the approaches to it outlined in the comments with the approach taken by one administrator at Kaiser. See "The Doctor Crisis" by Jack Cochran, MD. There are places where administrators protect their employees and patients from abusive prima donnas. Sadly they seem to be few and far between.
Years ago the OR was a very abusive environment, but we always tried to view it as letting off steam and not a personal attack. There would be yelling and carrying on and then we would be buddies in the break room. There was only one common break area so we really had to get along. I never did this, but I have witnessed scrub nurses smacking surgeons on the knuckles with a sponge stick if they got too far out of hand. The abuse could go either way. Usually if we were very good scrub nurses, we didn't have to worry about dismissal. The OR was a culture onto itself and I don't think anyone would have thought of registering a complaint to outside administration. Now that I am old, the bickering and being hollered at by surgeons is the thing I most miss.
As a patient at the hands of an abusive surgeon, because he was a sub specialist, he set the tone. The admin sets the tone because they tolerate this. People find out and it ruins respect for doctors, admin, hospital systems, etc. Until the culture of retaliation for telling stops, and everyone understands just how dangerous this attitude is in this profession, the better.
We had a major problem with abusive team leaders/managers. I would guess 20-30 people reported this multiple times on the anonymous 'hotline'. Nothing was ever done. If the problem goes all the way to VP of HR nothing changes. Sad.
This is DrMuchoGusto, twitter.
I come from a med student/surg in training perspective. Ive been yelled at, cursed at, etc. I have seen the instrument throwing, but not at me! However, if this was 10-20 yrs ago, haha, im sure something would have came my way. Listen, I love what I do. I really do have respect for the people teaching me and all house staff!
As a future surgeon I do wonder and worry about my voice in the OR, my leadership, how my confident personality could be perceived in a harmful way. Times are changing slowly, with the dismissal of Dr. K at UK hosp, I worry a lot that I too one day could be in a similar situation. I dont even know Dr K, UK surg, or anyone over there. Although he's accused of many things, one aspect that I am discussing is relationship with house staff. I don't want to dissect Dr. K's situation, but it worries me that someone could take a typical situation in the OR and twist it to have a surgeon disciplined or end his career. Even though I'm a rookie in this business, I have the surgical personality. To people outside of medicine or surgery in particular. there is a certain culture in the OR and in surgery that is different. I would never understand the culture of a professional football team's locker room because I am not involved with that. The same goes with surgery. Before becoming a doc, I never understood why some surgeons can be very tough to deal with. Now I am training to be one, I have been so forgiving for a lot of the surgeons who were not so nice at times. To get people's attention today it requires a variety of voices and styles. With the pressure so high, life and death situations, the expectation everything must go perfectly, the surgeon must get people focused immediately. Now throwing instruments at people is a big no no, I have NEVER seen that. I have seen instruments thrown though. I have seen abusive language and sarcastic remarks. Look I know I am bias, I am part of this fraternity. I know we have a lot of work to do, but its not going to change so easily. I worry if my confident nature and leadership will be a problem one day, sometimes you do have to raise your voice. I have the personality of getting along with everyone, but when the scalpel is your hand and no attending doctor is standing by your side, I am sure it's a lot different. I believe there needs to be a balance and there are boundaries. At the same time, I do think others have to realize what they are getting into by being a staff member in the OR. Surgery and the OR is not for every type of personality. I got to go, I'm working. I want to share more and give specific examples. But for all the negative incidents ive observed, house staff has never written up the surgeon. As many mentioned above, this has to occur, but there is understandable fear. To those in a hospital where little is done, I believe the challenge is having house staff come together and making a complaint collectively. Its just challenging to get one person to come forward, but when a hospital is so dependent on a surgeon either because he or she is one of few in their subspeciality or they just take a high volume of cases. I believe the only way to fight this in such situations is going forward as a group. I know its challenging. Thanks for the great discussion.
Great to see some different points of view.
There is strength in numbers. There is also strength in filing lawsuits against the perpetrator, be it the surgeon the hospital or both, alleging a hostile work environment. If the problem is rooted in money, perhaps the deprivation of money is a good stimulus for change.
I agree that there is strength in numbers and that a lawsuit is an option. However, I would advise anyone contemplating a lawsuit to be certain that the transgressions were adequately documented (preferably with witnesses who are willing to testify) and that a record of complaints filed and subsequently not acted upon exists.
There's something no quite right about how hospital governance is set up. Bad apples can't be disposed of easily, but hospitals are also too easily shielded from accountability if a bad apple continually misbehaves and they choose to keep it because of revenue.
I agree. Here's an example of some questionable hospital accountability. http://skepticalscalpel.blogspot.com/2013/09/on-horrific-story-of-texas-neurosurgeon.html
Anonymous Europe: The problem is, hospital bureaucracy has grown immensely somehow and the supplies of doctors have not grown as much.... Once I saw a diagram of how the budget of the university I work at is distributed: They spend 4-6 Million Euros (approx. 7-8 million US Dollars) a YEAR on the administrative department... whereas they are now trying to cut down on costs by reducing the number of doctors on call.... We should kick out 99% of the bureaucrats, suppress defensive medicine and lawsuits and lo and behold: health care would be cheaper at least by 70%.....
I was working in the OR as a tech. When no one was around, the surgeon hit me in the face with a piece of paper. His hand was firmly behind it. He pushed the paper into my face so hard that my reading glasses were smashed into my face. Later in the morning he had a melt down and was running up and down the hall yelling F-Bombs. Quite a few people witnessed that. I waited a week to report it because I was afraid of what would happen to me. I reported it, because if he hit me once, he would do it again. All hell broke loose, the doctor and his assistant tried to convince me I was mentally ill. I was moved to a different site with no explanation to them why I was there and I know he continues to bully the people I use to work with. It's been 3 years and I still have nightmares and I am afraid of everything. This is a huge hospital system that claims to have a zero tolerance for violence.
Anon Europe, nice to see that you have the same problems as we do here in the US.
Anonymous, sorry to hear about your situation. I wish there was something I could do to help. Email me if you have more to say. Skepticalscalpel at hot mail dot com.
Anon, I am so very sorry and scared for you. Make sure you have all your stuff in writing. They won't want to let go of their money maker surgeon. With all due respect, if the surgeon is doing that, they've done it to others and may be doing it in the family, etc. Either way they can potentially be going after the patient and the like if they're unable to deal with the stress. I was in your position as a patient who just recently had a doctor mention PTSD in regards to some of the "interactions" I had with a surgeon. I have an outstanding support system. Whatever any one can do to help, this group will.
I can vouch for Skep as being one of the decent guys, Artiger I think is also, MustoGusto too. On behalf of the decent ones, do what you can to protect yourself, others, and lets try to see if the good surgeons don't get a bad rep because of this one problem.
Anon Europe I would get rid of 90% of the admin and risk mgmt./lawyers. Then would have a 55-45% ratio of patient/doctors, patient led system to hear problems. Patients would have to qualify by having common sense and the ability to understand people and make some sense out of medical jargon. Doctors would have to disclose conflicts of interest. Then go from there, because medical boards are garbage to both sides. I think you can do a lot of change for the better for both sides if you had a faster arbitration system, which obviously the right to sue goes out there. Frankly, I hear from many harmed patients they're looking to change the system and get better medical care.
I for one have been very vocal about those who don't speak up, stand up for righteousness, keeping secrets, staying silent - feeling it's unethical, unjust, unfair and immoral. But let me say this to all of you,
I am so sorry from the bottom of my heart I did not realize more of you than not- try to do the right thing by your profession, each other and us as patients. And the repercussions you risk doing the right thing make you braver than the bravest of us all, and I get why now sometimes you just can't. ( this thread on this topic has changed my opinion forever) ! The true problem, the biggest problem seems to be coming from a certain Floor and office in every hospital in which none of us can truly rely and depend on. Thank you for all your hard work and dedication, I apologize on behalf of everyone who treats you unkind and unfair, those who are ungrateful and unappreciative.
I for one have been very vocal about those who don't speak up, stand up for righteousness, keeping secrets, staying silent - feeling it's unethical, unjust, unfair and immoral. But let me say this to all of you,
I am so sorry from the bottom of my heart I did not realize more of you than not- try to do the right thing by your profession, each other and us as patients. And the repercussions you risk doing the right thing make you braver than the bravest of us all, and I get why now sometimes you just can't. ( this thread on this topic has changed my opinion forever) ! The true problem, the biggest problem seems to be coming from a certain Floor and office in every hospital in which none of us can truly rely and depend on. Thank you for all your hard work and dedication, I apologize on behalf of everyone who treats you unkind and unfair, those who are ungrateful and unappreciative.
Carole, thanks for commenting. I appreciate the feedback. It is a very difficult situation for people without power to be in.
There are definitely some bad actors, and unfortunately many of them represent big profits for the hospital and thus are unlikely to get disciplined. In addition, in smaller communities, some subspecialists represent the only, or part of a very limited array of choices so hospitals cannot afford to end relationships with them unless they are willing to stop offering some services (and thus limiting transfers and referrals), regardless of how horrible they are.
Surgeons in general can have difficult personalities - I know this isn't true of everyone, but as an ER doctor I can tell you of the tantrums I've weathered, most came from surgeons. However, when I encounter this I remind myself of 3 things:
1. Surgery was my first clerkship in medical school, and during orientation the rotation director told us, "Sometimes you may hear or see things in surgery that seem aggressive, or wrong. Just remember that context is everything - if you saw people on the street interacting like football players, it would be assault, but during a game, it's good play."
2. A bit of perspective passed on by one of my ER attendings in residency, when I griped about surgeons being so testy in the OR during off-service rotations ("They scream if they get the wrong suture, while I'm sewing with no assistance, 4-0 where I should have 5-0 because the department's out, while crouching on the floor because there's no other way to get a good angle."). She pointed out a key difference in the perception of responsibility, "We get patients who are expected to die, and if we return them it's a miracle. They take a patient viewed as being in good health, and are expected to return them in the same condition, if not improved."
3. Finally, I never, ever have to take call. When someone is impugning my medical training, judgement, and the honor of my mother on the phone at 3am, I just try to remember how hard it must be to do clinic/surgery all day, get woken up by phone calls all night, and then work the next day too. Meanwhile, I get to go home, eat, sleep, whatever I want until my next scheduled shift.
Anon321, thank you for your thoughtful comments. I had not thought of things from your point of view. I would loved to have worked a consultant in your ED.
I have been a C.S.T for over 35 years. I have been yelled at, pushed and cursed at, more times then I would like to say. The one thing I do try to remember is it is the abusive surgeon who has the problem. We live in a non-perfect world. things happen, instruments are dropped, things are misplaced, mistakes are made BUT we are all adults. No one has the right to be disrespectful. Screaming and cursing does not solve problems and should not be tolerated by staff members who are honestly trying to do their jobs. The problem should be addressed and solved in a courteous manner because none of us are perfect we all make mistakes. Saying all this I am happy to announce I will be leaving this profession in December. If I had my life all over to do again my choice of work would be teaching never surgery. It has cost me sleepless nights and unneeded stress.
SBD, sorry to hear about your bad experiences over your long career. On behalf of those who abused you, I apologize. It's not much, but it's all I can do. I hope you enjoy your retirement.
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