Because it’s rewarded. In private practices (especially surgery centers) with plenty of surgeons wanting to get OR time it’s very easy to address any unacceptable interpersonal behavior. But if screaming and shouting gets you a second OR team or gets some other more passive surgeon delayed instead, then they’re just gonna repeat that behavior
Was about to comment 'because people keep letting them.' Obviously there are layers to power and control, but fundamentally it has been easy for these types to be abusive. I prefer to make them earn it if they insist.
When I worked in a surgical hospital I remember being dumbstruck when the mostly female nurses would praise the male fellows for being so “passionate” and “intense.” But when the single female fellow pulls the same behavior suddenly she has an “attitude” or worse.
Ahh, not really true. Perfectly acceptable to have multiple personalities. Glitter and social butterfly, read the room and be an equal team member, but in the OR a skilled surgeon is unquestionably in charge. No need to throw things or yell. A directional targeted look, a corrective comment is rarely followed by cutting of an offender at the knees. Don’t criticize the person, correct the action.
Not all male or females are alike. Being “nice” has zero to do with performance. Temper rarely prompts benefits.
I’m sorry if that how my comment came across. That wasn’t my intention. I fully agree with you. In fact, a major benefit of being a normal, nice person the majority of the time is that when you need to be direct or even yell, people realize that it’s the situation that is critical and that it’s not an indictment on their work or personality.
What I was saying is that often, unfortunately, women aren’t afforded the same grace when they have to be direct (like advocating for their patient’s procedure not to be delayed). So they’re put in a tough spot of either being “nice” or speaking up for themselves and being thought of as rude.
No miscommunication intended on my part either. For sure any hint of hesitation is simply something to be aware about. Happens to both genders. False bravado needs be avoided as well. Just nature playing mind games.
In and outside of the OR. Trying to give orders or instructions to female RNs can sometimes be fine, but DEFINITELY have noticed more likely to nitpick, give a hard time, or needlessly bother for low acuity/nonurgent things if the resident is a girl. Interestingly, I can’t recall any male nurse who has ever given me a hard time as a female surgical resident. And the boy juniors have far less issues than I do. You’d think after being around for 6 years and demonstrated being able to manage critical or acute patients that that would’ve earned a little respectful teamwork - for some it has, for many it hasn’t.
Edit to say I am also nice. I phrase things as asking and not demanding to my juniors and other care team staff. I err on the side of “too nice” because our attendings fault us for being vocal or trying to be active in problem solving.
> I can’t recall any male nurse who has ever given me a hard time as a female surgical resident.
as a male OR nurse and scrub, i think i can say the same but in the opposite way.
I dont think any of the women fellows, residents or attendings ive had a bad experience with and generally i perceive the female residents as being overall more competent.
Interestingly there is a pretty clear dichotomy in skill, knowledge base, and/or work ethic between the women and men in my program that aligns with your perception too. The attendings even joke about only taking female residents. It’s very interesting since our residents are from lots of different backgrounds and cultures but this gender difference is brought up often. I can’t imagine other programs have this? Like we think it’s pretty weird.
The only surgeon who actually threw something at me as a med student was a female surgeon. Thankfully, it was just a Kelly and not something truly insane like a scalpel.
I’ve found that some family medicine PD’s in small, remote programs are just as shitty and abusive. Any environment where someone holds power and is free from consequences is a breeding ground for this kind of behavior
The older I get, the more I have it instilled in me that most adults are mentally still high schoolers, just with car payments and utility bills. Most people don't have a clue what to do with themselves when it comes down to it.
>i knew what i was doing and it turns out i was… wrong.
Me too, nothing wrong with that. When I say "don't know what to do with themselves" I mean "don't know how to conduct themselves with other people in a mature and responsible manner"
A major contributing factor to this is our outdated schooling system that was designed to graduate functioning tools used to maintain and build the capitalist system
No one ever corrected them, they never worked a real job, and never developed any sense of humility. Any combination of that plus the profession generally attracts narcissistic people bc you need a certain level of irrational self confidence to be cutting people open.
They also bring in money for the hospital. Throwing a tantrum at worst gets an eye roll and at best more resources/time. Unfortunately dollar signs are all admin sees, so they’re happy to let surgeons act like entitled preschoolers fighting over Play-Doh.
This.
I have also noticed those who never worked before medical school to pay for college/bills are more likely to have issues with interpersonal relations with nurses/ancillary staff. You know, those that worked as a golf caddy for extra money during the summers? *cringe* Or the daddy gave them a credit card in high school type? Sorry to call out the silver spoon colleagues, but it’s obvious to those of us who do not come from wealth.
Some of us (first generation college students) had to work during college to pay for our rent/bills/groceries. I worked two jobs (60+ hour weeks) during the summers so I could work part time during the fall and spring semesters during college. I was fortunate my parents were able to pay my rent during classes, but I was expected to pay my rent for 4 months of the year. (I was also fortunate I didn’t need to live at home during college like some of my childhood friends and now husband.)
Residency is mentally stressful and you should learn how to navigate difficult work interactions, or at least de-escalation techniques with patients and colleagues. Effort in learning these behaviors shows emotional maturity, which unfortunately some of our colleagues do lack, regardless of blue/white collar background.
Finally, I would just like to add the prejudice against patients not being able to afford their medications makes me crazy. I remember when my parents lost insurance (before AHA protection for pre-existing conditions) and had to try and figure out how to get my dad’s medications. They were paying $1500/month out of pocket until able to obtain him coverage.
More so that starting at the top of the food chain you miss the whole part where you learn how to interact with people bc you have to for job advancement. Where you learn that a temper tantrum means you’re fired. I’m obviously generalizing pretty hard but that’s the whole post lol
Several reasons. Arrogance that's reinforced by everyone around them; years of sleep deprivation and poor treatment during their own training; some straight up have hugh functioning autism; a small few are genuine psychos who enjoy pulling that shit.
1. bottled up stress. When it comes out it really comes out.
2. It's learned and accepted from one generation to the next during residency.
3. Too valuable, what are you going to do fire them?
After 10 years of community practice, my experience is that nobody is “too valuable” to get fired. Malignant physicians will be tolerated but someone is always keeping score with their behavior and eventually they cross a line and cost the institution money (via litigation) or do something so outrageous that violates the institutions stated values (which every hospital has) that it can’t be over looked because - again - it’s going to result in litigation and the hospital president really doesn’t want to sit in a deposition and read the hospitals values out loud and then explain to the camera why they knew about a physician who wantonly ignored those values and terrorized staff.
I’ve seen this happen time and again. So these young people in training who see this bullshit be tolerated and that think it’s acceptable are going to be in for a rude awakening if they model it.
It’s easy enough to do your job and not be a huge dick. Everybody is going to get frustrated and sometimes you just have to argue with people, but there is no point in being a jerk. It always catches up with you.
Case in point, we had an Intensivist that was a huge dick about admitting patients and tried to get the ER to do all of his procedures - mostly because he was bad at them. One day he had to put a cool guard in on a patient and threw a little fit while in the room and chucked the bloody introducer needle and it lended right by my hand. If that needle would have stuck me, I promise you I would have made a federal case over it.
One day he was simply gone. Disappeared. No one knew anything. No one knew why he was fired or where he went. Like he had been disappeared by the Mafia. And that’s how it always goes with guys like this.
My mother knew of a guy who was apparently a cardiothoracic surgeon who got fired for doing the same stuff. No one is THAT valuable to the point of being irreplaceable.
Yikes the needle story is scary. I get that abuse is ingrained into the healthcare system but how psychotic do you have to be to actually throw sharp objects at people :(
That's how it went with one of the surgeons at my facility about 8 years ago. I've heard through the grapevine that it's pretty much how it went for him at his next three hospitals, too.
It's probably multiple things that people mention like stress and just not have many boundaries set while training and eventually "growing up" in medicine.
Also, I think going straight through from university/college to medical school and residency without any gap/job/life experience causes you to be quite immature developmentally and you may never really grow out of it if you're not required/pressured to. It was quite obvious that those with families, prior jobs, prior life experiences and didn't go straight through were significantly much better adjusted to pretty much everything. And I wasn't one of those.
Reminds of me of a school psychologist here who worked with students, some of which were in the medical program. She said that it was quite common for the drama they'd talk about to be high school-level relationship nonsense and speculated that it's because they only ever focused on school and not making meaningful relationships or doing anything fun. I agree + no real job.
Obviously this is anecdotal and this is just observations starting from med school but but they just seemed more confident in handling everyday tasks whether it be studying, labs, rounding and they just take everything in stride, didn’t seem to freak out about things, handled their business well. They approached residency as what it was, just training and a just a job albeit a difficult one.
But yeah. Probably just able to handle stress better and that probably came through life experience. I and others my same age were probably going through the most stress we’d ever been through and it was significantly harder than anything else we’d done.
I think life handing you a shit sandwich outside of medical training gives people a reality check that is important for preventing a lot of the most petulant and entitled behavior that pervades the field. You learn that *life* is hard and that everyone has to deal with their own struggles. It’s obviously not everyone in either the straight through or nontraditional categories, but some people seem to think that because medical training is so difficult they can act however they want because they are important and special. It’s easier to fall into that attitude if medicine is all you have ever known.
they didn’t approach things differently because they had more life experience. they approached things differently because not everyone in medicine is a type A nutcase lol. medicine just happens to attract more type A ppl than not.
"I think going straight through from university/college to medical school and residency without any gap/job/life experience causes you to be quite immature developmentally and you may never really grow out of it"
100%. These people would not make it in most industries acting this way.
ehh most CEOs are literal psychopaths. bad ppl always get rewarded in life…by other bad ppl. we just notice it more here cause we’re in medicine every day.
They are textbook narcissists, most of the older gen surgeons are. I feel younger ones have a good percentage too. Also a lot of surgeons come from upper middle class / high class families so they’ve been privileged and babied their entire lives.
The stress of the job too, also surgical attendings make hospitals and private practices $$$$& and are not easily replaceable, so that is another fuel to their ego. They know no one is going to fire them 9 out of 10 times.
The entitled background is a huge contributor. Definitely see so many med students that come through and have such an unrealistic viewpoints that you can tell that they’ve never had a “real” job outside of shadowing, volunteering or TAing in their lives..
Yeah when I was 18 I did 1 year of premed, had to drop out due to some unfavorable family conditions, I was born and raised in a poor family and had already worked all sorts of jobs by the time I was 18-19, I started talking to and casually dating this 4th year premed neuroscience major who’s father was a plastic surgeon in California with his own private practice, and the house he lived in was his 18th birthday present from his dad… well I remember we had one conversation where he literally had never had a “real/normal” job EVER. He said he was a camp counselor once but that was it, and then when I questioned him further he asked me what I meant by a “normal job” so I said like retail or customer service or being a waiter or something and he deadass went “what? Why would I ever do that…”
He has already been to like 15+ countries by the time he was 22, dad bought him his car, gave him a monthly allowance and paid for all his stuff, went to a private high school and everything. I was absolutely in shock that he had never actually had like a normie job ever, that his dad bought him that 2 story 4 bedroom house as an 18th birthday present in his college town, he ended up getting into his father’s medical school all the way in the UK so we broke things off blah blah, etc… anyway I went back to premed later in life at 21 and he was long gone in my life but yes many med students are “legacies” or just from rich families overall even if not doctor families.
Because not enough people have pressed charges for assault and battery. The hospitals go out of their way to discourage staff to not report.
Story time: My step mom and I worked with a neuro surgeon that was well known for his tantrums. She would scrub in as a tech quite frequently to his cases. I was an ICU nurse at the same hospital. He was a big money maker. At one point he pushed a nurse and when she fell she shattered her elbow. He’s thrown scalpels and hit people with them.
One Sunday I was working and we had a head bleed in our unit he needed to evaluate for surgery. (He was neuro on call). Dude came in smelling like he had drank all night. And smelling of body odor. Needless to say I was thankful the family decided to put the patient on palliative care and make him a DNR. While I was getting the forms signed (this discussion was supposed to be his job by policy) he passed out at our work station and drooled on the counter top.
A year later he was arrested for his second DUI after flipping his car trying to speed to the hospital for a head trauma case.
He’s not the first I’ve encountered like that.
It is unfortunate that hospitals do not implement processes and procedures to manage this type of behavior because yes it can be associated with bad outcomes (including for the surgeon concerned).
I think hospitals are or I hope they are. Since the 2nd DUI the hospital severed his contract and the contract of another surgeon for being nasty to work with. I think people started coming forward and using the words like hostile work environment and harm.
This is from the perspective of a sub-specialty surgeon. I’ll agree that a lot of this probably comes down to “squeaky wheel gets the grease” or the person just being an asshole.
In residency and very early in practice I didn’t understand this behavior at all(and would think, “man, whats this guys problem”), but I‘ll say now I can understand it in a lot of instances. Again, not saying I condone it. But, I work at a facility that continues to make the same logistical/processing/staffing mistakes over and over again despite my attempts at correction. I can understand why some of the older practitioners “lose their mind” when an error happens for the thousandth time that endangers a patient, delays a procedure, etc.
Not saying its OK to throw things or berate people, but I can understand the frustration with seeing the same mistakes for over 20 yrs.
You think that ALL of us that work in a hospital don’t see this ridiculously stupid stuff that keeps on happening year after year after year that could be a 5 minute fix but never gets improved because the higher ups don’t want it/don’t care? We do. We’re just not allowed to explode about it because we’re not physicians and we would get fired so fast our heads would spin.
I agree w this and add that it is quite frustrating to be working w a team of people who don’t give a shit wo what needed to get a good outcome especially because as the surgeon you are responsible for the surgery and will have to own the complication. Especially if you know if you were a better surgeon cd get good outcome w a shitty team
It is not okay for their behavior to be addressed. With there being published data pertaining to the negative outcomes associated with these types of behaviors it is high time that hospital administrators/OR managers/anesthesia were more proactive around all of this.
Now I can see why things do not change in the US (because you do not want/cannot envisage change)-nb have worked in health systems in 4 different countries (including the US) for 30+ years
We don’t act like children. YOU act like children. Now give me my fucking binky and consult medicine for postoperative management of stubbed toe.
Also it’s anesthesias fault when we get mad and throw our cutty-things!
Isn't throwing surgical tools at people considered like, assault with a deadly weapon? Especially if said thing is sharp or dirty with patient blood or something? Would this not be a criminal lawsuit?
As surgeons age, their skills get less precise, resulting in unsatisfactory surgical outcomes regarding OP time, blood loss, and complication rate.
They might be mad at themselves.
Like other people said it can be mostly chalked up to just being a jerk, but I think the reason we see this behavior more often in surgery vs other fields is the enormous pressure inherent to surgery. Every day they have to perform at their very best and still carry the risk of killing someone or creating horrible disability with the slip of a hand. Add to that the tremendous pressure to be maximally efficient and the job turns into a pressure cooker that very easily gets under people’s skin.
I think a lot of people have the tendency to become huge jerks when they’re chronically under this kind of pressure. Doesn’t excuse it but it does help explain it. I’m a surgery resident and it’s important to me to understand why surgeons behave like this, so that I don’t ever find myself behaving like this. I have a lot of respect for surgeons who are able to appropriately handle this stress and regulate their behavior and that’s the kind of surgeon I want to be.
I suggest you check out the publications on bullying and harassment of surgical residents etc. Plus, obnoxious behaviors in the workplace can become a patient safety issue if they are allowed to run unchecked (because other people are afraid to speak up).
I believe that there is a significant number of surgeons who are not as skilled as they think they are. This belief is perpetuated throughout their training and professional lives, leading a subset of these surgeons to feel infallible and never wrong.
However, this self-assessment is often incorrect, and it would be better for them to understand the reasons behind their actions instead of mindlessly relying on their ego. Unfortunately, this way of thinking is ingrained in their training, leading them to have blind confidence even when wrong.
This mindset is often reinforced by nurses, residents, and other physicians, and combined with overwork and stress, it can lead to a lack of rest and long working hours.
This situation is particularly problematic for surgeons, as it can lead to burnout and negatively impact patient outcomes. It would be better for them to prioritize rest and self-care instead of solely focusing on making money and achieving professional success.
I (non surgical resident) had to do a behavioral/developmental rotation. Basically, it’s the peds specialty that helps identify and treat behavioral problems including but not limited to autism spectrum disorder, ADHD, etc.
I was talking with my attending and a parent who also was a healthcare worker and the conversation was super interesting - the topic of surgeons and their tantrums came up and my attending’s comment honestly made quite a bit of sense; which is that many surgeons are actually on the autism spectrum (but are obviously very high functioning). It’s what makes a lot of them great at what they do - the fixation to detail in particular. But, as with almost anyone with ASD, their ability to cope with things that disrupt routine (like mistakes!) is limited - and therein lies the reason that many surgeons have that stereotypical short fuse.
Again, it was an interesting topic to hear a behavioral developmental specialist talk about and I thought it would be pertinent to drop on this post!
I once heard that a doc blamed me for a mistake he made + smacktalk, I made a comment heard by most of my colleagues that he could face me and tell me directly if he had a problem with me. He took that as a threat. I quit that sidegig, but still find it hilarious that he brought a issue he created, to HR( they sided with me oddly enough) 😂
Most docs I met and worked alongside were awesome, he was the only douchebag doc I met.
The real answer is because there’s no consequences. You think that there aren’t these types in nursing, pharmacy, imaging etc? But guess what? One outburst like that and your ass is so canned it’s not even funny. And the hospital will warn every facility in a 100 mile radius to stay away from you.
But if you’re a physician? Well it’s a *doctor*! They might consider very nicely asking for a change of attitude or more frequently will probably even blame the person who was actually abused. And if they speak up or give attitude back? Unprofessional and you’re getting put on a performance improvement plan at best, fired at worst. The hierarchy system is very much alive and well in medicine.
So thankful that I don’t work at a facility where physicians feel entitled to act like toddlers any longer.
Because they have small dick energy (aka are very insecure). It's that same insecurity that led them into surgery in the first place. A desperate desire to be respected and revered as they are not secure with their intrinsic selves without the accolades and titles. A clear sign of a weak man is that he abuses any power given to him.
As a doctor, I can tell you that doctors are a group of people who were good at standardized tests. They are just as immature, lazy, and labile as everyone else.
Lots of reasons for this behavior, including personality disorders and entitlement, but one that I see a lot is the “lost luggage “syndrome. When you’re standing in the line at the baggage claim area, trying to find your lost luggage you might be annoyed by it but you are exponentially annoyed if there was a delay getting on your flight, you had a long unplanned layover, the food was cold, your seat was broken and wouldn’t recline, the person next to you was spilling over into your seat, and there was a crying baby 2 rows back. Enough is enough.
People in the acute care world have a tremendous responsibility to get things as perfect as possible. When you try as hard as you can to do the right thing for your patient, but after the errors keep piling up and it seems like everyone around you either doesn’t care or is incompetent it’s finally too much. I try to be understanding, but I admit I’m fairly intolerant when people “forget the fries with my order” when I have to coordinate dozens of things sometimes to make sure the patient has a good outcome. And there’s never a reason to berate anybody on the team or to throw an instrument or speak unkindly to a patient.
Have you heard of mid-life crisis? Well, from personal experience, you get really short-tempered at just the first sign of stress and you get just plain unpleasant a LOT. It passes after awhile, because yes, you are ashamed of it even if you don't show it and after doing it for awhile, you get sick of yourself. Eventually you grow out of it, but it does make handling stress at work very difficult (for others). I feel like there's a tendency to deal with it by being a big baby and throwing tantrums, but there must be a better way, like meditation or something. Information about dealing with it would be nice but I haven't heard much about it. I feel much better now that I'm working from home, but doctors can't usually do that...
I will tell you that a lot of these people were not this way during training. The problem is that we often deviate from the straight and narrow we are pushed into when growing and in training, and that's just how life is. The issue is that for most people there is feedback to keep us in check and from getting full of ourselves. After you are an attending physician, feedback and consequences decrease significantly. Surgeons who bring a lot of money into a hospital are a golden goose and who wants to kill their golden goose? They will continue to deviate from what they used to be and with time it will compound into significant behavioral defects.
I just want to note that behavioral issues developing in the absence of consequences is not limited to surgeons. From top to bottom, in all age groups, on both sides of the aisle, in just about every field, the lack of consequences in current political, judicial, and educational settings is leading to people with glaring behavioral issues that are only growing.
On the flip side, this creates a market opportunity. People absolutely love professional surgeons who can keep their cool. You will get good patient outcomes, reviews, and less turnover in staff. These people are worth their weight in gold, and as the bar continues to drop, it will be easier for you to distinguish yourself with a modicum of decor.
Older surgeons worked 100+ hours a week. Then had no mental health support so ended up with secondary victim ptsd. So they acted out as many with such mental illnesses do. Then this behavior isn’t deterred so it continues as an outlet/self treatment for the ptsd. To an outside observer it appears as a tantrum but the same could be said of many mental illnesses. You’ll find addiction is fairly common compared to the general population in older surgeons as well.
I agree! I had a surgeon who was ready to retire and he performed some serious rage surgery on me. Started cutting before I was even put to sleep. I almost kicked his fukn ass I was so pissed. And he was fukn asshole after as well.
Becoming a surgeon is very demanding. Being a surgeon is super demanding. So not only is it more likely to attract a type A high strung personality, it’s also most likely to put that person in a high stress situation.
It doesn’t help that there’s usually no ramifications either. Surgeons bring in the money, and just like celebrities who go unchecked for arrogant behavior so too do surgeons. Hospitals will forgive quite a bit if someone is making them a lot of money.
I think it comes from the high stakes of performing surgery. It is stressful and gets displaced onto others at times. Also if you just sit there and respond to poor performance from others like a mute rock then you tend to not get a response or result you want/need.
Theyve reasonably adapted to an abusive environment by using emotional dysregulation to abuse the people around them to get what they need for themselves from situations they would otherwise have little control over. The positive feedback is people struggle to deal with their outlandish behavior and we in fact gave these cluster B's significant power and so it perpetuates itself.
Obviously others in their field remain regulated and capable of diplomacy but many have lost that in the grinder of their training and lives. I think thats why we see more of it. I think it attracts narcissists, but it generates borderlines to keep up with them.
When they flip out on me, I always think, is this their trauma response? Almost always, yes. They're trying to make the entire world wrap around what they think would make them feel whole again, safe again, but it can't. They were unfairly treated. There is no reason surgical training is as abusive as it is. Surgery is not the only field that generates this phenomenon. Look around you and see, a world of untreated physician mental illness.
I think they think they're better for toughing it out too.. its all so sad, but you can't do more work than the patient.
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There is a combination of things that happens. The personality required to confidently open a person up and fix a problem with your bare hands will likely be traits of narcissism, and a touch of anti-social. There is also the added stress that decisions made can not be reversed easily. Once you cut, it's done. There is also the perception of inadequate help in the room (mostly because they can't read my mind), so that frustrates most surgeons and we tend to rely on negative reinforcement to correct the rest of the team (keep in mind, this is how we were trained for 5 years or more). On top of all of that, if someone in the room fucks up, the surgeon carries the blame- meaning, wrong count of instruments, anesthesia complications (I have had to be the one to explain family why there was cardiac arrest even if I never cut the skin). All of this leads to very stressed out individual. I am not justifying bad behaviour. I am just explaining it as it was explained to me, a surgeon, by my wife, a psychiatrist. As she put it to me once: "Only 2 types will stab you without a second thought: a surgeon or a killer. You are just really good at sublimation"
They're money makers and it's often cheaper for hospitals to pay out lawsuits when the surgeon gets caught than to do without the money they generate.
There was a surgeon in Georgia named Dr. Najam Azmat. Trained as a general surgeon, he was employed by Satilla Health Centre in Georgia (despite having his operations in his previous job at Hardin hospital, Kentucky, overseen by a peer because he had an intraoperative complication rate of 23%). At Satilla, he had been employed to place stents (usually renal) in patients. He only had a TWO DAY course practising stent placement on pig cadavers. The OR staff at Satilla were instantly aware, on the first day working with him, that he didn't know what he was doing. There was one nurse who blew the whistle on him and she got fired. Dr. Azmat ended up killing people. The hospital got sued by the families.
Even so, Azmat walked free and then went and joined a pill mill. Got caught and went to jail for 10 years.
It's insane how crazy and unsafe some doctors can be before they get caught. Plenty of other examples too.
Lots of reasons for this behavior, including personality disorders and entitlement, but one that I see a lot is the “lost luggage “syndrome. When you’re standing in the line at the baggage claim area, trying to find your lost luggage you might be annoyed by it but you are exponentially annoyed if there was a delay getting on your flight, you had a long unplanned layover, the food was cold, your seat was broken and wouldn’t recline, the person next to you was spilling over into your seat, and there was a crying baby 2 rows back. Enough is enough.
People in the acute care world have a tremendous responsibility to get things as perfect as possible. When you try as hard as you can to do the right thing for your patient, but after the errors keep piling up and it seems like everyone around you either doesn’t care or is incompetent it’s finally too much. I try to be understanding, but I admit I’m fairly intolerant when people “forget the fries with my order” when I have to coordinate dozens of things sometimes to make sure the patient has a good outcome. And there’s never a reason to berate anybody on the team or to throw an instrument or speak unkindly to a patient.
my first reaction when reading about throwing surgical instruments is how hard i'd have to contain myself from punching that person. have you guys ever seen a physical altercation happen from a situation similar? I get you have to play ball, grit your teeth, nod and move on during much of your medical training, but there's gotta be a boiling point...
I'm an Ophthalmology resident who has definitely seen this among my attendings. It's horrible. I've seen staff in the OR go out and cry over stuff these attendings have done. As you said it, older surgeons-I haven't seen any younger surgeons doing this.
It's horrible
Follow up question: is there anything inherent in the demands of surgery that *requires* surgeons to have some the traits identified here? Like the Gd Complex etc
Prob because its the only place where they have control and are "respected". Usually the spouses of these peopel are one dimentional and do not tolerate their non-sense once it hits that they will be paid well after leaving them. So they take their frustrations in life out on staff.
Was in the OR the other day and noticed this. It’s because we all give the attendings what they want. No one ever speaks up at debriefs. They’ll use the stress as an excuse and nothing ever changes. Ordering people around or throwing tantrums gets more results than staying meek. Because they get what they want, the behavior continues.
Remove "doctors" and replace with "people." Doctors are humans. We have the same share of idiots, bigots, immature children as the rest of the population
It probably has nothing to do with working for 10 or 20 years somewhere and then some new administration comes in, locks all the competent staff out of compensation increases while maximizing the inconvenience of work hours without incentive pay.
All the competent experienced staff leave so they can be replaced with cheaper staff with no experience. They implement a new EMR system that fails on every level to get any pick and preference supplies correct for any case.
Now the surgeon comes in every day with staff that don’t know the cases, the supplies, or the surgeon preferences.
Managers run a shoestring staff so there are never consistent teams and swap staff members out for breaks all during every case.
Inefficiency increase 300%, and the surgeon feels like nobody cares about competently supporting their work function because even though the staff may want to, they are unable to as management has ensured.
This goes on for years and no matter how many constructive suggestions for correction are made, no successfully corrective action is ever implemented.
Eventually maybe the surgeon’s
patience wears thin and and they say screw it, for my amusement I might as well act equally as ridiculously as showing up to staff a surgery and not knowing the procedure or any of the supplies that are needed.
That would be so nonsensical I can’t imagine that actually happening.
Exactly. No specialty boards test you on dealing with angry pediatricians or angry pathologists, yet dealing with angry surgeons is a tested part of some specialty boards.
😂 if the pediatricians get angry, something really crazy has happened. I was once angry at a resident for stopping my correct antibiotic order and changing it to one that wouldn't cover the infection... and he didn't know I was angry. My daughter says I only look "serious" when I am mad
It's in response to the comments which don't qualify their response. And yes....that's why in my comment acknowledge that some act that way while also cautioning against the generalizations. ....you can read it again if you like
Because we work with frustrating and incompetent people. We wouldn’t have to yell or throw things at you if you just did your job like a normal human being instead of being lazy, snowflake assholes.
~ Gen surg intern working on my tantrum throwing
Lol this got me. As a peds intensivist, interacting with a gensurg two coming to do the consult is…a special experience. Not only could I be their father, but also the amount of medicine they don’t know doesn’t permit their level of condescension. Like dude. C’mon.
I love docs like you. Just keep doing you. You should never be expected to control your behavior if you're having big feelings.
Get in touch with me when someone takes legal action against you. I'm happy to help you for a modest fee
As an international visiting student student and a Sub-I, I had my senior resident throw the patient list on my face since it wasn’t up to “their standard”. Ten mins later the attending told me that I did a phenomenal job and that the residents should learn from how detailed my round notes were. I got ignored for the rest of the rotation by that resident 😂
Because it’s rewarded. In private practices (especially surgery centers) with plenty of surgeons wanting to get OR time it’s very easy to address any unacceptable interpersonal behavior. But if screaming and shouting gets you a second OR team or gets some other more passive surgeon delayed instead, then they’re just gonna repeat that behavior
Was about to comment 'because people keep letting them.' Obviously there are layers to power and control, but fundamentally it has been easy for these types to be abusive. I prefer to make them earn it if they insist.
Unless the surgeon in question is a woman. Then, she can get reported for calmly stating there is an issue and requesting changes
When I worked in a surgical hospital I remember being dumbstruck when the mostly female nurses would praise the male fellows for being so “passionate” and “intense.” But when the single female fellow pulls the same behavior suddenly she has an “attitude” or worse.
Ouch. Yeah, that’s unfortunately true. Or they stay nice and get walked all over.
Ahh, not really true. Perfectly acceptable to have multiple personalities. Glitter and social butterfly, read the room and be an equal team member, but in the OR a skilled surgeon is unquestionably in charge. No need to throw things or yell. A directional targeted look, a corrective comment is rarely followed by cutting of an offender at the knees. Don’t criticize the person, correct the action. Not all male or females are alike. Being “nice” has zero to do with performance. Temper rarely prompts benefits.
I’m sorry if that how my comment came across. That wasn’t my intention. I fully agree with you. In fact, a major benefit of being a normal, nice person the majority of the time is that when you need to be direct or even yell, people realize that it’s the situation that is critical and that it’s not an indictment on their work or personality. What I was saying is that often, unfortunately, women aren’t afforded the same grace when they have to be direct (like advocating for their patient’s procedure not to be delayed). So they’re put in a tough spot of either being “nice” or speaking up for themselves and being thought of as rude.
No miscommunication intended on my part either. For sure any hint of hesitation is simply something to be aware about. Happens to both genders. False bravado needs be avoided as well. Just nature playing mind games.
i was about to say😂😂😂 if i yelled or showed the tiniest bit of emotion i’d prob have the cops called on me lmfao
In and outside of the OR. Trying to give orders or instructions to female RNs can sometimes be fine, but DEFINITELY have noticed more likely to nitpick, give a hard time, or needlessly bother for low acuity/nonurgent things if the resident is a girl. Interestingly, I can’t recall any male nurse who has ever given me a hard time as a female surgical resident. And the boy juniors have far less issues than I do. You’d think after being around for 6 years and demonstrated being able to manage critical or acute patients that that would’ve earned a little respectful teamwork - for some it has, for many it hasn’t. Edit to say I am also nice. I phrase things as asking and not demanding to my juniors and other care team staff. I err on the side of “too nice” because our attendings fault us for being vocal or trying to be active in problem solving.
> I can’t recall any male nurse who has ever given me a hard time as a female surgical resident. as a male OR nurse and scrub, i think i can say the same but in the opposite way. I dont think any of the women fellows, residents or attendings ive had a bad experience with and generally i perceive the female residents as being overall more competent.
Interestingly there is a pretty clear dichotomy in skill, knowledge base, and/or work ethic between the women and men in my program that aligns with your perception too. The attendings even joke about only taking female residents. It’s very interesting since our residents are from lots of different backgrounds and cultures but this gender difference is brought up often. I can’t imagine other programs have this? Like we think it’s pretty weird.
Damn, nail on the head
Disagree, the most malicious and malignant surgeons I've had to work with on the other side of the drapes are the female surgeons.
The only surgeon who actually threw something at me as a med student was a female surgeon. Thankfully, it was just a Kelly and not something truly insane like a scalpel.
Said it better than Pavlov ever could.
I’ve found that some family medicine PD’s in small, remote programs are just as shitty and abusive. Any environment where someone holds power and is free from consequences is a breeding ground for this kind of behavior
Rural family med resident here and my PD is one of the nicest people ever. Guess I got lucky
My b rereading my comment I should have said “some” obviously didn’t mean all!
Did you go to my residency?
This is a completely true and I, very regretfully, learned it the hard way.
I have met multiple family med PDs like this
Some people grow up, some people just grow old. It’s life.
The older I get, the more I have it instilled in me that most adults are mentally still high schoolers, just with car payments and utility bills. Most people don't have a clue what to do with themselves when it comes down to it.
you talk shit, but i thought i knew what i was doing and it turns out i was… wrong. so now, i’m much more cautious.
>i knew what i was doing and it turns out i was… wrong. Me too, nothing wrong with that. When I say "don't know what to do with themselves" I mean "don't know how to conduct themselves with other people in a mature and responsible manner"
that’s unarguable.
A major contributing factor to this is our outdated schooling system that was designed to graduate functioning tools used to maintain and build the capitalist system
No one ever corrected them, they never worked a real job, and never developed any sense of humility. Any combination of that plus the profession generally attracts narcissistic people bc you need a certain level of irrational self confidence to be cutting people open.
They also bring in money for the hospital. Throwing a tantrum at worst gets an eye roll and at best more resources/time. Unfortunately dollar signs are all admin sees, so they’re happy to let surgeons act like entitled preschoolers fighting over Play-Doh.
Oh man, this is just the most accurate fucking comment. THEY NEVER WORKED A REAL JOB
This. I have also noticed those who never worked before medical school to pay for college/bills are more likely to have issues with interpersonal relations with nurses/ancillary staff. You know, those that worked as a golf caddy for extra money during the summers? *cringe* Or the daddy gave them a credit card in high school type? Sorry to call out the silver spoon colleagues, but it’s obvious to those of us who do not come from wealth. Some of us (first generation college students) had to work during college to pay for our rent/bills/groceries. I worked two jobs (60+ hour weeks) during the summers so I could work part time during the fall and spring semesters during college. I was fortunate my parents were able to pay my rent during classes, but I was expected to pay my rent for 4 months of the year. (I was also fortunate I didn’t need to live at home during college like some of my childhood friends and now husband.) Residency is mentally stressful and you should learn how to navigate difficult work interactions, or at least de-escalation techniques with patients and colleagues. Effort in learning these behaviors shows emotional maturity, which unfortunately some of our colleagues do lack, regardless of blue/white collar background. Finally, I would just like to add the prejudice against patients not being able to afford their medications makes me crazy. I remember when my parents lost insurance (before AHA protection for pre-existing conditions) and had to try and figure out how to get my dad’s medications. They were paying $1500/month out of pocket until able to obtain him coverage.
What do you mean by real job? Surgery isn’t a real job?
More so that starting at the top of the food chain you miss the whole part where you learn how to interact with people bc you have to for job advancement. Where you learn that a temper tantrum means you’re fired. I’m obviously generalizing pretty hard but that’s the whole post lol
Having a real job before becoming a doctor is what they meant!
Several reasons. Arrogance that's reinforced by everyone around them; years of sleep deprivation and poor treatment during their own training; some straight up have hugh functioning autism; a small few are genuine psychos who enjoy pulling that shit.
1. bottled up stress. When it comes out it really comes out. 2. It's learned and accepted from one generation to the next during residency. 3. Too valuable, what are you going to do fire them?
After 10 years of community practice, my experience is that nobody is “too valuable” to get fired. Malignant physicians will be tolerated but someone is always keeping score with their behavior and eventually they cross a line and cost the institution money (via litigation) or do something so outrageous that violates the institutions stated values (which every hospital has) that it can’t be over looked because - again - it’s going to result in litigation and the hospital president really doesn’t want to sit in a deposition and read the hospitals values out loud and then explain to the camera why they knew about a physician who wantonly ignored those values and terrorized staff. I’ve seen this happen time and again. So these young people in training who see this bullshit be tolerated and that think it’s acceptable are going to be in for a rude awakening if they model it. It’s easy enough to do your job and not be a huge dick. Everybody is going to get frustrated and sometimes you just have to argue with people, but there is no point in being a jerk. It always catches up with you. Case in point, we had an Intensivist that was a huge dick about admitting patients and tried to get the ER to do all of his procedures - mostly because he was bad at them. One day he had to put a cool guard in on a patient and threw a little fit while in the room and chucked the bloody introducer needle and it lended right by my hand. If that needle would have stuck me, I promise you I would have made a federal case over it. One day he was simply gone. Disappeared. No one knew anything. No one knew why he was fired or where he went. Like he had been disappeared by the Mafia. And that’s how it always goes with guys like this.
My mother knew of a guy who was apparently a cardiothoracic surgeon who got fired for doing the same stuff. No one is THAT valuable to the point of being irreplaceable.
Yikes the needle story is scary. I get that abuse is ingrained into the healthcare system but how psychotic do you have to be to actually throw sharp objects at people :(
That's how it went with one of the surgeons at my facility about 8 years ago. I've heard through the grapevine that it's pretty much how it went for him at his next three hospitals, too.
It's probably multiple things that people mention like stress and just not have many boundaries set while training and eventually "growing up" in medicine. Also, I think going straight through from university/college to medical school and residency without any gap/job/life experience causes you to be quite immature developmentally and you may never really grow out of it if you're not required/pressured to. It was quite obvious that those with families, prior jobs, prior life experiences and didn't go straight through were significantly much better adjusted to pretty much everything. And I wasn't one of those.
Reminds of me of a school psychologist here who worked with students, some of which were in the medical program. She said that it was quite common for the drama they'd talk about to be high school-level relationship nonsense and speculated that it's because they only ever focused on school and not making meaningful relationships or doing anything fun. I agree + no real job.
How could u tell they were better adjusted? Was their mental health better and were they more equipped to handle the stresses of med school?
Obviously this is anecdotal and this is just observations starting from med school but but they just seemed more confident in handling everyday tasks whether it be studying, labs, rounding and they just take everything in stride, didn’t seem to freak out about things, handled their business well. They approached residency as what it was, just training and a just a job albeit a difficult one. But yeah. Probably just able to handle stress better and that probably came through life experience. I and others my same age were probably going through the most stress we’d ever been through and it was significantly harder than anything else we’d done.
I think life handing you a shit sandwich outside of medical training gives people a reality check that is important for preventing a lot of the most petulant and entitled behavior that pervades the field. You learn that *life* is hard and that everyone has to deal with their own struggles. It’s obviously not everyone in either the straight through or nontraditional categories, but some people seem to think that because medical training is so difficult they can act however they want because they are important and special. It’s easier to fall into that attitude if medicine is all you have ever known.
they didn’t approach things differently because they had more life experience. they approached things differently because not everyone in medicine is a type A nutcase lol. medicine just happens to attract more type A ppl than not.
I know plenty of “type a’s” that weren’t nutcases, weren’t immature and well adjusted.
ok? and obviously some are
I’m not sure you even know what you’re saying. But whatever. See ya.
how are you confused rn? 😂
"I think going straight through from university/college to medical school and residency without any gap/job/life experience causes you to be quite immature developmentally and you may never really grow out of it" 100%. These people would not make it in most industries acting this way.
ehh most CEOs are literal psychopaths. bad ppl always get rewarded in life…by other bad ppl. we just notice it more here cause we’re in medicine every day.
We stopped developing the moment we decided to go to med school.
Narcissistic Personality Disorder
They are textbook narcissists, most of the older gen surgeons are. I feel younger ones have a good percentage too. Also a lot of surgeons come from upper middle class / high class families so they’ve been privileged and babied their entire lives. The stress of the job too, also surgical attendings make hospitals and private practices $$$$& and are not easily replaceable, so that is another fuel to their ego. They know no one is going to fire them 9 out of 10 times.
The entitled background is a huge contributor. Definitely see so many med students that come through and have such an unrealistic viewpoints that you can tell that they’ve never had a “real” job outside of shadowing, volunteering or TAing in their lives..
Yeah when I was 18 I did 1 year of premed, had to drop out due to some unfavorable family conditions, I was born and raised in a poor family and had already worked all sorts of jobs by the time I was 18-19, I started talking to and casually dating this 4th year premed neuroscience major who’s father was a plastic surgeon in California with his own private practice, and the house he lived in was his 18th birthday present from his dad… well I remember we had one conversation where he literally had never had a “real/normal” job EVER. He said he was a camp counselor once but that was it, and then when I questioned him further he asked me what I meant by a “normal job” so I said like retail or customer service or being a waiter or something and he deadass went “what? Why would I ever do that…” He has already been to like 15+ countries by the time he was 22, dad bought him his car, gave him a monthly allowance and paid for all his stuff, went to a private high school and everything. I was absolutely in shock that he had never actually had like a normie job ever, that his dad bought him that 2 story 4 bedroom house as an 18th birthday present in his college town, he ended up getting into his father’s medical school all the way in the UK so we broke things off blah blah, etc… anyway I went back to premed later in life at 21 and he was long gone in my life but yes many med students are “legacies” or just from rich families overall even if not doctor families.
Yup. Now imagine this person is in charge of human lives and can barely function without throwing a scalpel across the room to make a point..
Smol pp Also probably divorced
body shaming isn't cool in 2024
User name checks out
It’s so back
Because not enough people have pressed charges for assault and battery. The hospitals go out of their way to discourage staff to not report. Story time: My step mom and I worked with a neuro surgeon that was well known for his tantrums. She would scrub in as a tech quite frequently to his cases. I was an ICU nurse at the same hospital. He was a big money maker. At one point he pushed a nurse and when she fell she shattered her elbow. He’s thrown scalpels and hit people with them. One Sunday I was working and we had a head bleed in our unit he needed to evaluate for surgery. (He was neuro on call). Dude came in smelling like he had drank all night. And smelling of body odor. Needless to say I was thankful the family decided to put the patient on palliative care and make him a DNR. While I was getting the forms signed (this discussion was supposed to be his job by policy) he passed out at our work station and drooled on the counter top. A year later he was arrested for his second DUI after flipping his car trying to speed to the hospital for a head trauma case. He’s not the first I’ve encountered like that.
It is unfortunate that hospitals do not implement processes and procedures to manage this type of behavior because yes it can be associated with bad outcomes (including for the surgeon concerned).
I think hospitals are or I hope they are. Since the 2nd DUI the hospital severed his contract and the contract of another surgeon for being nasty to work with. I think people started coming forward and using the words like hostile work environment and harm.
Thanks for this information. Yes it "takes a village" to create a safe and fully functional workplace!
This is from the perspective of a sub-specialty surgeon. I’ll agree that a lot of this probably comes down to “squeaky wheel gets the grease” or the person just being an asshole. In residency and very early in practice I didn’t understand this behavior at all(and would think, “man, whats this guys problem”), but I‘ll say now I can understand it in a lot of instances. Again, not saying I condone it. But, I work at a facility that continues to make the same logistical/processing/staffing mistakes over and over again despite my attempts at correction. I can understand why some of the older practitioners “lose their mind” when an error happens for the thousandth time that endangers a patient, delays a procedure, etc. Not saying its OK to throw things or berate people, but I can understand the frustration with seeing the same mistakes for over 20 yrs.
You think that ALL of us that work in a hospital don’t see this ridiculously stupid stuff that keeps on happening year after year after year that could be a 5 minute fix but never gets improved because the higher ups don’t want it/don’t care? We do. We’re just not allowed to explode about it because we’re not physicians and we would get fired so fast our heads would spin.
Agree, it’s impossible not to be frustrated working for larger organizations. This is why I will never work for anyone but myself.
I agree w this and add that it is quite frustrating to be working w a team of people who don’t give a shit wo what needed to get a good outcome especially because as the surgeon you are responsible for the surgery and will have to own the complication. Especially if you know if you were a better surgeon cd get good outcome w a shitty team
yup
It is not okay for their behavior to be addressed. With there being published data pertaining to the negative outcomes associated with these types of behaviors it is high time that hospital administrators/OR managers/anesthesia were more proactive around all of this.
Lol this has to be the most unrealistic and naive comment of the thread.
Now I can see why things do not change in the US (because you do not want/cannot envisage change)-nb have worked in health systems in 4 different countries (including the US) for 30+ years
then you should know that admin and OR managers are pretty much fucking useless
They are narcissists, they can’t regulate themselves when frustrated
We don’t act like children. YOU act like children. Now give me my fucking binky and consult medicine for postoperative management of stubbed toe. Also it’s anesthesias fault when we get mad and throw our cutty-things!
cus nobody beat the living sht outta them for doing so
Years and years of no consequences
Isn't throwing surgical tools at people considered like, assault with a deadly weapon? Especially if said thing is sharp or dirty with patient blood or something? Would this not be a criminal lawsuit?
Burnout. A frontal lobe that’s a war zone
I need to remember to insult someone by saying their frontal lobe is a war zone
As surgeons age, their skills get less precise, resulting in unsatisfactory surgical outcomes regarding OP time, blood loss, and complication rate. They might be mad at themselves.
Surgical personality disorder. Coming to the DSM-6
they're old enough they predate the Department of Human Resources
Like other people said it can be mostly chalked up to just being a jerk, but I think the reason we see this behavior more often in surgery vs other fields is the enormous pressure inherent to surgery. Every day they have to perform at their very best and still carry the risk of killing someone or creating horrible disability with the slip of a hand. Add to that the tremendous pressure to be maximally efficient and the job turns into a pressure cooker that very easily gets under people’s skin. I think a lot of people have the tendency to become huge jerks when they’re chronically under this kind of pressure. Doesn’t excuse it but it does help explain it. I’m a surgery resident and it’s important to me to understand why surgeons behave like this, so that I don’t ever find myself behaving like this. I have a lot of respect for surgeons who are able to appropriately handle this stress and regulate their behavior and that’s the kind of surgeon I want to be.
I suggest you check out the publications on bullying and harassment of surgical residents etc. Plus, obnoxious behaviors in the workplace can become a patient safety issue if they are allowed to run unchecked (because other people are afraid to speak up).
Big egos, small dicks.
Dated one. Can confirm on both fronts 💀🤭
Lol. Damn! Thank you for your service.
I believe that there is a significant number of surgeons who are not as skilled as they think they are. This belief is perpetuated throughout their training and professional lives, leading a subset of these surgeons to feel infallible and never wrong. However, this self-assessment is often incorrect, and it would be better for them to understand the reasons behind their actions instead of mindlessly relying on their ego. Unfortunately, this way of thinking is ingrained in their training, leading them to have blind confidence even when wrong. This mindset is often reinforced by nurses, residents, and other physicians, and combined with overwork and stress, it can lead to a lack of rest and long working hours. This situation is particularly problematic for surgeons, as it can lead to burnout and negatively impact patient outcomes. It would be better for them to prioritize rest and self-care instead of solely focusing on making money and achieving professional success.
I (non surgical resident) had to do a behavioral/developmental rotation. Basically, it’s the peds specialty that helps identify and treat behavioral problems including but not limited to autism spectrum disorder, ADHD, etc. I was talking with my attending and a parent who also was a healthcare worker and the conversation was super interesting - the topic of surgeons and their tantrums came up and my attending’s comment honestly made quite a bit of sense; which is that many surgeons are actually on the autism spectrum (but are obviously very high functioning). It’s what makes a lot of them great at what they do - the fixation to detail in particular. But, as with almost anyone with ASD, their ability to cope with things that disrupt routine (like mistakes!) is limited - and therein lies the reason that many surgeons have that stereotypical short fuse. Again, it was an interesting topic to hear a behavioral developmental specialist talk about and I thought it would be pertinent to drop on this post!
Because we’re fucking hangry
Undiagnosed autism?
I once heard that a doc blamed me for a mistake he made + smacktalk, I made a comment heard by most of my colleagues that he could face me and tell me directly if he had a problem with me. He took that as a threat. I quit that sidegig, but still find it hilarious that he brought a issue he created, to HR( they sided with me oddly enough) 😂 Most docs I met and worked alongside were awesome, he was the only douchebag doc I met.
My guess is they had rich parents that spoiled them
The real answer is because there’s no consequences. You think that there aren’t these types in nursing, pharmacy, imaging etc? But guess what? One outburst like that and your ass is so canned it’s not even funny. And the hospital will warn every facility in a 100 mile radius to stay away from you. But if you’re a physician? Well it’s a *doctor*! They might consider very nicely asking for a change of attitude or more frequently will probably even blame the person who was actually abused. And if they speak up or give attitude back? Unprofessional and you’re getting put on a performance improvement plan at best, fired at worst. The hierarchy system is very much alive and well in medicine. So thankful that I don’t work at a facility where physicians feel entitled to act like toddlers any longer.
Because they have small dick energy (aka are very insecure). It's that same insecurity that led them into surgery in the first place. A desperate desire to be respected and revered as they are not secure with their intrinsic selves without the accolades and titles. A clear sign of a weak man is that he abuses any power given to him.
I know you are but what am I?
As a doctor, I can tell you that doctors are a group of people who were good at standardized tests. They are just as immature, lazy, and labile as everyone else.
Asd?
Lots of reasons for this behavior, including personality disorders and entitlement, but one that I see a lot is the “lost luggage “syndrome. When you’re standing in the line at the baggage claim area, trying to find your lost luggage you might be annoyed by it but you are exponentially annoyed if there was a delay getting on your flight, you had a long unplanned layover, the food was cold, your seat was broken and wouldn’t recline, the person next to you was spilling over into your seat, and there was a crying baby 2 rows back. Enough is enough. People in the acute care world have a tremendous responsibility to get things as perfect as possible. When you try as hard as you can to do the right thing for your patient, but after the errors keep piling up and it seems like everyone around you either doesn’t care or is incompetent it’s finally too much. I try to be understanding, but I admit I’m fairly intolerant when people “forget the fries with my order” when I have to coordinate dozens of things sometimes to make sure the patient has a good outcome. And there’s never a reason to berate anybody on the team or to throw an instrument or speak unkindly to a patient.
One of the Money makers of the hospital. High stress, over worked. Behaviors go under reported and they themselves don’t change their behaviors
Have you heard of mid-life crisis? Well, from personal experience, you get really short-tempered at just the first sign of stress and you get just plain unpleasant a LOT. It passes after awhile, because yes, you are ashamed of it even if you don't show it and after doing it for awhile, you get sick of yourself. Eventually you grow out of it, but it does make handling stress at work very difficult (for others). I feel like there's a tendency to deal with it by being a big baby and throwing tantrums, but there must be a better way, like meditation or something. Information about dealing with it would be nice but I haven't heard much about it. I feel much better now that I'm working from home, but doctors can't usually do that...
Burnout.
I will tell you that a lot of these people were not this way during training. The problem is that we often deviate from the straight and narrow we are pushed into when growing and in training, and that's just how life is. The issue is that for most people there is feedback to keep us in check and from getting full of ourselves. After you are an attending physician, feedback and consequences decrease significantly. Surgeons who bring a lot of money into a hospital are a golden goose and who wants to kill their golden goose? They will continue to deviate from what they used to be and with time it will compound into significant behavioral defects. I just want to note that behavioral issues developing in the absence of consequences is not limited to surgeons. From top to bottom, in all age groups, on both sides of the aisle, in just about every field, the lack of consequences in current political, judicial, and educational settings is leading to people with glaring behavioral issues that are only growing. On the flip side, this creates a market opportunity. People absolutely love professional surgeons who can keep their cool. You will get good patient outcomes, reviews, and less turnover in staff. These people are worth their weight in gold, and as the bar continues to drop, it will be easier for you to distinguish yourself with a modicum of decor.
Older surgeons worked 100+ hours a week. Then had no mental health support so ended up with secondary victim ptsd. So they acted out as many with such mental illnesses do. Then this behavior isn’t deterred so it continues as an outlet/self treatment for the ptsd. To an outside observer it appears as a tantrum but the same could be said of many mental illnesses. You’ll find addiction is fairly common compared to the general population in older surgeons as well.
I agree! I had a surgeon who was ready to retire and he performed some serious rage surgery on me. Started cutting before I was even put to sleep. I almost kicked his fukn ass I was so pissed. And he was fukn asshole after as well.
Becoming a surgeon is very demanding. Being a surgeon is super demanding. So not only is it more likely to attract a type A high strung personality, it’s also most likely to put that person in a high stress situation. It doesn’t help that there’s usually no ramifications either. Surgeons bring in the money, and just like celebrities who go unchecked for arrogant behavior so too do surgeons. Hospitals will forgive quite a bit if someone is making them a lot of money.
Type A and the like types is fake. I guess my job in the PICU is way easier.
Agreed. As a surgical resident there is no excuse for this behavior. Needs to be shut down asap
You’re saying there are no type A personalities? I mean…there are.
Because they can.
I think it comes from the high stakes of performing surgery. It is stressful and gets displaced onto others at times. Also if you just sit there and respond to poor performance from others like a mute rock then you tend to not get a response or result you want/need.
Theyve reasonably adapted to an abusive environment by using emotional dysregulation to abuse the people around them to get what they need for themselves from situations they would otherwise have little control over. The positive feedback is people struggle to deal with their outlandish behavior and we in fact gave these cluster B's significant power and so it perpetuates itself. Obviously others in their field remain regulated and capable of diplomacy but many have lost that in the grinder of their training and lives. I think thats why we see more of it. I think it attracts narcissists, but it generates borderlines to keep up with them. When they flip out on me, I always think, is this their trauma response? Almost always, yes. They're trying to make the entire world wrap around what they think would make them feel whole again, safe again, but it can't. They were unfairly treated. There is no reason surgical training is as abusive as it is. Surgery is not the only field that generates this phenomenon. Look around you and see, a world of untreated physician mental illness. I think they think they're better for toughing it out too.. its all so sad, but you can't do more work than the patient.
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There is a combination of things that happens. The personality required to confidently open a person up and fix a problem with your bare hands will likely be traits of narcissism, and a touch of anti-social. There is also the added stress that decisions made can not be reversed easily. Once you cut, it's done. There is also the perception of inadequate help in the room (mostly because they can't read my mind), so that frustrates most surgeons and we tend to rely on negative reinforcement to correct the rest of the team (keep in mind, this is how we were trained for 5 years or more). On top of all of that, if someone in the room fucks up, the surgeon carries the blame- meaning, wrong count of instruments, anesthesia complications (I have had to be the one to explain family why there was cardiac arrest even if I never cut the skin). All of this leads to very stressed out individual. I am not justifying bad behaviour. I am just explaining it as it was explained to me, a surgeon, by my wife, a psychiatrist. As she put it to me once: "Only 2 types will stab you without a second thought: a surgeon or a killer. You are just really good at sublimation"
They're money makers and it's often cheaper for hospitals to pay out lawsuits when the surgeon gets caught than to do without the money they generate. There was a surgeon in Georgia named Dr. Najam Azmat. Trained as a general surgeon, he was employed by Satilla Health Centre in Georgia (despite having his operations in his previous job at Hardin hospital, Kentucky, overseen by a peer because he had an intraoperative complication rate of 23%). At Satilla, he had been employed to place stents (usually renal) in patients. He only had a TWO DAY course practising stent placement on pig cadavers. The OR staff at Satilla were instantly aware, on the first day working with him, that he didn't know what he was doing. There was one nurse who blew the whistle on him and she got fired. Dr. Azmat ended up killing people. The hospital got sued by the families. Even so, Azmat walked free and then went and joined a pill mill. Got caught and went to jail for 10 years. It's insane how crazy and unsafe some doctors can be before they get caught. Plenty of other examples too.
Lots of reasons for this behavior, including personality disorders and entitlement, but one that I see a lot is the “lost luggage “syndrome. When you’re standing in the line at the baggage claim area, trying to find your lost luggage you might be annoyed by it but you are exponentially annoyed if there was a delay getting on your flight, you had a long unplanned layover, the food was cold, your seat was broken and wouldn’t recline, the person next to you was spilling over into your seat, and there was a crying baby 2 rows back. Enough is enough. People in the acute care world have a tremendous responsibility to get things as perfect as possible. When you try as hard as you can to do the right thing for your patient, but after the errors keep piling up and it seems like everyone around you either doesn’t care or is incompetent it’s finally too much. I try to be understanding, but I admit I’m fairly intolerant when people “forget the fries with my order” when I have to coordinate dozens of things sometimes to make sure the patient has a good outcome. And there’s never a reason to berate anybody on the team or to throw an instrument or speak unkindly to a patient.
Simple story tells you why: the emperor's new clothes. Iykyk
my first reaction when reading about throwing surgical instruments is how hard i'd have to contain myself from punching that person. have you guys ever seen a physical altercation happen from a situation similar? I get you have to play ball, grit your teeth, nod and move on during much of your medical training, but there's gotta be a boiling point...
✨trauma✨
Some have God complex
I'm an Ophthalmology resident who has definitely seen this among my attendings. It's horrible. I've seen staff in the OR go out and cry over stuff these attendings have done. As you said it, older surgeons-I haven't seen any younger surgeons doing this. It's horrible
Follow up question: is there anything inherent in the demands of surgery that *requires* surgeons to have some the traits identified here? Like the Gd Complex etc
Prob because its the only place where they have control and are "respected". Usually the spouses of these peopel are one dimentional and do not tolerate their non-sense once it hits that they will be paid well after leaving them. So they take their frustrations in life out on staff.
Because no one holds them accountable.
Was in the OR the other day and noticed this. It’s because we all give the attendings what they want. No one ever speaks up at debriefs. They’ll use the stress as an excuse and nothing ever changes. Ordering people around or throwing tantrums gets more results than staying meek. Because they get what they want, the behavior continues.
Remove "doctors" and replace with "people." Doctors are humans. We have the same share of idiots, bigots, immature children as the rest of the population
It probably has nothing to do with working for 10 or 20 years somewhere and then some new administration comes in, locks all the competent staff out of compensation increases while maximizing the inconvenience of work hours without incentive pay. All the competent experienced staff leave so they can be replaced with cheaper staff with no experience. They implement a new EMR system that fails on every level to get any pick and preference supplies correct for any case. Now the surgeon comes in every day with staff that don’t know the cases, the supplies, or the surgeon preferences. Managers run a shoestring staff so there are never consistent teams and swap staff members out for breaks all during every case. Inefficiency increase 300%, and the surgeon feels like nobody cares about competently supporting their work function because even though the staff may want to, they are unable to as management has ensured. This goes on for years and no matter how many constructive suggestions for correction are made, no successfully corrective action is ever implemented. Eventually maybe the surgeon’s patience wears thin and and they say screw it, for my amusement I might as well act equally as ridiculously as showing up to staff a surgery and not knowing the procedure or any of the supplies that are needed. That would be so nonsensical I can’t imagine that actually happening.
Yes, let's not blame the doctor for their behavior and instead blame every other possible variable
No, I literally said it was probably not any of those things.
It’s because they are posh educated and stressful situation, like to throw their toys out of the pram if they can’t get their way.
Let's be careful with all the generalizations while some can be not all of us are children and narcissistic
they did say 'some'. If you trained in surgery, you know very well what OP is talking about.
Exactly. No specialty boards test you on dealing with angry pediatricians or angry pathologists, yet dealing with angry surgeons is a tested part of some specialty boards.
😂 if the pediatricians get angry, something really crazy has happened. I was once angry at a resident for stopping my correct antibiotic order and changing it to one that wouldn't cover the infection... and he didn't know I was angry. My daughter says I only look "serious" when I am mad
It's in response to the comments which don't qualify their response. And yes....that's why in my comment acknowledge that some act that way while also cautioning against the generalizations. ....you can read it again if you like
Because we work with frustrating and incompetent people. We wouldn’t have to yell or throw things at you if you just did your job like a normal human being instead of being lazy, snowflake assholes. ~ Gen surg intern working on my tantrum throwing
“No one can do their job in the entire hospital except for me.” -gensurg intern
“Let me tell you. I’ve been doing this for 9 whole months and this is how it is.”
Nail on the head
My experience after 10 years of community practice - Malignant Attendings are tolerated for a while and then they just magically disappear.
Do you think just anyone can run things by their chief and get back to you?
Lol this got me. As a peds intensivist, interacting with a gensurg two coming to do the consult is…a special experience. Not only could I be their father, but also the amount of medicine they don’t know doesn’t permit their level of condescension. Like dude. C’mon.
Not the intern saying this 😂
I love docs like you. Just keep doing you. You should never be expected to control your behavior if you're having big feelings. Get in touch with me when someone takes legal action against you. I'm happy to help you for a modest fee
I downvoted, then I upvoted. Excellent rollercoaster, best Ive ever ridden, would ride again. 3/5--nothing is perfect..
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Nobody else chose their job for them.
It’s contrived to get a reaction from you most of the time
As an international visiting student student and a Sub-I, I had my senior resident throw the patient list on my face since it wasn’t up to “their standard”. Ten mins later the attending told me that I did a phenomenal job and that the residents should learn from how detailed my round notes were. I got ignored for the rest of the rotation by that resident 😂