Relationship with surgeons

[Nasty Gas]

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I hope this hasn't been done too many times....

I am currently a resident at a large academic institution with too many patients, too much surgery and way too much ego. Often surgeons are rude to anesthesia residents and junior attendings. More frustrating can be the OR RN's who are often in league with the surgeons.

How much of this dynamic between surgeons and anesthesiologists is endemic to the field in general or is it primarily seen in large tertiary care settings? Does it tend improve in private practice and/or smaller community settings? Obviously it's variable, but I'm curious if there are trends.

 

[UTSouthwestern]

I hope this hasn't been done too many times....

I am currently a resident at a large academic institution with too many patients, too much surgery and way too much ego. Often surgeons are rude to anesthesia residents and junior attendings. More frustrating can be the OR RN's who are often in league with the surgeons.

How much of this dynamic between surgeons and anesthesiologists is endemic to the field in general or is it primarily seen in large tertiary care settings? Does it tend improve in private practice and/or smaller community settings? Obviously it's variable, but I'm curious if there are trends.

It gets much better in practice. You are going through residency and large academic centers aren't the model for all other types of practice.

When I entered private practice, I had to fight the predetermined sense that I was heading into a me against the world situation. Far from it, I have thoroughly enjoyed my experience and have made many new close friends with my surgical colleagues.

The stress of a residency and being in a major academic institution can make anyone edgy and terse, not just the surgeons. Endure it, sharpen your skills, expand your knowledge base to be able to defend any decision you make, and be confident and thorough. That alone makes you less likely to be a target for anyone, especially when you can look the aggressive party eye to eye and calmly explain why something should or should not be done.

 

[mdjobexchange]

Residents get kicked around, it is an unfortunate fact of training, that I am sure is not lost on you.

It is much different in private practice. When you interview, see how the staff reacts when you and the group member walk into the OR. You can get an idea of how their group gets along with the staff. It can vary quite a bit. I have worked at about 40 different hospitals around the country and, maybe 20% of the places I worked had a bad atmosphere. At those places, it was global, everybody treated each other like crap, surgeons, anesthesia, nurses.

Don't do what I did. By my CA-3 year, I started mouthing off to anybody I felt like, including some pretty senior people. I got on some pretty thin ice and it didn't do much for me in the end, even though there was some significant short-term satisfaction. Try not to burn bridges.

 

[lobelsteve]

I slept with a few of them (they were chicks, man).
Nothing long term to speak of.
There are real wankers in the OR, and real sweathearts in the OR.
We all got our jobs to do.

I'm not even an Anes.

 

[Gern Blansten]

I'm not even an Anes.

No one called you an anus......as far as you know.🙂

 

[lobelsteve]

No one called you an anus......as far as you know.🙂

I'm a Pain Medicine doc with PM&R residency. But I'vebeen in the OR for SCS and pump implants/explants/revisions, discography, perc discectomy.

On some cases I had an anesthesiologist across the curtain from me. Way overkill as I only use CS (and fentanyl/versed at that). I think the hospital policy was to have the room staffed. It was cool for me because I got to ask him all the questions I felt I needed answered due to only brief training in CS during fellowship. If I were an anesthesiologist I'd keep a toy baby bottle on the cart and hold it up when the surgeon got condescending/snippy/or too big for his britches.

 

[doc02]

If I were an anesthesiologist I'd keep a toy baby bottle on the cart and hold it up when the surgeon got condescending/snippy/or too big for his britches.

That would probably stop working once he placed it up your rectum.

 

[lobelsteve]

That would probably stop working once he placed it up your rectum.

Not if he maintained sterile technique.
Equating poor attitude and work environment with physcial attack is not making any sense. The spirit of the thread is on how/why/how often/and how to diffuse this type of behavior, not on being an asshat.🙄

 

[coprolalia]

Often much of this behavior occurs because you are an unknown entity. When the surgical/peri-op staff gets to know you better, and you prove that you are both competent and efficient, you will get more respect. If you are neither of those, you're going to have some continuing issues.

-copro

 

[Tenesma]

bottom line when there is a relationship that is established it is hard for anybody to be an ass --- if you are an unknown entitity it makes it a lot easier...

so if they know your name, they know that you are confident, assured, on-top of your game then you'll really never have a problem - the ones who continue to be a problem I refused to do their cases and documented it each time thoroughly for hospital admin - worked like a charm

as far as OR rn-s go... they like poopin' on people - so i made sure i knew them all by first name and that they knew me by first name, and would chat with each of them between cases (asked them about kids, family, funny halloween stories) --- when people realize you are a person they treat you like one... also knowing your **** and garnering respect helps a lot...


so bottom line cure: read, read, read, read, read, know every study out there, chat with everybody, be friendly, memorize everybody's first names - and by your CA-2 year you will be a mini rock star

 

[phillyfornia]

OR nurses mouth off? that's ridiculous. what do they possibly yell at you about?

 

[coprolalia]

OR nurses mouth off? that's ridiculous. what do they possibly yell at you about?

Many, many things. They often see you only as another technician, especially as a resident. I had a scenario where a circulator walked by my "space" and felt the need to comment on the blood pressure. Went something like this...

Her, "That blood pressure is a little low. Everything okay?"

Me, "Yeah, it's not my first day, ya know?"

Her, "Well, are you going to do something about it?"

Me, "If I need your help, I'll ask for it."

End of discussion.

This was a "problem" circulator who often took it upon herself to manage everything in the room, and who didn't know me that well at the time. What she didn't know was that they were near the end of the surgery and were packing the abdomen before closing to check for residual bleeding. The IVC was being compressed and she just happened to walk by for the 30 seconds that the pressure was low. It had otherwise been fine during the entire case, and I knew it would be fine again when they removed the packing.

It's not your job to have to explain yourself or your actions to the rest of the staff in the OR, unless there is a problem and/or you don't know what's going on (at which point you should calmly ask the surgeon to pause, if possible, and figure it out). There are many people who want to interlope and tell you how to do your job. Take the suggestions with a grain of salt. If it persists, then you can get snarky and explain why or why not you should do what they say.

But, on occassion I've found that they may tell you something that you don't know, which can be helpful. So, it's appropriate to maintain a certain level of humility most of the time. Other times, they often need to be set straight about who's in control of what, especially when THEY might not have all the facts. But, it is always advisable to do that as diplomatically as possible, especially if they are being an a-hole about it. In thiscase, I've never had a problem with this particular circulator since.

-copro

 

[Tenesma]

i disagree with your approach

the goal of a harmonious OR is to work as a team - and to try to bring in others instead of pushing them away.

you could have easily have said something like: "I know - i have been watching it closely - it is low right now because the IVC is compressed"

usually they do this (especially in larger teaching hospitals) because they don't know everybody and they have seen their fair share of disasters when residents were either not paying attention or were to slow to react (ie: call for help, etc...)

so as soon as they buy into the fact that you are watching, and that you don't take anything personally and that you are competent - they will usually back off

remember that life in the OR changes drastically when you become an attending (in the larger hospitals the nurses will know you by now - or when you make the transition to a private hospital without residents you will see the RNs treat you like the child of god)

 

[Tenesma]

the only people i became snarky with were a few surgical residents who were full of crap (which is usually the PGY2-3 range - the interns are wide-eyed and very deferential - the seniors know enough to feel confident without having to act like a jerk to make up for potential knowledge gaps) - and nothing puts them down faster than to humiliate their knowledge by citing studies on whatever they had to say....

for example, know your blood transfusion studies (including from the surgical literatue) and your blood pressure studies (including from the surgical literature) cold - that way you can play smack down - they won't bug you again.

i used to routinely read the latest abstracts of surgical literature published by the surg. department (posted in the hallway) and nothing would beat a smack down in the OR of a surg. resident when quoting a recent article by the operating surgical attending...

so bottom line - the more you know, the less anybody can hurt you

 

[coprolalia]

you could have easily have said something like: "I know - i have been watching it closely - it is low right now because the IVC is compressed"

I agree, generally, with your sentiments, Tenesma. The difference here was that this particular circulator is notorious for giving residents a hard time. If you cave to her, she thinks even more that she's in control and has the right to question everything you do. I do not have to justify myself or my actions to a circulator, just my attending and (ultimately) the patient. There is no "blanket" way to act, and that's the point. Each personality - each situation - is unique, and it requires the deft and appropriate response in such a situation. Point is, she didn't have all the facts and had no right to question anything I was doing. This was not her role, and I made sure it was loud and clear that it wasn't.

-copro

 

[CremeSickle]

hehe

My mentor told me something which he said should always guide my relationship with surgeons for my whole career

"Patients do not come to the OR for anesthesia"

Always be professional and respectful of the surgeon and make sure they know you are there to facilitate their ability to do their job.

If you cannot put away the ego as an Anesthesiologist you will be doomed.

 

[deleted126335]

.

 

[divinemsm]

...but without anesthesia, patient's do not want to come to the OR.....

hehe

My mentor told me something which he said should always guide my relationship with surgeons for my whole career

"Patients do not come to the OR for anesthesia"

Always be professional and respectful of the surgeon and make sure they know you are there to facilitate their ability to do their job.

If you cannot put away the ego as an Anesthesiologist you will be doomed.

 

[coprolalia]

Always be professional and respectful of the surgeon and make sure they know you are there to facilitate their ability to do their job.

If you cannot put away the ego as an Anesthesiologist you will be doomed.

I was specifically talking about a circulator (nurse) who'd overstepped her bounds. Otherwise, if you act like a jackass all the time, you'll be treated accordingly. And, as I already said, "There is no "blanket" way to act, and that's the point. Each personality - each situation - is unique, and it requires the deft and appropriate response in such a situation." If a surgeon - I don't care who he/she is - asks me to do something inappropriate or, worse, dangerous, I don't care if the patient didn't come there just to get anesthesia. I'm going to say something. You can bet that that same surgeon ain't going to get your back in court if something goes wrong.

-copro

 

[Voodoo]

To the OP:

Just be respectful and do your job. As was eluded to, in large teaching institutions the OR staff doesn't know every resident or their individual levels of training or capability. I'm sure sometime in the past they probably did work with an Anesthesiology resident who sucked the royal dick, and just were doing what they thought they should in order to protect the patient in case you were another one of that type.

Don't take it as a blow to the ego. Just be respectful, don't cause waves, and trust in the fact that when you get done people will treat you with the same level of respect that you treat them.

Oh yeah, and try and have fun doing your job. After all, you're not the one standing for countless hours and getting ridiculed by a surgeon for not holding the retractor in [insert arbitrary position here].

 

[CremeSickle]

Banana Hammocks Rule

LOL


nice tagline!

 

[toughlife]

This idea of "patients don't come to the hospital to get anesthesia" is ridiculous. Patients also don't go to the hospital to get xrays or CT scans but rather to be cared for by an internist, but without the radiologist the internist can't do his job.

So lets stop this attitude and recognize we all have a role to play in caring for the patient.

 

[CremeSickle]

Tough

the point is that all the ancillary is there to allow the surgeon to do his/her job. Pissing off the surgeon simply because you want him to recognize that your a doc too will only lead to problems. Surgeon can request whomever they want, more importantly, they can request NOT to have someone and the hospital listens. They complain enough about an anesthesiologists attitude and you will be history.

Everyone has a role to play but some roles ARE more important (in regards to power) than others. No matter your initials, there is always a hierarchy.

 

[phillyfornia]

"Patients do not come to the OR for anesthesia"

i disagree with this. i'd say that the reason patients come to the OR is to get their appendectomy/cholecystectomy/boob job/etc. as safely and painlessly as possible.

 

[CremeSickle]

lol

you just agreed with me!

They never come for anesthesia alone (maybe pain mangmt.). The point is simple, we have a job b/c of surgeons work, not the otherway around as surgery would still continue without anesthesia just as it started without it.

 

[coprolalia]

lol

you just agreed with me!

They never come for anesthesia alone (maybe pain mangmt.). The point is simple, we have a job b/c of surgeons work, not the otherway around as surgery would still continue without anesthesia just as it started without it.

I think the point, CremeSickle, is that the patient comes to the hospital to have their problem fixed, and that requires the coordinated and professional efforts of multiple people. Surgeons attitude that "the patient doesn't come to the OR for anesthesia" is arrogant and dimishes everyone else's role in the process.

I heard a story that occurred before I got to my program about a notoriously arrogant plastic surgeon, who wasn't happy with the pace of the induction of the anesthestic on a particularly complex patient (you know, the old "hurry up so I can take my time" attitude) and boisterously made the "patient isn't here for anesthesia" statement, to which the anesthesia attending in the room said, "Fine, please feel free to do the procedure without our help."

Now, guess which of those two physicians is still at our institution? I'll give you a hint: it's not the surgeon.

-copro

 

[CremeSickle]

Ok, i think this conversation went south of reality.

Im not suggesting (nor did i) to kiss the surgeons ass or do anything that could put the patient at risk. What i am saying is not to spout off at the surgeon (like some suggested) since it is clearly unprofessional and unrealistic.

if you have a complaint about a surgeon, take it up with your chief not the surgeon unless it is a pt saftey issue.

 

[timtye78]

You could always tell the surgeon-I am not cancelling the surgery, just the anesthesia

hehe

Funny, you get someone offering a common sense response, then someone comes by and says now that there is a more PC response. Geez.

People, there is no cookie-cutter way to interact with OR staff in all situations. You will encounter jerks in every environment. You do what is right for the patient, and then help the surgeon get their work done. The goal is to get the heck out of the OR with a stable, comfortable pt. Screw all those people who need to constantly spar with everyone to prove who is superior. who cares. take care of the patient. Do what is right. Mouthing off doesn't achieve anything, but to help answer the original question, the general concensus is that most people are happier in a non-academic setting for a host of reasons. That sets the mood a little better I would guess.

Critical or not, the surgeon wants you to be fast, competent, and wake up a stable comfortable patient. Also, most surgeons know that you can take extra time, cancel cases, etc. They want to do surgeries and bill. We help them accomplish this. It is a partnership. sorry if I rambled..

 

[coprolalia]

Well said, Tim.

-copro