Spineless Attendings, I am Disappoint

[FranklinK]

How many times have you seen some scrub tech, circ nurse, perfusionist, or other non-MD in the OR disrespect a resident? Talk down to him? Berate her? Too many, no doubt. But what blows my mind as a med student is that residents have to be nice, which attendings know, but attendings do not - they can easily publicly chastise the rude non-MD and reduce future incidents - yet they do not.

I'm not saying that residents don't fuk up, it's just how condescending these dudes can be. Rather than politely correcting the resident, the resident is scolded like child. And the attending notices, may even look uncomfortable, but says nothing. It's pathetic. I would never let my residents be treated like scum in the OR. I'll stab a scrub tech with a 12 gauge of propofol swifter than a demon's whisper. (no psycho)

Thoughts?

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[anes]

How many times have you seen some scrub tech, circ nurse, perfusionist, or other non-MD in the OR disrespect a resident? Talk down to him? Berate her? Too many, no doubt. But what blows my mind as a med student is that residents have to be nice, which attendings know, but attendings do not - they can easily publicly chastise the rude non-MD and reduce future incidents - yet they do not.

I'm not saying that residents don't fuk up, it's just how condescending these dudes can be. Rather than politely correcting the resident, the resident is scolded like child. And the attending notices, may even look uncomfortable, but says nothing. It's pathetic. I would never let my residents be treated like scum in the OR. I'll stab a scrub tech with a 12 gauge of propofol swifter than a demon's whisper. (no psycho)

Thoughts?

Hopefully you will... Most likely you won't. You are there for 3-4 years. The attendings are there for the long haul and want as little friction with the OR staff as possible.

 

[Random Anesthesiologist]

I have had two male attendings stick up for me immediately in the moment when disrespected. Once was by a male IR nurse, the other was by a male surg resident who was in my equal year of residency.

I could have handled the resident, but
my attending just jumped in there.

It was pretty awesome.

If it doesn't directly affect pt care, I tend to let a lot of things go and unleash on my spouse at the end of the day. Poor guy.

 

[Triple AAA]

I trained at a program where the attendings were like this. Needless to say, I still feel bitter towards my program

 

[chocomorsel]

Haha Tripple AAA. I feel the same about my program for other reasons besides spineless attendings. And there were plenty.

 

[pjl]

After training, at certain hospitals, one physician complaint =probation for staff, two is discipline, three is new employee. Not that this is fair or better, but at least the janitor isnt yelling at you.

 

[BuzzPhreed]

I was never scolded like I was a child during residency. Not from my anesthesia attendings. That simply wasn't tolerated. Even from when I started residency 11 years ago. Maybe I was just lucky, but it was simply our program's culture. Attendings who did stuff like that weren't allowed to work with residents. And if it was done repeatedly they were asked to leave the program. I heard one that this specifically happened to before I started the program.

Also most of the surgical attendings didn't give us a hard time. They knew we were there to learn. And they almost always got our back. A few of the circulators (and some of the nurses on the other units) occasionally tried to test us or give us a hard time, but our PD always got our back when we brought it to her attention.

If you guys suffered through abuse in residency I feel sorry for you. That was not my experience at all. It wasn't easy or anything like that. Just when someone tried to pull out the **** gun and aim it at me or one of my fellow residents, one of my superiors usually stepped in and made sure they got covered with their own feces - not one of us.

 

[Sirach38]

I was never scolded like I was a child during residency. Not from my anesthesia attendings. That simply wasn't tolerated. Even from when I started residency 11 years ago. Maybe I was just lucky, but it was simply our program's culture. Attendings who did stuff like that weren't allowed to work with residents. And if it was done repeatedly they were asked to leave the program. I heard one that this specifically happened to before I started the program.

Also most of the surgical attendings didn't give us a hard time. They knew we were there to learn. And they almost always got our back. A few of the circulators (and some of the nurses on the other units) occasionally tried to test us or give us a hard time, but our PD always got our back when we brought it to her attention.

If you guys suffered through abuse in residency I feel sorry for you. That was not my experience at all. It wasn't easy or anything like that. Just when someone tried to pull out the **** gun and aim it at me or one of my fellow residents, one of my superiors usually stepped in and made sure they got covered with their own feces - not one of us.

If you don't mind me asking, where did you train? I want to go tl a place like this...

 

[Ignatius J]

Much more common in academics than private practice.

 

[BuzzPhreed]

If you don't mind me asking, where did you train? I want to go tl a place like this...

Nah. Not important. This is a good question to ask when you're interviewing, though. "How does the program director's office handle the inevitable interpersonal conflict between residents and other staff? Is there a resident ombudsman?" Etc., etc.

 

[Sirach38]

Nah. Not important. This is a good question to ask when you're interviewing, though. "How does the program director's office handle the inevitable interpersonal conflict between residents and other staff? Is there a resident ombudsman?" Etc., etc.

Do you think people are actually going to give a straight forward and honest answer to these questions? Probably unlikely...

 

[risnwb]

Where I trained senior residents ended up standing up for themselves and the juniors a lot more than the attendings. Attendings were always playing nice because they wanted a job. The residents basically didn't give a fu*k. I think at my place it was harder to fire a resident than an attending. Attendings didn't even have actual contracts... Each one was reviewed yearly and once in a while one who failed to teach or
who just sucked for other reasons was asked to leave... Once I figured out that they were worried about losing their jobs I stopped being annoyed when they played nice with the surgeons and or staff...


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[chocomorsel]

Where I trained, most of the attendings were spineless, however, as a resident you'd better not talk back to anyone/stand up for oneself, unless you wanted to have disciplinary action in your file. It used to be a nicer place at one point.

 

[BuzzPhreed]

Where I trained, most of the attendings were spineless, however, as a resident you'd better not talk back to anyone/stand up for oneself, unless you wanted to have disciplinary action in your file. It used to be a nicer place at one point.

I think you need to frame it that you are standing up for the patient especially if someone starts yelling. I broke-up fights (as a resident) between other services before saying things like, "Can you guys please table your discussion and focus on taking care of the patient?"

Don't learn how to be spineless from spineless attendings. You can speak for yourself so long as you don't put someone else down or belittle them in the process. I always found that having your facts straight was the best defense.

But, sometimes you have to kick a little ass, even in PP land. When I first started my job early after residency I had a surgeon (who infrequently booked cases at our hospital) sarcastically challenge me about why I hadn't seen his pre-op antibiotic order in the chart (when one wasn't given pre-incision). He directed a question to me with a smirking and condescending tone in front of the whole room, "Don't you read the chart and know your patient's history and plan before you give anesthesia?"

I simply replied, "Well, Doctor, you had ample opportunity to address that during the time out, which you ignored. Besides, a pre-op antibiotic is not indicated in this procedure. And none of your colleagues routinely order one. I didn't think it was indicated so I didn't make an issue about it... like you are now. Would you still like me to give it now?"

That shut him up quickly. And then I went and spoke to one of his partners about his behavior. Haven't heard a peep since.

 

[kingcer0x]

The medical profession is not what it used to be. It is no longer worth going through torture as the reward keeps dwindling down. Residents in the future need to be treated as valuable members of the healthcare team, not indentured servants. The hierarchies and military like structure really just need to boil down to supervisor > employee, like everybody else in the hospital. Maybe a union will help bring our contributions to the operations of an academic medical center to light.

 

[BuzzPhreed]

He directed a question to me with a smirking and condescending tone in front of the whole room, "Don't you read the chart and know your patient's history and plan before you give anesthesia?"

I must admit though that even now when I think about this interaction my blood boils a little. I really wanted to say to him at the time, "Who the f*** do you think you're talking to?" and then invite him to continue the conversation outside.

But that really wouldn't have solved anything at the time and I just would've looked out of control in front of the OR staff. Instead I responded matter of factly and everyone got the point. And addressing it later with his partner was more appropriate.

Keep your facts straight. You are still the one who may be in a position to need to assert control in the room when the doo-doo occasionally hits the fan. It's better to have the respect of being calm and in control.

But if someone is absolutely losing their **** on you, you are well within your right to calmly ask, "Why are you talking to me like that?" or "Why are you yelling at me?" A lot of times people don't actually realize that they are losing it and directing it at you, and it's amazing how this snaps them out of it. Seen it work multiple times. And after you say that and if they keep yelling, just ignore them. Don't respond at all. Don't encourage that behavior. Afterwards go and talk to their superior (chair, PD, etc.) and let them know what happened. Do it early. Do it calmly. Do it matter of factly. Before the dust settles.

 

[Ignatius J]

I am pretty easy going. When I do have a problem, I just say my point bluntly and nicely. Towards the end of residency I didn't give a damn and it was obvious. Not how I suggest doing things.

Yesterday was doing a robot and before induction the circulator kept saying we had to move the patient to a certain point in the bed for lithotomy. Finally, just said "we are going to induce and secure the airway and then we will position." Seems obvious but I am sure there are people who just say okay and position or go to the other extreme and go off on them. Just be professional and courteous and most people will listen.

 

[Yo GabbaPentin]

The title of your post makes it sound like you are Borat the anesthesia resident.

Keep your head down. They can't stop time.

 

[BuzzPhreed]

How many times have you seen some scrub tech, circ nurse, perfusionist, or other non-MD in the OR disrespect a resident?

Me? Residents? Never.

Medical students? Yeah. All the time. Med students are somewhere usually slightly above pond scum. And they don't usually have the ability to defend anything they do.

This is the "standard brief" for med students.

 

[uk_anaesthesia]

This fascinated me. I am an anaesthetist in the UK and in many operating theatres, the anaesthetist is seen as the "patient advocate" and so held in fairly high esteem. The surgeons are generally very respectful of junior and senior anaesthetists, and any derogatory comments are reported to the "Chief" and dealt with by senior surgeons and anaesthetists. I suppose it is much easier to stand up for yourself if the chap shouting can not get you fired. The US system has huge advantages (you guys use drugs we only read about) but this is an aspect that belittles you.

 

[BuzzPhreed]

This fascinated me. I am an anaesthetist in the UK and in many operating theatres, the anaesthetist is seen as the "patient advocate" and so held in fairly high esteem. The surgeons are generally very respectful of junior and senior anaesthetists, and any derogatory comments are reported to the "Chief" and dealt with by senior surgeons and anaesthetists. I suppose it is much easier to stand up for yourself if the chap shouting can not get you fired. The US system has huge advantages (you guys use drugs we only read about) but this is an aspect that belittles you.

In the UK the government pays for your healthcare. In the U.S., the surgeon brings the business to the hospital. Therein lies the rub.

 

[chocomorsel]

I thought OZ was where all the cool drugs were used. And of course the respect.

 

[uk_anaesthesia]

The key difference is that (for now) money is way down in the pecking order of what UK anaesthetists and surgeons think about when managing patients. It seems to pervade what you guys do (i.e. don't bother with X as you can't code for it) and what you say (i.e. don't annoy the surgeons). I find it hard to imagine working with such restraints.

Clearly this doesn't apply to all of your practices, as there are some comments from those who will not tolerate disrespect from surgeons.

Are there any areas where it is the anaesthetists who are the main "bread-winners" e.g. an anaesthetist who also works as a pain physician and brings in lots of money from pain procedures, or a regional anaesthesia expert who is the reason why day case rates have increased for distal surgeries?

I wonder if this inequality is a reason for the proliferation of CRNAs in the USA, compared to the few numbers in the UK?

Saying that, we over the pond have our own problems...