demeanor of a friend

[jayman]

hey everyone...i've got a quick question about a buddy here:

one of my chums here in med school has what you might call an anxiety problem - whenever he interviews a patient or is put on the spot for whatever, he breaks out into a horrible sweat, stutters, and pretty much falls apart.

he originally wanted to do pediatrics, thinking that kids would be less intimidating than adults...but he just finished his 3rd year surg rotation and proclaims that he loves it because he really didn't have to interact with patients that often (at least while they were conscious), felt more at ease in the OR where the contact with patients was depersonalized, and enjoyed actually "doing" something (i.e. holding back the clamps, some minor suturing, etc)...he also said that he enjoyed the surgeon he worked under because he wasn't "too critical" and treated him "nicely" (something which apparently doesn't happen to him too often in the hospital).

don't get me wrong...i'm happy that he finds surgery interesting, but something tells me that he's getting the wrong impression about:
(1) the patient interaction you have as a surgeon
(2) the interaction with other surgeons
(3)the ability to deal with stress/anxiety as a surgeon.

i haven't been on my surgical rotation yet, so i can't comment about any of his experiences first-hand...but i was wondering what you all thought about his view of surgery/being a surgeon.

thanks.

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[woundvac]

i would recommend Buspar.

surgery? maybe surgical pathology.
i'd love to see him doing a rectal, using the protoscope, or banding hemorrhoids in the clinic.

 

[womansurg]

Originally posted by jayman
he also said that he enjoyed the surgeon he worked under because he wasn't "too critical" and treated him "nicely"

This is - unforunately - the exception rather than the rule for surgery training. If he can't tolerate intense scrutiny and occasional harsh criticism, he would flounder in any surgery residency that I know of.

 

[fourthyear]

yeah, unfortunately sometimes the limited experience we get on our rotations clouds our impression of a feild by the people we happened to work with. You have great attendings and residents a certain month and of course it makes you think you would have more fun with that specialty, although it's not necessarily representative of all people in the specialty.

There are some nice surgeons, but in general when you start a surgical residency you expect a certain level of criticism and even the occasional getting chewed out for something you did no matter how hard you worked to get it right and no matter how non-malignant your program is. That's just the way it is, maybe because in surgery, more than many other fields, your actions could cause someone serious complications, even death, so tensions tend to run kinda high and people lose their tempers sometimes.

There's actually a TON of patient interaction in surgery. How do surgeons get theri patients? By seeing them in clinic, taking them in from the ER, all of which involves talking to them and figuring out what's wrong, then explaining the procedures in depth, getting patients to trust them, then dealing with them in follow up after surgery and explaining complications and diagnoses - including cancer. All these things demand communications skills. Your friend may be able to get over his anxiety issues as he gets more comfortable, but if he truly doesn't enjoy interacting with patients much, he probably will not enjoy surgery. Path or Radiology may be a good option if he likes thinking and anatomy more than patient interaction. Or if he likes procedures, anesthesia is a procedure-heavy field with less patient interactions required. He should check these out and do another surgery rotation with a different/more malignant attending to see if he still loves surgery despite a less enjoyable environment.

 

[Teufelhunden]

Originally posted by womansurg
This is - unforunately - the exception rather than the rule for surgery training. If he can't tolerate intense scrutiny and occasional harsh criticism, he would flounder in any surgery residency that I know of.

I?ll never understand this.

Womansurg, why does criticism need to be "harsh" in the first place? What is it about surgical training that requires such acerbic behavior towards trainees? Do you think that education would suffer if criticism was offered politely and professionally? Surgeons sometimes seem to revel in the fact that their training is so malignant. I?m just trying to figure out why you all think it?s necessary. Is it just tradition?

It seems that one of the unwritten requirements of a successful surgical intern/resident is that he/she be ?thick-skinned? enough to tolerate unkind treatment from attendings, senior residents, or whoever is dishing it out. Wow, what an excellent way to screen future surgeons!

So basically, don?t apply to surgery unless you?re willing to be treated like ****. Am I getting this right?

We?re all adults at this point, and supposedly in a ?profession.? So why can?t training be conducted in an ?adult? and ?professional? manner?

Listen, if someone can?t cut it, by all means?sit them down and counsel them?point out all their discrepancies?let them know of consequences?and if they fail to correct those deficiencies, kick ?em out of the program?I?m fine with all that. But, all that can be accomplished without yelling?without derogatory comments?without treating someone disrespectfully.

This is a big issue for me as I?m interested in surgery, but have great reservations because of this issue. And don?t confuse me with some thin-skinned little wimp who couldn?t put up with the abuse. I spent six years in the Marines?I am a veritable ?pro? at taking abuse. I can endure having someone stand within inches of my face and scream?all without batting an eye. I spent years in an environment where every wrong move resulted in being told to ?Get on your face!? i.e. time for more push-ups.

So, I?ll take the Pepsi-challenge against anyone when it comes to ?who can tolerate more abuse.? However, it?s not the point. The question isn?t ?can I?? tolerate this type of treatment, it?s ?do I want to??

Personally?all these stories of screaming, scalpel-throwing surgeons are sad. People that behave this way must be truly insecure. This type of behavior is truly a feed-thy-own ego phenomenon of ?little? people. I may know squat about surgery, but I know a great deal about leadership?and good leaders don?t need to scream and yell to be effective. Conversely, the most respected leaders I?ve come across treated everyone with respect and dignity. Unfortunately it sounds that this type of leadership is a rarity in surgery.

 

[LaCirujana]

Originally posted by Teufelhunden

Personally?all these stories of screaming, scalpel-throwing surgeons are sad. People that behave this way must be truly insecure. This type of behavior is truly a feed-thy-own ego phenomenon of ?little? people. I may know squat about surgery, but I know a great deal about leadership?and good leaders don?t need to scream and yell to be effective. Conversely, the most respected leaders I?ve come across treated everyone with respect and dignity. Unfortunately it sounds that this type of leadership is a rarity in surgery.

The program I am training at now is phenomenal in terms of the leadership skills of the attendings (the vast majority of them, anyway) from the chairman on down to the first-year-out-of -residency staff. Abusive behavior just isn't tolerated and when I've f**ked up, which I have, the way in which I have been corrected has been approached from a "what can you learn from this mistake" angle, rather than harshly. The few staff who are less than stellar, are not screamers/instrument throwers; they're just not calm, dynamic people, so they stand out from the rest. There have been attendings who yell, treat the residents like ****, etc., here in the past--it wasn't tolerated and they are no longer on staff.

The surgery attendings at my medical school were, for the most part, pretty good, too. There were, however, a couple that were great w/their hands and had good clinical judgement, but you really had to have a thick skin to work well with them.

Having worked w/both types, I think having the experience of the harsh treatment and the ability to "suck it up" and still act professional really pays off when confronted w/difficult patients or family members, other staff, consultants, etc. That's not to say that I think all surgical residents should have a daily session of abuse, but one is going to encounter all kinds of people in the world, and being able to deal appropriately with all of them is just part of being a successful physician.

Incidentally, it's the IM progam, not surgery, at my institution that is known for its malignancy.

 

[Foxxy Cleopatra]

Originally posted by Teufelhunden
I?ll never understand this.
So, I?ll take the Pepsi-challenge against anyone when it comes to ?who can tolerate more abuse.? However, it?s not the point. The question isn?t ?can I?? tolerate this type of treatment, it?s ?do I want to??

Personally?all these stories of screaming, scalpel-throwing surgeons are sad. People that behave this way must be truly insecure. This type of behavior is truly a feed-thy-own ego phenomenon of ?little? people. I may know squat about surgery, but I know a great deal about leadership?and good leaders don?t need to scream and yell to be effective. Conversely, the most respected leaders I?ve come across treated everyone with respect and dignity. Unfortunately it sounds that this type of leadership is a rarity in surgery.

I am a PGY-1 in surgery and I have went through the same thoughts myself, especially around the 2nd month of my internship. There are all sorts at my program from the berating type to the diplomatic version. Like many others, I have encountered enough adversity in life that I know I can handle berating and humiliation, but I have thought long and hard as whether I want to.

The bad things about surgery that I have seen so far include berating staff members, litiginous, angry patients, an understaffed and inefficient charity hospital system, lots of non-surgical work (get ready to have a phone glued to your ear as you set up appointments, try to coordinate necessary aspects of patient care, etc.)

On the other hand, there are plenty of exciting, stimulating, and rewarding moments. It tends never to be dull. If you love to operate and want that as a part of the repetoire of what you can offer your patients, then you will still find gratification at the end of the day.

I agree, I still do not find abuse as a particularly necessary or effective way of education, but it is out there. It now rolls off of me as I realize that it is not personal. Plus, there are plenty of incredibly intelligent, diplomatic varieties out there as well.

 

[womansurg]

Originally posted by Teufelhunden
So basically, don?t apply to surgery unless you?re willing to be treated like ****. Am I getting this right?

To some extent this is true. That is not commentary on how the system ought to work, but rather on how it actually does.

Anyone who has been around SDN long enough to know me knows that I have been an outspoken critic of the abusive structure and traditions of surgical training. Certainly I walked a difficult couse in my own training, due to my lack of tolerance of this pathological nonsense.

Nonetheless, in order to survive surgical training as it is today, a pretty strong sense of self identity is requisite. Surgery has one of the highest attrition rates in medical training, and it isn't because trainees don't love the discipline itself. They simply fold under, or choose to not endure, the awful treatment. Times are changing and many people are working from within the system to move this process along. But an individual who finds himself struggling to work within social frameworks in general would certainly find the rigid and unforgiving environment of surgical training to be injurious. Really injurious. There are an awful lot of bitter, damaged ex-surgery residents out there.

So, for someone considering going through surgery residency, some soul searching and honest self assessment beforehand is certainly in your own best interest.