Whazzup with Docs?

[jagdkampf]

I work with physicians on a daily basis and have done so for 30 years. One thing I fail to understand is why they consistently treat other health care workers so crappy. I was present in an OR situation the other day where a surgeon reduced a tech to tears because she took one iota too long finding a particular instrument. It was the first time we had performed this procedure with this particular setup and the rep was fairly useless in inservicing the staff. The surgeon shows up 5 minutes late and having never looked at the setup expects everything to be perfect. He was a total A## through the entire case and by the end of the day, the general opinion of him was not good. Ok, docs, what does this kind of behavior accomplish. Consider that the average OR tech makes only slightly more than a waitress and doesn't get the tips, yet they are expected to function at a very high level of performance. Have you ever considered taking an hour or so and inservicing personnel on new equipent or techniques. Granted you have busy lives and time is money, but if you want efficiency in the OR it's in your best interest to take the time to teach. Oh, you say it's the hospitals responsibility to do this. Wrong! The hospital has no responsibility to cater to you. They provide the place, equipment, medication and personnel and coordinate the whole process so that you get your start time with the equipment, drugs and personnel you need. Consider this a piece of friendly advice: take the time, teach what you want done, treat coworkers as valued personnel and you will get what you want. Otherwise, someday you are going to Pi## off somebody like me and I'm going show you what it means to feel really small.
Out here
Jag

[Craig]

Jag,
Id guess there is only 2 or 3 docs on this board - unless there are more just lurking. Id also suggest that you are preaching to the converted with your concerns over behaviour. Pretty much any doc who works pre-hospital is well into teamwork. No excuses for bad behaviour, but I think you choose the wrong audience for your rant - I agree with nearly every word you said. But by writing generically about docs you imply we are all like you describe -thats not fair.

I do have several points though. Firstly there are some people who cannot cope with working in high pressure environments - and hospitals shouldnt employ or assign them there if they cannot cope, but again there is no excuse for abusing them, but it can be damn frustrating when inappropriate people get put in critical care areas, and cannot perform.

Secondly, in terms of teaching, Im actively involved in teaching - med students, residents, nurses, techs - pretty much when ever Im asked. But if Im working with a nurse in the ED, and there is a new piece of equipment (or procedure) in the department - that they are responsible for using or assiting with - I think its reasonable for me to expect that they will be able to use it / do it when its required. Again no excuse for resorting to abuse if they cannot - but I would see it as the Nurse Educators / Nurse specialists role (with assistance from us, if required or wanted) to ensure their staff could use the equipement or perfrom any other task expected of them. Its explicitly not my job to teach them - although Im happy to help where I can.

Craig

P.S : As Im sure you know - Surgery attracts a certain type of personality frequently anyway - that explains alot :smile:

[jagdkampf]

Craig,
If this were an isolated incident, I would chaulk it up to stress, etc. However, I have seen this verbal abuse occur on an almost daily basis for quite a few years. I quess I do need to qualify this a bit though. Not all offenders are physicians, I have seen fellow anesthetists who were just as guilty. In general I have had very good experiences with Trauma docs and ED docs. Although they would occasionally bark at someone during a stressful situation, it was never personal and they almost always apologized later. The situation I am describing is almost exclusive to the OR. On the other hand, it takes two to tango and it is my firm belief that bad behavior only flourishes if it is tolerated. As to preaching to the choir, maybe, but I was not only preaching but pondering why this behavior is so common. While you can chaulk a lot of things up to stress, I don't think that you can use it to excuse bad behavior. One surgeon I work with considers his ability to intimidate and insult techs and nurses a sign of his prowess in the OR. I have heard him on occasion brag about it. Unfortunately, this is not just at one hospital. I have worked across the USA from NV to ME in various assignments and find it prevalent in most OR's. Call it a rant if you want but I think we need to get a grip on this situation. The average median age of nurses is rising (somewhere around 44-45 years), if memory serves correct and the number of applicants to nursing programs and allied health professions are dropping. Hospitals are cutting back in the face of the money squeeze and most mid-level administrative positions such as Nurse Educators are being cut or reduced. At our hospital, we have one nurse educator for the entire hospital and she knows virtually nothing about the OR. Her annual inservice usually has to do with something like infection control, etc. Continuing education is pretty much left to the personnel. Usually this is done by the sales reps who may or may not have the full scoop. Otherwise, they have to take vacation time and travel to a seminar for continuing education. Although this is just a part of the overall picture, I think it is signifigant in the attrition of OR nurses and techs. Combine an abusive enviroment with long hours, mediocre pay and a stressful job and you have a recipe for burn-out. At the previous hospital I worked at, half of our OR crew were locum providers. OR nurse and tech positions had been posted for over a year with no takers. I believe the onus for change is with the physicians and practicioners. As long as the gravey train arrives at the station, the hospitals are not going to address it. We need to be proactive in addressing this abuse. We need to be personally accountable for any incident we witness and take corrective actions. I am glad to hear that you are active in teaching and inservicing personnel. I too will gladly teach and inservice because ultimately I am the one who benefits. If we don't step up to the plate and provide a positive work enviroment for our coworkers we are going to bare the brunt of this attrition and "remote, austere, wilderness and third world medicine" might well describe our practices in the near future.
Jag

[RESQDOC]

Well said both of you. When this was posted I felt a bit insulted and that Jag was painting us all with a broad brush. I decided to wait a bit and compose a reasoned reply - and now I don't have to, Craig said it all for me. Jag's reply to Craig is to the point and also correct.

The fundamental question is this: physicians have a Type A personality, significant ego, and well developed "prey drive" or they don't make it through the process. But why is it this way, and why is it tolerated? I once saw a surgeon get mad because his scrub nurse wasn't paying attention to him (she was getting a piece of equip. ready) and grabbed a towel clamp (has sharp points) and crunched it full force on her breast. She had to have plastic surgery on the nipple. The surgeon got suspended from operating for one month only. Nobody could believe he did it or that he got away with it. The nurse had all of her expenses covered by the hospital, one of the surgeons plastic surgery buddies did the reconstruct, and the nurse got incredible pressure to not file charges. This guy could have gone to jail for a year for aggravated battery, but all was swept under the table. Stories like this are legion, I have seen many other cases almost as bad.

And yet two of the surgeons I trained with were some of the most gentle, kind physicians I have ever had the pleasure of knowing, that NEVER acted like that no matter how much stress they were under. In the same group as the guy above. Go figure.

Clearly part of it is the selection process, like picking like, some of it the training process, and most of it is the "it's always been that way" crowd who condone and put up with such behavior as long as the case log is full, OR's are busy, and money is flowing in. Administrators and department heads won't change it until physicians and staff insist it change.

Just my .02 worth.

[jagdkampf]

My apologies if my brush was too broad. The reason I posted this here is that in my opinion the members of this board are willing and eager to share, teach and instruct others on the aspects of their knowledge and specialties. I only wish that some of the Docs I work with would take the same attitude with their coworkers.
Jag

[tangent]

No problem w/ the rants (here and in the bulletin board), but might I suggest that in the future these type of things get posted in "Wart Talk" - the "off topic discussion forum"...?

I've seen my share of bad behavior by docs too, but lets at least try to keep these main boards focused on the medically relevant information - please?

[jagdkampf]

No problem, just not sure where it belonged. Administrators have full rights to change my posts anywhere that they deem necessary. If it seems too provocative, just stomp it to death, delete it and e-mail me that you have done so.
Jag

[Reasonable Rascal]

No problems mate. It's relevent but perhaps not directly to this forum. I've seen my share and relish the ones that are still grounded on Earth. Let's practice medicine and leave the Apollo's to their Olympus and Jaguars.

Now as far as administrators, there's an off topic...... ;-)

RR