Do they call you "doctor"?

[Audrey Hepburn]

Just wanted to get an idea of how it's done at other institutions -

I'm an anesthesiology resident at a big medical center. A question (or two) about who calls you what -

What do the nurses in the OR call you? Dr. Lastname? Your first name only? "Hey, Anesthesia?" Does it ever bother you? Do you think it affects the level of respect (even subtlely?) you receive in the OR? What do the surgeons call you? Do you give a damn how anyone addresses you?

I ask because I feel that at our institution, we are not really respected as MD residents - that much of the OR staff feel as if we are mere technicians, and their REAL purpose in life is to help the surgeons - answer their pages or their cell phones, jump to get anything "the DOCTORS" need, scramble to scratch their balls if so desired. (Even the surgery residents get this kid-glove treatment.)

Me? I ask for some fluid, and I get the eye-roll-WHAT-do-you-want-now-in-a-minute-when-I-finish-my-sudoku from some (not all) of the nurses, techs, patient care peoples..... And I don't want to be a bitch (but I'm certainly not overly nice anymore...) but I'm trying to figure out how to bring some respect back into the OR. (Not much help coming from above....)

I feel I act like a professional, treat people with respect, am confident, competent, very polite (please, thank you - mama raised me well.) If you are called Dr. so and so by the nurses, other staff, do you feel this changes things? Have you found anything else that changes things?

Just looking for some feedback from other places....

-AH

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[johankriek]

Just wanted to get an idea of how it's done at other institutions -

I'm an anesthesiology resident at a big medical center. A question (or two) about who calls you what -

What do the nurses in the OR call you? Dr. Lastname? Your first name only? "Hey, Anesthesia?" Does it ever bother you? Do you think it affects the level of respect (even subtlely?) you receive in the OR? What do the surgeons call you? Do you give a damn how anyone addresses you?

I ask because I feel that at our institution, we are not really respected as MD residents - that much of the OR staff feel as if we are mere technicians, and their REAL purpose in life is to help the surgeons - answer their pages or their cell phones, jump to get anything "the DOCTORS" need, scramble to scratch their balls if so desired. (Even the surgery residents get this kid-glove treatment.)

Me? I ask for some fluid, and I get the eye-roll-WHAT-do-you-want-now-in-a-minute-when-I-finish-my-sudoku from some (not all) of the nurses, techs, patient care peoples..... And I don't want to be a bitch (but I'm certainly not overly nice anymore...) but I'm trying to figure out how to bring some respect back into the OR. (Not much help coming from above....)

I feel I act like a professional, treat people with respect, am confident, competent, very polite (please, thank you - mama raised me well.) If you are called Dr. so and so by the nurses, other staff, do you feel this changes things? Have you found anything else that changes things?

Just looking for some feedback from other places....

-AH

hey man i feel ya..

if it gets to be a problem where you are not getting adequate assistance from the nurses in the OR. Just go to the OR manager and voice your concerns. IF things still dont get handled, call the VP of nursing in the administration and let her know how you feel. Unfortunately, you are in training just go to your attending and chairman.

 

[2ndyear]

I hear ya, asking for anything from a circulator is a huge deal. Huge. Some nurses call me doctor, but since I readily don't in the OR (I'm a resident...come on) I guess I don't expect it from them. Generally, surgery residents are first name with the OR staff as well. Surgery attendings are usually Dr. Anesthesia attendings, plus/minus where I am. Pedi usually first name. Others depends, but most OR staff will call them Dr.

 

[militarymd]

It's all a matter of institutional culture. I'm afraid that if that is the prevalent culture where you are located, then it is likely to stay that way for a long time.

I like to compare changing the institutional culture to steering the Titanic with a canoe paddle....ie it can be done, but it will take tremendous patience and hard work.

Where I'm located, I am addressed as Dr. by everyone....including by the surgeons....the nurses that work around the OR (circulators, CrNA, preop, pacu) who know me well...just call me by my last name....I've made it clear to them that my first name is fine, but that seems like too much of a stretch for many of our nurses...but they will leave out the "dr." and just address me by my last name....which is kind of funny because that's how my wife addresses me when she is mad at me.

A couple have nicknames for me...which are only used when there are no patients around.

NO ONE calls me or any of my staff "anesthesia"....except when overhead paging....although if they did, I doubt that any of my staff would care.

Bottom line...institutional culture...and as a resident, I'm afraid you have very little power to change any of it....and if you try, you will probably be labelled with a name that you will like less than "anesthesia"

 

[SleepIsGood]

Unfortunately what you are describing has transpired because anesthesiologists previously didnt care, they were too non-chalant. Fast forward 10-20 yrs to know, and well we have the situation you have described.

What have I noticed? Well, more often than not it's an institutional culture. But you can change that. It's all about how you introduce yourself one the FIRST day. Yes, the FIRST day. And you have to be confident. I think all too often residents dont have the confidence to introduce themselves as Dr. XYZ.

Non-Believers will say, "oh well it's not a big deal...blah blah". It is. You have to show them 1)you're competent 2)you're capable true. but the title is a must. Or else, the nurses, etc will start prancing all over you from Day 1.

Unfortunately, once the attendings are called by their first name at places, well then you are in

 

[VolatileAgent]

they call me doctor in the SICU and on the wards in front of patients. rarely in the OR. most of the senior nurses call everyone (even the attending surgeons who've been there for 20 years) by their first name. it's clearly a power trip thing, but no one cares.

when some nurse (or ancillary) calls me doctor away from a patient's earshot, i often tell them that they only need to do that if they're naked and i'm clincally probing one of their orifices (ie., i actually am acting in the capacity as their doctor). otherwise, i really don't care. there are bigger things to get your panties in a bunch over.

now, if i insist that some reasonable, pertinent, and critical patient care task be undertaken by them urgently through my capacity as an ordering physician - and am subsequently denied for whatever reason, the wrath of god is brought down upon their heads to the best of my capability to do so. in that case, i don't care who they know or how long they've been there... or what they call me before, during, or after.

 

[Gasboy07]

I don't care what they call me - I feel more comfortable on a first name basis with people anyway. I introduce myself to the patients by my first name as well, and introduce my boss as Dr Anaesthesia.

However I make it quite clear that when in the OR I am in charge of the patients overall safety and wellbeing. I don't see that the patient is the attending (consultant's) responsibility only - even though legally it is the bosses, I feel that as I often know the patient better than the boss I'm the one in the position to be responsible for the patient.

How this happens depends on whether I trust the nurses or not - some places they can pick up trouble before I might (when I'm paying attention to 5 things at once) and I'm a lot more informal with them. The ones that I don't get the talk of I'm in charge and what I want done is the first priority.

It might put a few people off side first up, but once they work with me for a while they are more comfortable with that attitude...

Once we head to the pub though - all the respect disappears! Hehe, in fact I think it's better once they know me on a social level, as then the nurses realise that it's just a work front (a veneer of professionalism?!) I have and that I'm alright company after...

 

[UTSouthwestern]

http://forums.studentdoctor.net/showthread.php?t=222842

 

[opa beleza?]

My strategy: Don't shti where you eat. Just train. Don't worry about your name -- never address the issue publicly, it is self destructive to do so -- people know who you are very well. Become an irreplacable part of the team. Check your ego at the door and demonstate your qualifications by your actions and ability to bring the best out of everyone. Pump out the cases flawlessly. Be the one they -- everyone -- janitor to chairman, can count on for anything --- anything. Do this for your entire career. I think this will be noticed more than a title, and bring you more respect and a better job down the line, and a stronger group when you start one.

 

[Planktonmd]

I think it is helpful to get humbled during residency and learn to become completely independent. It's also helpful to become less sensitive.
No matter how mean they are to you, you need to keep your attitude as neutral as possible and look as confident as possible.
You should not expect any help from anyone in the OR, because you might very well find yourself in a place where no one will or can help you.
The fact that the OR staff is there to "scratch the surgeon's balls" is a fact of life and it's everywhere.
The good news: it gets better after residency and if you act like a doctor they will treat you like one.

 

[lushmd]

Sort of OT, but this thread reminded of an incident during my MS3 surgery rotation: anesthesiologist is placing an A-line, circulator fiddling with suction tubing near anesthesiologist's feet, circulator repeatedly barks at anesthesiologist to get his "fat a$$" out of her face. As if this wasn't shocking enough, nobody said anything to her (not the anesthesiologist, not the surgeon; I couldn't believe it). I'm all for being humble and all that, but when I'm an attending I'm not putting up with that BS.

 

[Gasboy07]

I don't know how you guys tolerate that sort of attitude - but no nurse ever say that to me (or any other resident / attending).

I was running and arrest and telling the nurse to give CPR faster (they weren't getting 30:2 in fast enough) and she said "why don't you come and help" to which I responded
"I'm running this arrest, I stand back and think and tell you what to do"

All of a sudden everything I wanted got done.
You've got to make them realise the anesthesiologist is the person in charge of the overall safety, wellbeing and survival of the patient, and as the resident you're the 2IC.

The patient is the most important person in that room, and as the person ultimately responsible, everybody else (including the surgeon) is at your beck and call (of course they don't think that...). Where I've worked, nearly every surgeon (even the very senior ones) ask me (a very junior resident) as a matter of courtesy whether it's okay to start. It's sorta a subtle way of acknowledging that they usually get all the credit, but if **** hits the fan we sort it out.

 

[mikeshana]

i was actually talking to my dad about that a few weeks ago (he is an attndng anes). He said that most (not all) places that train residents are like that. Most private practice places are somewhat different. he bascially said that regardless of what is said, anes is in charge of the room, taking care of the pt. As an aside just remember who will really save the pts life if it comes down to it. I also think circulators who talk sh-t have not been in a situation where sh-t hit the fan and saw what an anesthesiologist really does think a little bit different

If not, f-k them, just remember at the end of the day when u leave at 4pm to have dinner with your family and everyone else is still stuck in the room who is really taking home the phattest paycheck

 

[Stimulate]

The surgeons and surgery team will always get more respect so that is something to just get used to. The circulators and techs usually work in one area (i.e. urology) so they work with the same surgery teams day in and day out. So if they don't scratch that surgeon's balls just the way he likes it then he will make their lives miserable for years to come. When they don't help the anesthesiologist there are rarely any consequences.

In anesthesia there are so many different faces, doctor x relieving doctor y, etc. that you are just a service as far as they are concerned. Part of this is our own fault because we frequently interchange ourselves to enhance our quality of life. However, when things hit the fan in the OR, you invariably end up earning the respect that really should be there already.

I don't care about being called doctor in the OR or on the nursing floors with the exception of when we are in front of patients. I won't tolerate being referred to with my first name in front of patients (i.e. when I am trying to establish a rapport and build up the patient's confidence outside the OR door). One of our attendings has a saying that goes like this..."in life you only get the respect that you demand". To be honest with you though, as a resident I wouldn't make a big issue out of it because you will undoubtedly lose in the end.

As an aside, I have noticed that in pain management I am consistently treated with much more respect than I ever am in the ORs doing anesthesia.

 

[militarymd]

...., circulator repeatedly barks at anesthesiologist to get his "fat a$$" out of her face......

What if you HAVE a fat ass...like one of the guys that i fired?

and that fat ass IS in her face....I don't think I would blame a circulator.

 

[Unconscious]

Where I am, its a mix, some nurses call me by my 1st name (usually the ones that are friendly) the ones with attitude, I had given them attitude back at the begining of residency so by now they know not to mess with me, I have a reputation not to tolerate any disrespect even from attending surgeons, I've told them off several times, but you have to be smart about it, no disrespect but just stand your ground. when a surgeon called me anesthesia, I answered back: yes surgery!! my name is so and so, trust me, OR staff see how you deal with Surgeons and approach you accordingly. I'm not trying to make a big deal about it, but if its bothering you, you should say something to that person saying: I'm Dr. so and so, if you get attitude, then tell them that thats your title and that you did not get your medical degree from their freakin mother's back yard, you get the point. I see some departments at my hospital where every resident is reffered by Dr. so its realy not too late to set people straight, you earned that title, so use it.

 

[me454555]

Its funny how we talk about this it and it becomes an issue in the hospital b/c we don't want to seem pompous or superior yet in the army, people are always addressed by their title and its never really an issue

 

[Unconscious]

Its funny how we talk about this it and it becomes an issue in the hospital b/c we don't want to seem pompous or superior yet in the army, people are always addressed by their title and its never really an issue

I'm quite familiar with military residency, it is true, you don't run into these problems. it's always yes sir/ma'am. I wish civilian world operates that way. although I knew few nurse managers/head nurses in the army that outrank some attendings but yet they still took orders from doctors. Sometimes I wish I signed up when I started med. school

 

[me454555]

I'm quite familiar with military residency, it is true, you don't run into these problems. it's always yes sir/ma'am. I wish civilian world operates that way. although I knew few nurse managers/head nurses in the army that outrank some attendings but yet they still took orders from doctors. Sometimes I wish I signed up when I started med. school

And its not just the hospital alone. Whenver you address someone its private so and so, sergent so and so, or Lieutenant so and so. Everyone does it and no one feels about being called by it b/c its a title they have earned. Just like us

 

[Stimulate]

One of our former residents had a sign with her name on it in big black letters that she would post on the anesthesia machine in easy visibility of the surgeons and circulator. She did this because she hated being called "anesthesia", not so much out of concern with being called doctor. She had her "full name, MD" on the sign.

 

[FLK 1]

.

 

[pgg]

I'm quite familiar with military residency, it is true, you don't run into these problems. it's always yes sir/ma'am. I wish civilian world operates that way. although I knew few nurse managers/head nurses in the army that outrank some attendings but yet they still took orders from doctors. Sometimes I wish I signed up when I started med. school

I think rank in military medicine creates more problems than it solves.

What there ought to be is a hierarchy based on education and training. Crudely put, attending physician > resident/intern > nurse > techs ...

Unfortunately there's a very small but vocal population of the nurse or medical service corps that believes their military rank affords them the right to anything from a sense of casual familiarity with the doctors to authoritative input[1] into the management of patients. The existence of midlevels, particularly those who are already pushing for equality to physicians, only stirs the pot further. And then you can add in the fact that operational necessity results in either tacit or explicit approval of said midlevels functioning totally independently. While deployed, I've seen nurses, CRNAs, PAs, even line officers with EMT certification try to pull rank on doctors. What was more appalling than that was the fact that the doctor couldn't simply tell those *****s to STFU without assuming the risk of some kind of reprimand.

Then you've got an annual pool of brand spanking new residents returning from GMO tours. Some of these guys will be O4s and will outrank board certified attendings who went the FAP or no-GMO path, and some of them are just goofy enough to think that the rank means something.

I'm not talking about the new O3 resident who respectfully introduces himself as lieutenant because it's what a few years with Marine infantry has bred into him and he's trying to be polite and deferential to his superiors. I'm pretty sure I've seen militarymd comment on his annual July beat-downs of new post-GMO residents who thought running a medical department on a ship or with the Marines somehow imbued them with ... something. And, just to complete the picture, consider the rare insecure attending who's supervising a resident who outranks him. That's an ugly scene; I'd rather watch monkeys fling poo on the Discovery channel. Pretty soon one finds incentives to marginalize rank or simply pretend we're not in the military at all.

I can't think of a single way that the existence of rank in military medicine positively impacts anything except (sometimes) allowing you to respectfully greet a patient and make him feel at home.


[1] I'm doing my best to be polite in choosing this phrase.

 

[Unconscious]

I think rank in military medicine creates more problems than it solves.

What there ought to be is a hierarchy based on education and training. Crudely put, attending physician > resident/intern > nurse > techs ...

Unfortunately there's a very small but vocal population of the nurse or medical service corps that believes their military rank affords them the right to anything from a sense of casual familiarity with the doctors to authoritative input[1] into the management of patients. The existence of midlevels, particularly those who are already pushing for equality to physicians, only stirs the pot further. And then you can add in the fact that operational necessity results in either tacit or explicit approval of said midlevels functioning totally independently. While deployed, I've seen nurses, CRNAs, PAs, even line officers with EMT certification try to pull rank on doctors. What was more appalling than that was the fact that the doctor couldn't simply tell those *****s to STFU without assuming the risk of some kind of reprimand.

Then you've got an annual pool of brand spanking new residents returning from GMO tours. Some of these guys will be O4s and will outrank board certified attendings who went the FAP or no-GMO path, and some of them are just goofy enough to think that the rank means something.

I'm not talking about the new O3 resident who respectfully introduces himself as lieutenant because it's what a few years with Marine infantry has bred into him and he's trying to be polite and deferential to his superiors. I'm pretty sure I've seen militarymd comment on his annual July beat-downs of new post-GMO residents who thought running a medical department on a ship or with the Marines somehow imbued them with ... something. And, just to complete the picture, consider the rare insecure attending who's supervising a resident who outranks him. That's an ugly scene; I'd rather watch monkeys fling poo on the Discovery channel. Pretty soon one finds incentives to marginalize rank or simply pretend we're not in the military at all.

I can't think of a single way that the existence of rank in military medicine positively impacts anything except (sometimes) allowing you to respectfully greet a patient and make him feel at home.


[1] I'm doing my best to be polite in choosing this phrase.

I'm not trying to paint a great picture of the military medicine, I agree that there should be a cap on rank or longer promotion period for non-physicians (i.e. nurses, RRT's, PAs, CRNAs) in the armed forces to avoid these conflicts. But again, medicine in the military does take a back seat to years of service. But in everyday life, you don't see these individuals that try to pull this rank s#$t that often. when you are in the vacinity of a medical facility, you are the boss, and they know that. Just like civilian world, they will test you to see what can they get away with. outside the hospital, as long as you salute them, wear your uniform properly, etc... they can't do too much. when it comes to saluting, think about it as they are your elders, out of respect... you get the picture.
Again, I totaly agree with how you feel. I was trying to make a point.

 

[cfdavid]

A few years ago, there was a young new attending at my residency program who had zero tolerance for “hey anesthesia”. On one of his first few days, he quietly told the anesthesia resident that he was leaving the room for a little while, and that when he came back, he wanted to be introduced to each person in the room by name. He returned half an hour later, and the resident introduced everyone by name as he’d been instructed. The attending was polite as he met everyone. When the introductions were finished, he simply said to the room “now what’s my resident’s name?” Crickets chirping. He then said, “wait a minute….my resident just introduced me to each of you by name, and not a single one of you (surgeons included) knows his name? Is it ‘anesthesia’? No, his name is Dr. ____”.

Unfortunately, he didn’t stick around. Guys like him never seem to stay in the academic environment for very long.

The bottom line is that if you have balls and command respect, you'll get it. Even in a bad culture hospital, I'd think that by 1) making it a point to be called Dr. X (there are any number of opportunities in which this can be accomplished, and 2) doing a great job and earning respect, then things will then take care of themselves.

I realize the customer/provider relationship b/t surgeons and anesthesiologists in private practice, but nevertheless, you can have great relationships and still demand the kind of treatment that you deserve.
I think that would actually strengthen professional relationships given that mutual respect is necessary.

 

[Gasboy07]

It seems different in private land as you're likely to be working with your friends / mates / people you get on with / play golf with etc etc... I haven't been there yet but that's what I'm hearing. Also I have a number of surgical trainee friends that I'm sure I'll work with later on once we're finished and I think this will certainly promote a different atmosphere.

 

[EtherMD]

It seems different in private land as you're likely to be working with your friends / mates / people you get on with / play golf with etc etc... I haven't been there yet but that's what I'm hearing. Also I have a number of surgical trainee friends that I'm sure I'll work with later on once we're finished and I think this will certainly promote a different atmosphere.

Yes, you are correct. At my Institution treated with respect and make a lot of tough calls in the O.R. Anesthesiology (M.D.) decides whether a case goes and whether to bump another surgeon. Even most of the CRNA's call you Doctor because you are the BOSS.

One or two of the older (60 plus) R.N.'s call me by first name. I figure that after 30 plus years in Nursing what the heck. BUt, this is definietely the exception and not the rule. A good Physician Anesthesiologist doing advanced Regional, Cardiac, TEE, U/S, etc. EARNS respect as a Physician.

 

[Robert Loblaw]

These are all very interesting comments, and I do appreciate the sentiment that those who are fine with first-name bases express. I do, however, sometimes wonder whether it is important for we physician anesthesiologists to present ourselves in the most professional light, in order to accentaute the differences between us and those other anesthetists. This may not apply to those older attendings who have, I'm sure, a certain presence that commands respect. But for those of us younger trainee's without that air about us yet, I feel like it is very important to present ourselves in a certain fashion. This means, contrary to some of the residents I have seen, we should have appropriately fitting, non-wrinkled, SHIRTS TUCKED IN, scrubs with some article of embroidered clothing (OR cap, scrub top, or even white coat [at least in pre-op], though I know how impractical the latter is) that says Name, M.D. Perception is reality. I can say with certainty that if this standard were enforced, perceptions would change drastically...I guess this is kind of the Broken Windows Theory of improving respect for anesthesiologists.

 

[IceDoc]

Where I've worked, nearly every surgeon (even the very senior ones) ask me (a very junior resident) as a matter of courtesy whether it's okay to start. It's sorta a subtle way of acknowledging that they usually get all the credit, but if **** hits the fan we sort it out.

And I always thought that was b/c they wanted to make sure the patient wouldn't object to incision!

 

[Gasboy07]

I didn't realise the patient had a say in the matter!