just a question - hope to not offend

[loveumms]

Hey guys/gals,

So I'm running towards the gate of my fourth year (and I can't wait for this year to be over).

I'm currently on my OB/GYN rotation - in the depths of GYN ONC. I guess I really didn't notice the interaction b/t anesthesia and surgery during my three months of surgery, since it was the beginning of this year and I was not looking into anesthesia (my gas rotation was at the end of surgery).

Anyway, this past week has really made me wonder how you get along with the surgeons. Some of the ones I've worked with have egos the size of Montana (and that is being conservative). They whisper under their breath about the anesthesiologists skills and then expect them to smile and ignore their comments. At one point the surgeon said that the anesthesia for this case sucked and the anesthesiologist actually said “yes sir, sorry sir”. I just find it so rude and was wondering how you deal with the egos.

I also found that the surgeons called the anesthesia docs by their first name but anesthesia would call the surgeon by “Dr. X”. These are full time anesthesia attendings. The scrub nurses and everyone else also called anesthesia by their first names. I think it’s cool that the gas docs are cool enough to go by their first name but at the same time, I feel that being called “Dr. X” commands some respect from everyone. Is this how it is in many hospitals??

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[militarymd]

I turn of the machine and walk out of the room saying "if you think you can do it better, then do it yourself"

 

[Idiopathic]

I turn of the machine and walk out of the room saying "if you think you can do it better, then do it yourself"

of course you do

 

[SleepIsGood]

I think there's a fine line b/t being laid back and cool, and then just getting simply run over. As you've probably seen many of the current anesthesiologists are foreign and may have problems standing up to surgeons. I think the budding Anesthesiologists will definitely bring about change to this. Most of us newbies will be assertive (note this is different from being a total a$$).

Also, I think it's important that docs get away from this culture of letting nurses/ancillary staff call them by their first names. Yes, it's cool to be known as "Jim or Jack" or whatever. However, I think it's important to establish that doctor vs ancillary staff respect. Sure respect is obtained by other methods such as how you interact with people,etc. But letting non-physicians call you by your first name really blurs the line of doctor vs...

 

[supahfresh]

last week, I was working with a trauma surgeon with a bad rep for things like this. My attending came in the room and said "oh, you're using a BIS?" I said yeah, watching this guy operate is so damn boring I put the BIS on myself and set the alarm if I fall asleep.

another instance. CT surgeon tells Barash that the patient is moving. barash replies "so?"

point is that it depends on your personality and whether you know what you are doing. If you know your s hit, then you are golden. I am a sarcastic muthaf*** in the OR and I really lay into these guys once and a while.

another thing too. nobody from GYN should be ripping on anybody....

 

[Carm]

Hey guys/gals,

So I'm running towards the gate of my fourth year (and I can't wait for this year to be over).

I'm currently on my OB/GYN rotation - in the depths of GYN ONC. I guess I really didn't notice the interaction b/t anesthesia and surgery during my three months of surgery, since it was the beginning of this year and I was not looking into anesthesia (my gas rotation was at the end of surgery).

Anyway, this past week has really made me wonder how you get along with the surgeons. Some of the ones I've worked with have egos the size of Montana (and that is being conservative). They whisper under their breath about the anesthesiologists skills and then expect them to smile and ignore their comments. At one point the surgeon said that the anesthesia for this case sucked and the anesthesiologist actually said “yes sir, sorry sir”. I just find it so rude and was wondering how you deal with the egos.

I also found that the surgeons called the anesthesia docs by their first name but anesthesia would call the surgeon by “Dr. X”. These are full time anesthesia attendings. The scrub nurses and everyone else also called anesthesia by their first names. I think it’s cool that the gas docs are cool enough to go by their first name but at the same time, I feel that being called “Dr. X” commands some respect from everyone. Is this how it is in many hospitals??

That is an embarrassing anesthesia department. Drop a couple.

 

[Bobblehead]

Also, I think it's important that docs get away from this culture of letting nurses/ancillary staff call them by their first names. Yes, it's cool to be known as "Jim or Jack" or whatever. However, I think it's important to establish that doctor vs ancillary staff respect. Sure respect is obtained by other methods such as how you interact with people,etc. But letting non-physicians call you by your first name really blurs the line of doctor vs...

Just curious but have you tried this in an ICU setting?

 

[SleepIsGood]

Just curious but have you tried this in an ICU setting?

That's funny you mentioned that. In fact, I had this same conversations with my mother and aunts (both of who have 15+ years of ICU experience as nurses). They are the ones that gave me this sage advice about how I should never have nurses/midlevels always address me as "Dr. so-so". Their account was that docs that dont command this in the LONG run get less respect. Again, they also noted that you shouldnt be a jacka$$ and overly cocky about it. Unfortunately, they gave me this 'lecture' because they knew I was going into Anesthesiology, and in their 'tenure' as mainly ICU nurses, they've seen the line of respect notoriously get blurred because of the lack of assertiveness of docs in our profession.

 

[SouthSideSteve]

That's funny you mentioned that. In fact, I had this same conversations with my mother and aunts (both of who have 15+ years of ICU experience as nurses). They are the ones that gave me this sage advice about how I should never have nurses/midlevels always address me as "Dr. so-so". Their account was that docs that dont command this in the LONG run get less respect. Again, they also noted that you shouldnt be a jacka$$ and overly cocky about it. Unfortunately, they gave me this 'lecture' because they knew I was going into Anesthesiology, and in their 'tenure' as mainly ICU nurses, they've seen the line of respect notoriously get blurred because of the lack of assertiveness of docs in our profession.

I don't think calling a MD by their first name necessarily commands less respect. The title alone doesn't necessarily command total respect. While the tile does command some, demeanor and competancy count for a lot as well. I've worked with some physicians that prefer seasoned nurses call them by their first names, and other that never corrected someone calling them Dr. X. Never noticed a difference in their perceieved respect because of how they were addressed, and any disrespect was because of reasons other than how they were addressed.


Now of course around patients/family/other staff calling an MD by their first name is never appropriate. I appreciate and respect both ways and ultimately its the physician's choice. Just a difference in personalities.

 

[burntcrispy]

I think being called "Dr X" vs "Bubba" depends on the institution and the MD. Before going to Med school I worked as a nurse for a number of years in the ICU. In some of the private hospitals I never even knew the physicians first names because the interactions were very formal. It all depends.

From my experience, I would prefer to be called Dr X. Its nice to be chummy with the staff and all but when it comes down to business you want them to see you as captain of the ship instead of thier "best pal".

Just my .02

As far as the surgeon vs anesthesiologist interaction, it varies with institution also. At an institution with strong anesthesia you won't see many of the surgeons mouthing off because the anesthesiologist won't tolerate it. If you see the surgeons consistently disrespecting your anesthesiologists I would be more hesitant to do a residency there.

 

[UTSouthwestern]

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

Try now

 

[SleepIsGood]

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

link doesnt work bro

 

[VolatileAgent]

another thing too. nobody from GYN should be ripping on anybody....

 

[SleepIsGood]

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

Try now

Great link.

 

[threepeas]

titles in medicine are similar to ranks in the military. lives are at stake in both environments. we are not flipping burgers, or doing someones taxes, or trying to get a touchdown in a football game. decorum and respect both up and down the ladder should be maintained and addressing folks by their appropriate title helps maintain this. you shouldnt have to be called by your first name to create a laid back fun atmosphere at work. but maintaining titles is that little reminder that we are at work, peoples lives are in the balance, we all have our roles, and that we respect each other for their effort.

 

[burntcrispy]

Funny this should come up. A surgeon asked one of our attendings last night "Hey, are you anesthesia?". He said, "No anesthesia comes in a bottle, I'm Dr X" It made me laugh.

 

[Gimlet]

Funny this should come up. A surgeon asked one of our attendings last night "Hey, are you anesthesia?". He said, "No anesthesia comes in a bottle, I'm Dr X" It made me laugh.

Now THAT is a great response!

 

[dogbone65]

Understandable. You should really try some adult beverages and lighten up a little. If you insist on being called doctor..........no prob. Just remember to call me MISTER.

 

[SouthSideSteve]

Funny this should come up. A surgeon asked one of our attendings last night "Hey, are you anesthesia?". He said, "No anesthesia comes in a bottle, I'm Dr X" It made me laugh.

Correct me if I'm wrong but the reason people throw around 'anesthesia' is they are using it as the service? While you wouldn't look at a surgeon and ask him if he was 'surgery', I'll say 'anesthesia is coming up to intubate'. I would never call a singluar person 'anesthesia' or 'surgery'. You can never go wrong with 'Dr.'.

 

[cfdavid]

The more alpha males (and females, mind you) we produce in our profession, the more this issue will become obsolete. It's one thing for surgeons to think they can push around some dude from Syria, that may not have all of the traditional American social skills (i.e. understanding cultural nuances and jokes etc.), but quite another to do that to an anesth. doc that can hold his/her own.

Changing these cultural problems can take time. But, it's not that hard. You can never get bent out of shape (a sign of weakness which is the root of all bullying). And, you need to choose your battles.

An example would be addressing an indiscretion that occured in front of a patient or their family would be better than something that occurs in the OR. Simply pull the surgeon aside, and eye to eye, explain that you may not be as sensitive about things in the OR, but when representing the hospital to the patient, that you demand being called Dr. X. You do this personally with the surgeon, and face to face. Then, while looking at him directly in the eye, you smile and say "I knew you'd understand".

 

[militarymd]

The more alpha males (and females, mind you) we produce in our profession, the more this issue will become obsolete. It's one thing for surgeons to think they can push around some dude from Syria, that may not have all of the traditional American social skills (i.e. understanding cultural nuances and jokes etc.), but quite another to do that to an anesth. doc that can hold his/her own.

Changing these cultural problems can take time. But, it's not that hard. You can never get bent out of shape (a sign of weakness which is the root of all bullying). And, you need to choose your battles.

An example would be addressing an indiscretion that occured in front of a patient or their family would be better than something that occurs in the OR. Simply pull the surgeon aside, and eye to eye, explain that you may not be as sensitive about things in the OR, but when representing the hospital to the patient, that you demand being called Dr. X. You do this personally with the surgeon, and face to face. Then, while looking at him directly in the eye, you smile and say "I knew you'd understand".

And then the surgeon just takes all his cases to the surgery center in town that he and his buddies built and hires only CRNA's....who he addresses as "anesthesia"....and if they need MD's...they hire that Syrian fella with no social graces and pays him twice what you're making...because you have no cases to do.

 

[The_Sensei]

And then the surgeon just takes all his cases to the surgery center in town that he and his buddies built and hires only CRNA's....who he addresses as "anesthesia"....and if they need MD's...they hire that Syrian fella with no social graces and pays him twice what you're making...because you have no cases to do.

Unfortunately this is absolutely, 100% true. The sooner you accept the reality that the market is surgeon-driven the better off you'll be. Just ignore any perceived "disrespect" and you are the much stronger man. Trust me, I could easily destroy every single surgeon who has become confrontational with me in less than 0.4 seconds. But do I? No. Why? Because it takes infinitely more patience and social maneuvering to placate our number one customer - the surgeons. Don't get caught up in the whole "so-and-so just called me anesthesia and now I'm pissed" nonsense because only two things will occur:

1) You will spend your entire career pissed
2) You will still be referred to as the non-entity "anesthesia"

 

[militarymd]

Unfortunately this is absolutely, 100% true. The sooner you accept the reality that the market is surgeon-driven the better off you'll be. Just ignore any perceived "disrespect" and you are the much stronger man. Trust me, I could easily destroy every single surgeon who has become confrontational with me in less than 0.4 seconds. But do I? No. Why? Because it takes infinitely more patience and social maneuvering to placate our number one customer - the surgeons. Don't get caught up in the whole "so-and-so just called me anesthesia and now I'm pissed" nonsense because only two things will occur:

1) You will spend your entire career pissed
2) You will still be referred to as the non-entity "anesthesia"

I disagree with you about our number customer being the surgeon. I think the patient is the number one customer.

And...I think the patient gets better care with me and my hospital than at the surgery center without backup....soooooo....don't be too confrontational, take care of the patient, and you'll be paid a whole bunch of bucks.

 

[Sammich81]

I disagree with you about our number customer being the surgeon. I think the patient is the number one customer.

And...I think the patient gets better care with me and my hospital than at the surgery center without backup....soooooo....don't be too confrontational, take care of the patient, and you'll be paid a whole bunch of bucks.

From what you private practice guys have said--mil, jet, etc--aren't there places where you can have relative parity with the surgeons? It's definitely going to be them running the OR but they don't have to be a-holes about it. Just like the anesthesiologist doesn't bitch out the surgeon when he lacerates a vessel and the BP goes to hell, are there no surgeons who can mind their manners when the gas needs some fine tuning?

 

[UTSouthwestern]

Once again, I will say that I have very rarely seen this type of antagonism in private practice, save for one person who I believe was literally born with Craniorectal Insertion Syndrome. Even he, though, values a stable relationship with us (considering he's been fired by two other groups previously).

Yes you will see egos, but the majority understand that letting us do our jobs gives them a greater degree of comfort during the case.

I have also noticed that surgeons like to pounce on the hesitant/unsure anesthesiologist as a way to motivate them to learn more if they seem too uncomfortable doing a certain type of case.

Be knowledgeable, be thick skinned, and let the little things flow like bird poop off teflon paint. Pick the battles you must fight (cancelling a case for patient safety). In the end, it is a team effort and in even the most difficult of situations, you have to be the voice of reason and calm.

 

[UTSouthwestern]

Although the threat of losing surgeons to surgery centers is a oft voiced threat, understand that if a surgeon owns a surgery center, he/she would most likely take most of their business to a facility from which they draw administrative fees. If they are still at a hospital, they are there for a reason (referral base, inpatient priveleges, etc.) and that threat tends to be a two edge sword.

 

[jetproppilot]

From what you private practice guys have said--mil, jet, etc--aren't there places where you can have relative parity with the surgeons? It's definitely going to be them running the OR but they don't have to be a-holes about it. Just like the anesthesiologist doesn't bitch out the surgeon when he lacerates a vessel and the BP goes to hell, are there no surgeons who can mind their manners when the gas needs some fine tuning?

I think the sensitivity to this subject blows it out of proportion.

Like I've said before, in any place I've been, the majority of anesthesiologist/surgeon interaction is friendly...and with some its fraternity-like. Busting each others chops, etc...

Rick the orthopedic surgeon: "Hey Bill! Saw your Yukon parked at The Pubb last nite!" (a gay bar in the quarter)

Jet: "Yeah, well, thats where your wife said you'd never look. Guess you caught us."

Then theres the more business like surgeons who arent as personable, but know when the chips are down we'll be there for their patient and them. They are thankful for our expertise and respect our opinion.

Its uncommon to be f%^ked with.

But it does happen.

If it is low key, it is tolerated.

If it is over the top, it is dealt with.

The point that needs to be taken home by you pre-med/med student/resident colleagues out there, though is this:

and please take this to heart:

Anesthesiologists cater to surgeons.

If you've got a problem with that, you need to pick another career.

Now let me clarify myself about the above comment.

If you are a strong clinician with a confident personality, "catering" doesnt mean abused by or less than.

It means when its your turn to be on call or your turn to run the board, you're gonna do everything in your power to get the case done as soon as possible.

And even this comment needs to be amended.

Surgeon posts case. For whatever reason, you see a problem and the case isnt urgent.....this is VERY rare, but happens.

Cancel it.

This will happen once or twice a year.

Otherwise, cut through the chase, keep on top of all the B.S. (uhhh, Ms. Front Desk, you sent for the patient, right? Please call two-north to see if the transporter has left with the patient yet...)

Don't order-and-wait-for-useless-labs for a case thats gonna have to be done anyway.....i.e......open fracture....bone sticking out of lower leg with a red-balloon fragment from grandson's birthday party hanging off the end...it doesnt really matter what the labs are, since incidence of infection/sepsis are very high without surgical intervention within a certain time....

twenty minutes before going to the OR, call the surgeon from your cellphone.

"Dude, where are you? We're going back in twenty minutes. See you then."



The above is what I mean by catering.

Surgeons will love you for it, you'll be gratified at work, and you'll make great bank and have plenty of time with your family to boot.

The occasional problem surgeon, like I said previously, is tolerated if infractions are minor.

An intervention takes place if he gets out of control. Please search my/UT's posts for experiences with this. In a nutshell, if this issue gets to this point, the dude is a total a s s hol e since we are so easy to get along with. And he is dealt with at this point, behind closed doors, with this in mind.

But again, very uncommon.

 

[cfdavid]

And then the surgeon just takes all his cases to the surgery center in town that he and his buddies built and hires only CRNA's....who he addresses as "anesthesia"....and if they need MD's...they hire that Syrian fella with no social graces and pays him twice what you're making...because you have no cases to do.

What? You didn't know I had it all figured out? Hell, I'm starting MS1 in just 3 months!! lol

Good point.

 

[drrosenrosen]

In this or the other thread about "titles" and respect, I've never seen the notion of reciprocation brought up. This applies, in my mind, not just between so-called peers, but up and down the chain. If you are going to insist on being called Dr. X, for the sake of formality and professionalism, then you should address fellow physicians as Dr., and other staff by title and surname, or at least Mr/Mrs. If what you're really after is professionalism, then you'll recognize that these forms of address fall under that heading. If you insist that nurses call you Dr., while you call them by their first names, then you're just into getting your rocks off by being called doctor. My standing rule as a resident is that if a nurse insists on calling me dr, I will address her by last name. If she's comfortable with first names, so am I.

 

[Gimlet]

In this or the other thread about "titles" and respect, I've never seen the notion of reciprocation brought up. This applies, in my mind, not just between so-called peers, but up and down the chain. If you are going to insist on being called Dr. X, for the sake of formality and professionalism, then you should address fellow physicians as Dr., and other staff by title and surname, or at least Mr/Mrs. If what you're really after is professionalism, then you'll recognize that these forms of address fall under that heading. If you insist that nurses call you Dr., while you call them by their first names, then you're just into getting your rocks off by being called doctor. My standing rule as a resident is that if a nurse insists on calling me dr, I will address her by last name. If she's comfortable with first names, so am I.

I agree that if you are going to insist on being called doctor, you should hold yourself to the same standard.

In this situation, is it more appropriate to call them Mr./Ms./Mrs. Smith rather than Nurse Smith? I could foresee someone misinterpreting Nurse Smith as a sarcastic dig or something, but if you are addressing people by job titles (Doctor) rather than social prefix (Dr.), then it could make a difference. Does anyone address their nurse coworkers as Nurse Smith? If you do that, then do you have to call the custodian Janitor Jones?

 

[dogbone65]

Thanks Andy! I've been trying to get that point across to people for years. Nurse, physician, lawyer, engineer, booger eater, etc are all occupations/professions. Mr/Ms/Mrs/Dr are titles.