Personality for Anesthesia

Discussion in 'Anesthesiology' started by Strength&Speed, May 31, 2008.

  1. Strength&Speed

    Strength&Speed Need more speed......
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    I did a post search and found only one thread which was only moderately helpful. What sort of personality do you think is key for Gas? By the way...I HATE micromanagers. Hopefully there aren't a shyteload of those in this field. Ineffective micromanagers are my kryptonite.
     
  2. coprolalia

    coprolalia Bored Certified
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    I can definitively tell you what are some key personality traits/behaviors that are not conducive to a good anesthesiologist:

    (1) Lazy
    (2) "Linear" thinkers (one way is the only way)
    (3) The "I'm always right" confrontationalist
    (4) The book-smart-but-zero-common-sense types
    (5) Timid
    (6) Uncoordinated
    (7) Short-cut artists
    (8) Slow pokes
    (9) Easily angered / low provocation factor
    (10) People who always expect to be deferred to

    These are just a few, a starter list if you will. If you can be/are the opposite of these, then you'll probably do okay.

    -copro
     
  3. Strength&Speed

    Strength&Speed Need more speed......
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    I do like a good short cut now and again. Otherwise im fine. :) Can I do this residency in just 2 years? :p
     
  4. huktonfonix

    huktonfonix board certified!
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    hmm....I could be in trouble.......hopefully the anger just comes from residency.
     
  5. Bertelman

    Bertelman Maverick!
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    It's been covered, but not how you searched. There's been a few recent (as in past year) threads on "how to survive private practice" or some such title.

    1) Don't expect to be the top gun. That's the surgeon's role. Anesthesiologists play an important part, but usually don't call the shots in the OR. At the same time, ignore the surgeon v. anesthesia dialogue you see in academia. It usually doesn't work that way in PP

    2) Must be a team player, from working with the surgeon to the circulator to the PreOp/PACU nurse to the anesthesia tech to the OR charge nurse.

    3) Things can change quickly in the OR. Whether it's turning over cases, changing rooms with a colleague, or your own case heading downhill fast. You've got to be able to react and roll with the punches.

    4) It helps to have a sense of humor, and to know when to lighten the mood in an often tense environment.

    I like to think of the role as being your buddy's wingman going out at night. You know the night's not really about you, but it wouldn't happen if you weren't there. Sometimes you get stuck with the ugly chick, sometimes you get high-fives for your strong work. Either way, if you have the right attitude it's rewarding. In the end, you're still going out and partying at night, while your Medicine buddies are stuck in the library studying.
     
  6. jetproppilot

    jetproppilot Turboprop Driver
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    Go to Anesthesia FAQ 3, scroll down until you see the link for my Are You Ready For Private Practice? post.

    BTW, I didnt do the red-ink s hit.

    Happened when Venty posted it.
     
    #6 jetproppilot, May 31, 2008
    Last edited: May 31, 2008
  7. coprolalia

    coprolalia Bored Certified
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  8. coprolalia

    coprolalia Bored Certified
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    And, you know what? I read that post and I couldn't agree more, Jet. I'm at the point where I can see the behaviors of some of our attendings... and why they could never hack it in private practice.

    Just the other day, I got pulled aside and lambasted by an attending. Suffice it to say that he was criticizing my attitude, something about how I try to take charge too much for a resident, and that I don't know my place (i.e. I don't know as much as I think I do..., etc, etc). He was really trying to knock me down a peg or two. Why? I didn't realize initially. I had to think about it a little.

    I was deeply bruised by this encounter. I thought long and hard about it afterwards. Then, it finally struck me. I realized the most important thing about this negative interaction we'd had.

    I realized, from this interaction, that this dude could never hack it in private practice. Here's how I came to this conclusion...

    I've noticed over the past few months that, when I'm in a non-urgent room, the surgeon usually looks over at me and asks how things are going, what's the next step (extubation vs. going to the unit), etc. It's natural. You develop a reputation after a while. People learn that they can start to trust your judgment.

    Well, this happened about two weeks ago with this particular attending in the room towards the end of an ORIF. I noticed that, instead of the attending who was standing right there, they addressed me, and asked me what we were going to do for this patient who was going to CT scanner immediately after the case was over.

    Well, my attending answered anyway. Then, I made the mistake. I said, right after he was done answering, what I thought should be done. It was different from his plan. It was a judgment call. He wanted to go tubed. I said, "Or, we could extubate and we can keep him sedated, if necessary, with a little midazolam." There was no need to keep this particular patient tubed. What happened? We ended-up going tubed.

    This guy apparently was really stewing about this for a couple of weeks, and saved it until the other day when we were working together again. Now, you have to understand, many of the surgeons can't stand working with this particular anesthesia attending. One has even flat-out refused to do cases with him. He's a bona fide egomaniac and bully. He's strong clinically, don't get me wrong, and is an expert anesthesiologist in every sense of the word, but his personality often gets in the way. I think this is why they usually put him with CA-1's because he knows a lot, and is less likely to be challenged by them. As someone finishing CA-2 year, I made the stupid mistake of challenging him in front of a room of people.

    This was a bruised ego at work, no doubt.

    In my mind, extubating made more sense. This would've saved time recovering the patient. We could've gone to the CT scanner, I could've "recovered" him while there, and then he would've gone back to the floor. The attending wanted to keep him tubed, I guess, for convenience and the assurance that he absolutely wasn't going to move in the scanner. That's reasonable too, I suppose. But, then he was going to have to go back to the PACU to be recovered. This would tie-up resources up there, and it would've just taken more time, as well as potentially added additional risk (transporting an intubated patient, setting up an infusion to keep him sedated, etc.). Remember now, this was a relatively healthy 20-something trauma patient who needed a follow-up belly scan. We were finishing an ortho procedure. He wasn't ventilated before the case. This was an issue of getting scanner time. The trauma service wanted him scanned that day, and our slot just happened to be after the ortho case was over. No plans to take him back to the OR for an ex-lap or anything. I thought my plan was reasonable too, and certainly less resource intensive. I challenged his plan. After all, I'm growing my fledgling wings and starting to crawl towards the edge of the nest. I should start to develop and use my cerebral cortex a little more during this point in my training, shouldn't I?

    So, apparently over the past couple of weeks, this gas attending had been brooding over this episode. He'd apparently been "saving it up" for the next time we worked together, which was a few days ago. What really bothered me most was that, when he finally confronted me the other day, it was after a heavy pimping session in the OR. I haven't been pimped that hard since the beginning of my CA-1 year. Mostly now with other attendings we have "discussions" about what the best course of action in a particular case is. That's what I've gotten used to over the past six months. But, instead, this guy launches into me with a full-bore pimp session during our first case. At the end, tells me basically that I don't know ****. That I'm never going to pass the boards. Then, he brings up the issue related to wanting to extubate before going to the CT scanner. He recounts about ten reasons why it was stupid of me to even think that - his reasons. Then, even worse, he starts going into **** that occurred over a year ago. The coup de grace was when he starts delving into what he perceives to be my personality flaws.

    I just sit there and take it.

    Now, this particular attending has a notoriously checkered history, as alluded to above. You know the type. Inevitably, he always feels compelled to "chime in" at Grand Rounds and challenge whomever is presenting. He routinely embrasses our department, in my opinion, especially when we've invited a prestigious speaker from somewhere... and he has to point out what he perceives to be flaws in their presentation.

    After what was tantamount to a verbal abuse session, I was fuming. I wanted to go to my PD and tell him that it was unacceptable to use that as a forum to blast me.

    Then, I stopped. It hit me. I have no power. I am a peon. And, I realized that I'm going to be outta here in a year.

    I've just got to bide my time, learn as much as I can, take the good pointers and teaching when they come, and not worry about these a**holes who have such abrasive personalities that they could never hack it in the "real" world. These are the ones I allude to above in my list. The "number (3)" people. They want to make everything an argument. They want to argue with residents. They want to argue with their colleagues. The even want to argue with the surgeons. People start to avoid these people, because they can't even have a polite conversation without it turning into some sort of disagreement ("It's a nice day today, isn't it?", "Well, not really, it's going to rain later.") This particular guy even started giving unsolicited pointers to the attending surgeon during our third case that same day when he was having a little trouble getting a view on his scope. Unbelievable.

    =============================================

    I think a big part of residency, in addition to learning what to do, is to carefully observe certain people and trying to learn what not to do. There are some basic human interpersonal skills that, I believe, some people just can't be taught. I'm spending a large part of my time, at this point, picking up on things that I think are "slick", and also thinking about how I would've done something differently than my attending.

    What's been disappointing to me is learning that you can't always have an open conversation with every person about what you think may have been a better way to do something. If you disagree with them, and you express it, they start to store these things up. Like Jet says, there's a lot of "water cooler" talk going on behind your back. Impressions are formed. Behaviors are observed. Character traits are assigned. Just as I've done here. It pays to learn how to play the game early on, and play it well. Most importantly, as a resident (or junior attending) one should recognize that you have no power. It sucks, but that's just the way it is. Apologize a lot if confronted about a perceived (or real) judgment issue, even if you weren't necessarily "wrong". Know when to keep your mouth shut. Ultimately, you gotta look out for #1, which is yourself.

    -copro
     
  9. dhb

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    With your permission i will rephrase: "YOU CAN NEVER HAVE AN OPEN CONVERSATION" whatever you say will be held against you, academic attendings have their beliefs and are not going to reconsider them based on a discussion with a slave.
    If you quote something from a book then the book is outdated if you try to apply something from a study then your practicing experimental medicine and should go back to basic principals... unfreaking believable
     
  10. coprolalia

    coprolalia Bored Certified
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    As I've said before, I've had the opportunity to work some moonlighting in a PP gig (basically functioning at the level of a glorified CRNA), and I've seen how it's done in the "real" world.

    The thing that's struck me most is the empowerment I feel to make decisions in that environment without having to defend every choice I make. At that gig, they kind of expect me to do the right thing. Everyone has been very helpful when there, and there is always a "supervising" attending present to help out if/when I get stuck. There's no judgment when calling for help. I don't have to worry about some negative evaluation getting stuck in a file somewhere.

    Sure, I know I'm on display and the group is looking at me as a "test drive" for a potential spot when I'm done. I know this going in. But, still, everyone is very supportive and keen on helping me out. They want me to succeed.

    I can't say I always feel this when I'm at my program. I'm sure they always have my best interests in mind, but there's often just so much ego flexing that it makes me a little sick to my stomach. In fact, I'm often baffled at some of the decisions our residency attendings make, and how vehemently they feel the need to defend those decisions. At the PP gig, it's more like "well, yeah, we can do it that way, or we can do it this way... you choose."

    World of difference.

    -copro
     
  11. huktonfonix

    huktonfonix board certified!
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    I completely agree that some attendings can be way to confrontational and would not cut it in PP. However, even though you'll notice that toward the end of CA2 and especially CA3 year they will trust you and respect your judgement, there is still a heirarchy. I've realized that even if you dont neccesarily agree with an attendings plan there are many ways to skin a cat so I won't publicly argue or disagree unless I feel it compromises patient care. I will however, either discuss it quietly with the attending either behind the drapes or after the case and ask if we could do it the way I thought appropriate. Sometimes they'll agree sometimes they wont. This way no egos are bruised , and the attending is usually more than happy to explain why they did it their way rather than just calling you a ****** and storming off. The point being that even if they are an a#$hole or incompetent, they have worked to get to where they are and still deserve the basic courtesy of not being shown up in front of their colleagues.
     
  12. coprolalia

    coprolalia Bored Certified
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    I agree with you, but I don't think I was exactly "showing up" this particular attending. I just publicly offered a different plan. A mistake. One I won't make again.

    Only 13 months to go... and counting the days already...

    -copro
     
  13. Planktonmd

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    Although I agree with most of what you posted, I have to say that challenging your attending's plan openly and in the presence of surgeons is not a smart move.
    It's his case, and his license, you can discuss it with him quietly and privately but he ultimately calls the shots.
    In the future you will have people practicing under your license and your liability, I bet you will expect them to do what you say.
     
  14. huktonfonix

    huktonfonix board certified!
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    like many wise CA3s before me have said, "fly under the radar". CA3 year will bust your a$$, but it can be a lot of fun too. Good luck!
     
  15. coprolalia

    coprolalia Bored Certified
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    If what I say may not be the best course of action, I would hope they would speak up. Especially true if I'm overlooking the obvious. That's what, personally, I would expect in a true "team" environment. I'm not God, nor do I ever intend on trying to become Him.

    In my mind, this boiled down to, for him, an ego contest. Trust me when I tell you that was the furthest thing from my mind when I spoke up. And, he got his way anyway. I didn't protest after he said, "We're taking him tubed." In fact, I didn't say anything at all after that except, "Okay. Will do."

    Bottom line, the patient did fine. Ultimately, that's all that really matters.

    -copro
     
  16. coprolalia

    coprolalia Bored Certified
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    Good advice. :)

    -copro
     
  17. Strength&Speed

    Strength&Speed Need more speed......
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    cop- your post struck a nerve with me because it mirrors a lot of the experiences I had as a resident. I think your assessment is good. For people who take pride in themselves and their work, it is fairly traumatic to get chewed out. For instance, I was in clinic one time, and (this may sound silly) but an attg asked me how to treat our patient who had a sprained ankle...and I basically said RICE, whatever. the usual. She was like....NO, you need early mobilization, and do these particular foot exercises or whatever. Anyhow, basically she used this as a springboard to tell me how I basically didn't know anything and that she essentially felt I was incompetent and was afraid for me practicing on my own. Obviously she didn't care much for my personality, which was driving much of it i assume. Because she is one of the most distasteful aggressive liberal women you'll ever come across, which is a terrible personality for me. Anyhow, in any case, she said "you don't even know how to treat a sprained ankle" in her effort to be as belittling as possible. It affects you....you get angry, you doubt yourself, and then you get angry later because you doubted yourself. It's a difficult world at times, which you described above. I think you dealt with it well, and properly identified that this guy's ego is what driving a lot of it. All you can do is keep working hard I guess.

    Oh, and yes, in PP for me it was very much different. Frankly I was far more advanced than many of my colleagues, and my knowledge was appreciated. So try not to sweat it.
     
    #17 Strength&Speed, Jun 2, 2008
    Last edited: Jun 2, 2008
  18. coprolalia

    coprolalia Bored Certified
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    Thanks, my man. I needed to hear that.

    I definitely don't believe that perception always meets reality, and the academic attendings occassionally forget how much power they wield and how easily it is to f**k-up a resident's otherwise dedicated, hard-working, willing-to-go-the-extra-mile track record with their somewhat limited, and perhaps tainted-with-their-own-ego, interactions.

    -copro
     
  19. 2win

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    Now I understand your posts... Frustration Copro. takes a lot of maturity to deal with this stuff and u don't have it. I will kick u out of my program easily. U're a smart dude - but who cares if u don't behave? Confronting your attending in the front of a surgeon is a NO. take it easy and maybe u'll have a letter of recomm.
     
  20. Hawaiian Bruin

    Hawaiian Bruin Breaking Good
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    Jet or any other mod, can we get that thirty ought six up in here and stop this silliness?
     
  21. coprolalia

    coprolalia Bored Certified
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    Speaky EEN-glish!

    -copro
     
  22. militarymd

    militarymd SDN Angel
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    :laugh::laugh::laugh:
     
  23. Jeff05

    Jeff05 Senior Member
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    at this point, unless the attending's plan will directly impact patient care in a negative way (which does happen at an outside hospital we rotate in - filled with FMGs who can't pass the boards) i don't say anything.

    if i work with an attending who is comfortable letting me do my thing - i do it. if i work with an attending who is NOT comfy - i do their thing. that's the name of the game. i don't take it personally. i'll be calling the shots soon enough.
     
  24. jetproppilot

    jetproppilot Turboprop Driver
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    Theres no way on planet earth that I could agree with you more.
     
  25. Trisomy13

    Trisomy13 ultra
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    you basically need at least two minor personality disorders. they don't have to be bad, and can be beneficial (OCD), but two seems to be the minimum around here. :laugh:
     

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