Further Thoughts on Getting Chewed Out [guest post]

Jae Won Joh is a classmate friend of mine from Stanford. He’s a super smart, super nice guy who in his third year of medical school at Baylor. He’s also written over 400+ high quality posts on Quora.

I recently shared the Why Chewing People Out for Mistakes is a Bad Idea post with him and he got some passionate about the topic that he wrote up the following post and I felt I had to share it with the readership here. Hope you enjoy it! – Jason


Hey Jason, I loved your post about the surgeon chewing out his nurse. After reading through the post and its subsequent commentary, I strongly suspect that anyone who sides with the surgeon has never personally been in surgeries with both calm and temperamental surgeons; the difference is vast, and anyone who supports the latter type can only be doing so out of ignorance, so let’s set the record straight.

Myth #1: The 10 minute delay put the patient at serious risk.

False. Delays happen all the time in all stages of surgery–10 minutes is nothing. Surgeries that are estimated to take 3 hours regularly last 5, 6, 7 or even longer. The increase in chance of infection in 10 minutes? Probably quite minimal given the big picture–many surgeries involve giving the patient a dose of antibiotics beforehand anyways.

As for the patient’s general status, that’s what the anesthesia team is there for–they manage heart rate, blood pressure, fluid status, etc. If the anesthesia team is seriously concerned about a 10-minute delay, chances are the patient should never have been considered a surgical candidate, as I’ve seen a good anesthesia team keep someone under for well over a day.

Myth #2: Surgery is very delicate and there is no room for error.

This belief stems from the unrealistic expectation that the medical profession should always be perfect. Hate to say it, but all surgeons, no matter how experienced, make mistakes. Period. Everyone’s got slightly different anatomy, and sometimes, stuff that’s supposed to be there isn’t, and vice-versa–it’s confusing business, and yes, sometimes there are slip-ups. Thankfully, the beautiful part about surgery is that the patient’s already cut open, so you can generally fix whatever went wrong (about the only possible exception I can think of is neurosurgery). The argument that a mistake in surgery “could kill someone” and therefore justifies berating is ludicrously hyperbolic to the point of fallacy–it would be like saying a germ in my Subway sandwich “could kill me” and therefore justifies me berating the employee for not drowning his gloves in alcohol in between every customer.

Myth #3: It’s the nurse’s job to check supplies before surgery.

No, that’s not her job. Please stop thinking of nurses as monkeys responsible for all scutwork. Stocking the supply room is a tech’s job. Even if it was her job, she can’t, because…

Myth #4: It’s always known what will be needed, or possibly needed for each surgery.

When a surgery case is posted on the schedule, the surgeon is required to write the basic equipment he wants available. Beyond that, it’s whatever the specific case ends up demanding. Surgeons call for additional/different equipment all the time in the middle of surgery, because again, every case is slightly different, and has different needs that the surgeon must adapt to on-the-fly. Most of the time, the stuff is close by; occasionally, it might well have to be transported from another hospital. Anyone who thinks they can successfully predict that mess should (a) enter the stock market, (b) become a weatherman, and (c) play the lottery.

Myth #5: The surgeon’s behavior ultimately maximizes patient care.

No, it doesn’t. It just earns him a bad reputation, which actually degrades the quality of care, because now no one will want to work with him. His residents will shy away from surgeries with him, meaning they might get less experience in the long run. The staff will no longer do the small things they did as favors even though it wasn’t in their job description. And as you pointed out, his attitude stifles creativity…and anyone who thinks surgery doesn’t have a significant creative element is a fool. There is absolutely nothing about his behavior that would possibly increase the quality of care in that hospital. It would only decrease it. All because he was just impatient for whatever reason and projecting his frustration on the target with the least amount of power.

Myth #6: The surgeon was the leader of the team, and was therefore acting like a football coach yelling at a player.

No, the surgeon is actually much more like the quarterback. He may be responsible for making plays happen, but he is nothing without the rest of the team: the circulator, the scrub nurse, the resident, hell, the people who clean the OR after each case and make sure it’s sanitary. Everyone needs to work as a solid unit for things to go well. Nota bene: surgery involves tons of teamwork. People who suck at teamwork suck at surgery. Actually, that’s true of medicine as a field.

To put it musically: the surgeon is less like the director of the orchestra and more like the first violin. He might be able to pull off some sweet solos on his own, but it’s only with the backing of the full orchestra that he can deliver a majestic performance.

I have seen great surgeons at work, and they treat everyone with respect. They are loved, things get done quickly for them, and everything in general just runs smoothly because everyone involved feels that they are a part of something amazing. It is an incredible moment to see a resident thankful to be with a particular surgeon because they know the 16-hour procedure (all done while standing, mind you) will be less grueling. That resident is going to be less stressed. That resident is going to be less depressed by the fact that his dear 4-month-old daughter won’t even see him that day. And yes, this will make a difference in how he performs. :-)

Myth #7: The asshole, perfectionist surgeon is better than the nice, forgiving surgeon.

People have clearly been watching too much House. This is a true story:

An administrative official was looking through the complication rates for each of his staff surgeons, and noticed that one stuck out. He spoke to the surgeon’s colleagues, and indeed, they were quick to out this surgeon as an incompetent buffoon. Furious but curious, the official dug a bit deeper, and on a whim, played with various factors with regards to surgeries. Completely by accident, he noticed that the surgeon in question was always operating out of the smallest OR. Oddly enough, it was only when he operated in this OR that he had complications arise; whenever he was in any other room, his record was literally perfect. The official went to the staff and asked what was going on.

Turns out, no one enjoyed working in that OR because air circulation was poor and it often became warmer than was comfortable. This particular surgeon was nice enough to always let his colleagues have the nicer rooms whenever they wanted as he toiled away in the small OR with the crappy air.

The official immediately shut down the OR in question and had it renovated. Once that was done, the surgeon’s complication rates shot far below his colleagues and set a new record/standard. The colleagues who had thought him a talentless fool were having complication rates 4-5x this guy’s.

Because he was nice, the multi-million-dollar hospital nearly fired the best surgeon it had seen in decades.

~~~~

Conclusion: You were absolutely correct in saying that the surgeon should not have needlessly berated the nurse. It’s unprofessional at best and damaging to patient care at worst.

Cheers,

~The Medical Dork

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1 comments
annedreshfield
annedreshfield

Very interesting! I have several friends who are pre-med and we all enjoy the typical shows about doctors and hospitals together -- glad to see real life is quite a bit different. :)

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