Why do surgeons have attitude?
August 24, 2007 3:35 PM Subscribe
Why do surgeons have "attitude?"
I know the question relies on a cliche: The all-knowing, all-powerful, god-complex surgeon who lords it over patients and other members of the medical community. You see them on TV and sometimes encounter them in person. And of course this is not true of all surgeons, perhaps not of most, perhaps even of just a minority.
To the extent that there is a grain of truth to the cliche, why are some surgeons like that? Is it a result of their training? Or a lack of empathy? Or does the profession simply draw those who are more self-confident or ego-driven? Is there a generational change between older and younger surgeons? Are there studies of surgeons attitudes and manner, as perceived by patients? And if so, have those studies caused any change in the training of surgeons?
(And my apologies to any offended surgeons out there: Of course you aren't the one I'm asking about. And my sympathies to patients who have encountered one of these...)
I know the question relies on a cliche: The all-knowing, all-powerful, god-complex surgeon who lords it over patients and other members of the medical community. You see them on TV and sometimes encounter them in person. And of course this is not true of all surgeons, perhaps not of most, perhaps even of just a minority.
To the extent that there is a grain of truth to the cliche, why are some surgeons like that? Is it a result of their training? Or a lack of empathy? Or does the profession simply draw those who are more self-confident or ego-driven? Is there a generational change between older and younger surgeons? Are there studies of surgeons attitudes and manner, as perceived by patients? And if so, have those studies caused any change in the training of surgeons?
(And my apologies to any offended surgeons out there: Of course you aren't the one I'm asking about. And my sympathies to patients who have encountered one of these...)
Sorry to state the obvious, but surgeons *take people apart* and then *put them back together*.
Maybe you need to have that kind of ego to do this job? And it probably is a self-reinforcing culture, with every success you have, and every other surgeon you work with, you only find more attitude. Personally, I'm not sure I mind the inflated ego if they perform exceptionally.
posted by dendrite at 3:44 PM on August 24, 2007 [1 favorite]
Maybe you need to have that kind of ego to do this job? And it probably is a self-reinforcing culture, with every success you have, and every other surgeon you work with, you only find more attitude. Personally, I'm not sure I mind the inflated ego if they perform exceptionally.
posted by dendrite at 3:44 PM on August 24, 2007 [1 favorite]
As I understand it, scientific studies (which I have no ability to cite) indicate that surgeons who maintain a dispassionate attitude towards their patients are statistically more successful than those who empathize with their patients.
posted by saladin at 3:47 PM on August 24, 2007 [1 favorite]
posted by saladin at 3:47 PM on August 24, 2007 [1 favorite]
I think there was a similar question recently...something about how doctors train themselves to be detached...but that's be my answer: doctors, and I would think *especially* surgeons *need* to be detached and/or have a lack of empathy to some degree. And yeah, what dendrite said...aren't surgeons, at least in theory, about the closest thing we have to "god"?
posted by edjusted at 3:48 PM on August 24, 2007
posted by edjusted at 3:48 PM on August 24, 2007
...on second thought, maybe that was a bit too dramatic, but I think it still gets the point across...
posted by edjusted at 3:49 PM on August 24, 2007
posted by edjusted at 3:49 PM on August 24, 2007
God complex.
posted by rachelpapers at 3:56 PM on August 24, 2007
posted by rachelpapers at 3:56 PM on August 24, 2007
For my two cents: surgeons who are jerky/cold/mean/etc to their patients get sued a lot more than surgeons who are nice to their patients. It pays to be kind. With the emphasis shifting from medical advances to medical lawsuits, surgeons might start to be more friendly after a while.
posted by nursegracer at 3:58 PM on August 24, 2007 [1 favorite]
posted by nursegracer at 3:58 PM on August 24, 2007 [1 favorite]
I recently attended a "white coat" ceremony for my stepson who is entering a phd/md program. You would have seen the answer to your question had you listened to the remarks of the faculty as this induction started.
Physicians do see themselves as God, above the rest of us, and they communicated exactly that to the incoming med students.
posted by HuronBob at 4:20 PM on August 24, 2007 [1 favorite]
Physicians do see themselves as God, above the rest of us, and they communicated exactly that to the incoming med students.
posted by HuronBob at 4:20 PM on August 24, 2007 [1 favorite]
I had a cousin who scored frighteningly high on his entrance exams to med school, and was admitted to an interview. But he was rejected at the interview stage. Why? Because he referred to the work of a medical doctor as a "job", and not as a "calling".
Granted, surgeons shoulder an immense responsibility, and there's no doubting that. But my cousin's experience demonstrates that there's at least some indoctrination going on during med school (pardon the heinous pun).
posted by LN at 4:22 PM on August 24, 2007 [1 favorite]
Granted, surgeons shoulder an immense responsibility, and there's no doubting that. But my cousin's experience demonstrates that there's at least some indoctrination going on during med school (pardon the heinous pun).
posted by LN at 4:22 PM on August 24, 2007 [1 favorite]
I know the stereotype exists for a reason, but for what it's worth, I've never encountered a surgeon with attitude. I've had five major surgeries in my life, my son has had two minor ones, and the surgeons I've dealt with have been kind, compassionate, knowledgeable, and all had very good bedside manners.
I wonder what the percentage of attitude-y surgeons is vs. non-attitude-y ones. And I also wonder if maybe people don't take the crap anymore. Second opinions and all that, and we (I mean Americans in this case) approach healthcare with a much more consumer bent than ever before.
posted by cooker girl at 4:40 PM on August 24, 2007
I wonder what the percentage of attitude-y surgeons is vs. non-attitude-y ones. And I also wonder if maybe people don't take the crap anymore. Second opinions and all that, and we (I mean Americans in this case) approach healthcare with a much more consumer bent than ever before.
posted by cooker girl at 4:40 PM on August 24, 2007
There's a filtration process involved, I think. The responsibility associated with being a surgeon is really very great. The potential for really badly harming someone is always there.
What kind of person would seek out such a job? It seems as if it would only be attractive to someone who is supremely confident to the point of arrogance, simply because everyone else would be scared away.
posted by Steven C. Den Beste at 4:48 PM on August 24, 2007
What kind of person would seek out such a job? It seems as if it would only be attractive to someone who is supremely confident to the point of arrogance, simply because everyone else would be scared away.
posted by Steven C. Den Beste at 4:48 PM on August 24, 2007
It's not just surgeons, it can be generalized to most medical doctors. I deal with a ton of them for both of my children and the medical profession has an unusually large population of arrogant pricks. As others have said, I wouldn't mind it if they weren't off the mark so often. The book How Doctors Think is an excellent discourse on this topic, from a doctor.
posted by mattholomew at 4:59 PM on August 24, 2007 [1 favorite]
posted by mattholomew at 4:59 PM on August 24, 2007 [1 favorite]
Best answer: I dated a surgeon once. I was always a little shocked by his dispassionate, ironic and detatched attitude toward patients, since it did not reflect who he was in his private life. I don't think he lorded it over his patients, and he often used irreverent humor as a way of relating, but I did come to understand why he needed to construct a certain psychological distance in order to do his job well. This is no excuse for arrogance, but as dendrite points out, surgery is a high pressure arena with no room for mistakes. My friend often worked in the emergency room and this meant that his efforts sometimes came too late. He didn't have the emotional energy to open his heart to every patient or family member. It's simply too draining when you face life and death possibilities every day. You create a hard shell of indifference to keep yourself sane.
posted by amusebuche at 5:09 PM on August 24, 2007
posted by amusebuche at 5:09 PM on August 24, 2007
Best answer: Having recently spoken with a friend who is considering leaving his surgery residency program, I think I have some perspective on this.
Surgeons train for significantly longer than other specialties, their hours are worse and less predictable, their responsibilities are greater than other specialties (almost limitless on any given day), they don't begin earning the big bucks until they finish up to nine years of residency and fellowship training. Yes, they do chose their specialty, but developing an "attitude" seems like a predictable consequence of spending year upon year keeping up with the superhuman expectations of a typical surgeon's training regimen (and the lack of balance in one's life that goes along with that). Workaholics of all vocations tend to have less than sparkling personalities, so why is it a surprise that surgeons would be any different?
posted by man on the run at 5:11 PM on August 24, 2007 [2 favorites]
Surgeons train for significantly longer than other specialties, their hours are worse and less predictable, their responsibilities are greater than other specialties (almost limitless on any given day), they don't begin earning the big bucks until they finish up to nine years of residency and fellowship training. Yes, they do chose their specialty, but developing an "attitude" seems like a predictable consequence of spending year upon year keeping up with the superhuman expectations of a typical surgeon's training regimen (and the lack of balance in one's life that goes along with that). Workaholics of all vocations tend to have less than sparkling personalities, so why is it a surprise that surgeons would be any different?
posted by man on the run at 5:11 PM on August 24, 2007 [2 favorites]
Surgeons are exceptionally smart people. Most smart people have a bit of a God-complex, and won't be good at hiding it unless they are required to (e.g. politicians, salespeople, etc.)
posted by randomstriker at 5:41 PM on August 24, 2007
posted by randomstriker at 5:41 PM on August 24, 2007
If you want to be a doctor but don't have a warm and fuzzy "people-person" disposition, surgery would be the perfect specialty-- your patients are unconscious. I think it's also a self-fulfilling prophecy- the more time you spend cutting people open, fixing them, and closing them up, and the less time you spend interacting with and examining live people, the more detached and spooky you're going to get.
posted by sneakin at 5:43 PM on August 24, 2007
posted by sneakin at 5:43 PM on August 24, 2007
My father is a surgeon, and I think amusebouche captures it pretty well. He's got a carefully cultivated detachment, but he's both saved plenty of lives and seen a fair share die on the table. I can't imagine anyone wanting to ride that kind of emotional roller coaster.
posted by mkultra at 5:49 PM on August 24, 2007
posted by mkultra at 5:49 PM on August 24, 2007
a grain of truth to the cliche
Sure, there's a grain of truth to it but I don't think it's any different than any high-pressure career. Jobs that require specialized knowledge and skills in stressful environments with long hours favor Type A personalities. They certainly don't all develop the attitude you describe. But those that do have it either came into their careers with it or developed it during their training or work career. You see it in investment bankers and corporate lawyers as well. At the same time, professions that are highly skewed towards performance metrics like these are also more forgiving of brash personalities. I wouldn't hesitate for a second to let the biggest prick in the world manage my portfolio if he could consistently give me a 25% return.
Here, let me rephrase your question to illustrate:
I know the question relies on a cliche: The all-knowing, all-powerful, god-complex surgeon/banker/lawyer who lords it over patients/clients and other members of the medical/banking/legal community. You see them on TV and sometimes encounter them in person. And of course this is not true of all surgeons/bankers/lawyers, perhaps not of most, perhaps even of just a minority.
posted by junesix at 5:49 PM on August 24, 2007
Sure, there's a grain of truth to it but I don't think it's any different than any high-pressure career. Jobs that require specialized knowledge and skills in stressful environments with long hours favor Type A personalities. They certainly don't all develop the attitude you describe. But those that do have it either came into their careers with it or developed it during their training or work career. You see it in investment bankers and corporate lawyers as well. At the same time, professions that are highly skewed towards performance metrics like these are also more forgiving of brash personalities. I wouldn't hesitate for a second to let the biggest prick in the world manage my portfolio if he could consistently give me a 25% return.
Here, let me rephrase your question to illustrate:
I know the question relies on a cliche: The all-knowing, all-powerful, god-complex surgeon/banker/lawyer who lords it over patients/clients and other members of the medical/banking/legal community. You see them on TV and sometimes encounter them in person. And of course this is not true of all surgeons/bankers/lawyers, perhaps not of most, perhaps even of just a minority.
posted by junesix at 5:49 PM on August 24, 2007
Quite simply it's exactly what rachelpapers succinctly said: "God Complex".
I have to have some contact with surgeons as my company creates training courses for hospitals, many of them for surgical teams. The courses deal with how to avoid "accidents", but the surgeons basically say anything that happens in the OR is it the fault of somebody else, they (in general) maintain that they are blameless.
posted by 543DoublePlay at 5:50 PM on August 24, 2007
I have to have some contact with surgeons as my company creates training courses for hospitals, many of them for surgical teams. The courses deal with how to avoid "accidents", but the surgeons basically say anything that happens in the OR is it the fault of somebody else, they (in general) maintain that they are blameless.
posted by 543DoublePlay at 5:50 PM on August 24, 2007
I work in the O.R., (IANAD, but I am a Registered Nurse). God complex is some of it, but not all surgeons have it. You have to be able to stand long periods of time working in extreme conditions, not eating, drinking or using the bathrooms. They train long and hard.
I would say your "older surgeons" are more apt to be this way, but many of the younger ones are not. Again, I would say it's a stereotype.
posted by 6:1 at 6:43 PM on August 24, 2007
I would say your "older surgeons" are more apt to be this way, but many of the younger ones are not. Again, I would say it's a stereotype.
posted by 6:1 at 6:43 PM on August 24, 2007
Best answer: There's an element of detachment to it, and the God Complex mentioned above as well, but I think it has more to do with the 'hazing' involved. Between medschool, interning, and residency, there's a very masochistic sense to the training, and the hours and stress continue to be nasty (although I'd guess not quite that nasty) even in an established career. Like with any group that puts you through that sort of punishment - fraternities and military groups are the classic examples - it builds a sense of brotherhood, as well as a bit of a superiority complex.
The way our society fetishizes the MD doesn't help, either.
IANAD, but I am a career patient.
posted by spaceman_spiff at 6:47 PM on August 24, 2007
The way our society fetishizes the MD doesn't help, either.
IANAD, but I am a career patient.
posted by spaceman_spiff at 6:47 PM on August 24, 2007
Best answer: 543DoublePlay: Would you want to own up to being responsible for a patient dying? Surgery isn't accounting or programming, when mistakes are made, people die.
The immense pressure that is inherent in the profession requires a certain level of detachment: guess who feels most responsible when a patient dies, even if nothing could be done? I think the "attitude" is simply one form of dealing with the high stakes and lack of any room for error. Frankly, I'll give these amazing men and women this small concession.
posted by PuGZ at 7:36 PM on August 24, 2007
The immense pressure that is inherent in the profession requires a certain level of detachment: guess who feels most responsible when a patient dies, even if nothing could be done? I think the "attitude" is simply one form of dealing with the high stakes and lack of any room for error. Frankly, I'll give these amazing men and women this small concession.
posted by PuGZ at 7:36 PM on August 24, 2007
A lot depends on where you are. Academic centers may be more likely to attract these sorts of people. In the community where I work it's rare to see, and the quality of surgical care rivals anything I've seen elsewhere in training. The docs that have attitude don't get a lot of respect from their colleagues. The first time any of them treat a patient or me disrespectfully their referrals run dry.
posted by docpops at 8:38 PM on August 24, 2007
posted by docpops at 8:38 PM on August 24, 2007
Best answer: And a lot of what seems like arrogance is just plain fatigue and having too many damn things to do in a given day. The good doctors don't convey their hurriedness and impatience, but every one has less time than you think and every one is generally thinking of the ten things they have to do immediately after they finish with your problem. And it isn't to make more money, either. There's just always more work then there is time.
posted by docpops at 8:41 PM on August 24, 2007
posted by docpops at 8:41 PM on August 24, 2007
Best answer: i think it's a self-selecting population, like formula 1 drivers or snowboarders. a certain type of personality is attracted to a certain job or activity, so that personality type seems overrepresented (even stereotypical) of that job or activity.
besides, you kind of -have- to be cocky to crack someone's chest and replace their heart, and you -have- to stay cool when things go pear-shaped.
i imagine the people who choose to be surgeons already have those inclinations, and training and experience ingrains them.
posted by thinkingwoman at 9:22 PM on August 24, 2007
besides, you kind of -have- to be cocky to crack someone's chest and replace their heart, and you -have- to stay cool when things go pear-shaped.
i imagine the people who choose to be surgeons already have those inclinations, and training and experience ingrains them.
posted by thinkingwoman at 9:22 PM on August 24, 2007
Sure, there's a grain of truth to it but I don't think it's any different than any high-pressure career.
When I forget to initialize or free a block of memory, no one loses their father.
posted by secret about box at 9:52 PM on August 24, 2007
When I forget to initialize or free a block of memory, no one loses their father.
posted by secret about box at 9:52 PM on August 24, 2007
Best answer: Reading some of Atul Gawande's work will give you insight into the reality of what surgeons do, and the challenges and decisions they face on a day-to-day basis (and why some of them fit the type you describe). Gawande is himself a surgeon, but is essentially the opposite of the stereotypical surgeon you're describing. His depictions of surgery, and medicine more generally, are critical and thoughtful.
Complications: A Surgeon's Notes on an Imperfect Science
Better: A Surgeon's Notes on Performance
posted by splendid animal at 9:53 PM on August 24, 2007
Complications: A Surgeon's Notes on an Imperfect Science
Better: A Surgeon's Notes on Performance
posted by splendid animal at 9:53 PM on August 24, 2007
Best answer: It seems that most posts are coming from the view that a large part of this has to with individual characteristics of those who self select the position and everything follows from there. Robbie Davis Floyd, in her book 'Birth as an American Rite of Passage', uses anthropological methodologies and relies on substantial interviews. In her chapter on the training of obstetricians and obstetric nurses (yes I know the question is about surgeons), she details the training processes required for literally being transformed through the rite of passage to being a part of the profession. Yes of course there is some self selection. But she argues and provides substantial evidence to support that the training process literally transforms the person into that profession (and then continues to demonstrate how that process also transforms the processes associated with hospital births).
IAASocProf, and it seems to me that the socialization (learning) processes associated with the profession are critical for maintaining the social institution of medicine, and that the surgeons are both a product of these socialization processes and also instrumental in maintaining them.
posted by kch at 10:06 PM on August 24, 2007
IAASocProf, and it seems to me that the socialization (learning) processes associated with the profession are critical for maintaining the social institution of medicine, and that the surgeons are both a product of these socialization processes and also instrumental in maintaining them.
posted by kch at 10:06 PM on August 24, 2007
I think junesix makes an important point. Maybe the reason surgeons have more of a reputation for "attitude" is because we norms are more likely to encounter them (unlike, say, super-wealthy finance folks, unless you live in Manhattan), and in more stressful situations. No-one likes having to entrust their life (or that of a loved one) to some stranger, so we take it extra-personally and hold it against them as a representative of their group when they aren't warm and fuzzy enough to give us the reassurance we want.
posted by No-sword at 10:25 PM on August 24, 2007
posted by No-sword at 10:25 PM on August 24, 2007
Surgeons, by the very nature of their profession, simply have to know they are damn good at what they do. TWould you want a surgeon who was unsure of his talents? I doubt it. This trait leads to an arrogance, a swagger, and saved lives.
By the way - my best friend, who i've known since I was 7, is a senior surgery resident at a large hospital. She wasn't arrogant about her talents until med school (albeit brilliant and very driven) - but they seem teach it while you're there. You're being taught by people with the same traits, and quickly learn that you need to stand up for yourself, stand quite forcibly behind every decision you make, and take shit from very very few. Those who can't are quickly weeded out. She's a damn good surgeon as well - and not even 28 yet.
posted by cgg at 11:05 PM on August 24, 2007
By the way - my best friend, who i've known since I was 7, is a senior surgery resident at a large hospital. She wasn't arrogant about her talents until med school (albeit brilliant and very driven) - but they seem teach it while you're there. You're being taught by people with the same traits, and quickly learn that you need to stand up for yourself, stand quite forcibly behind every decision you make, and take shit from very very few. Those who can't are quickly weeded out. She's a damn good surgeon as well - and not even 28 yet.
posted by cgg at 11:05 PM on August 24, 2007
It is part of the culture of being a surgeon: your peers expect it of you. I also think that patients, to some degree, expect it also.
Or, maybe Alec Baldwin's monologue in the movie Malice covers it:
The question is, "Do I have a God complex?" Which makes me wonder if this...lawyer, has any idea as to the kind of grades one must receive in college, to be accepted to a top medical school? Or if you have the vaguest clue about how talented someone must be to lead a surgical team? I have an M.D. from Harvard. I am board certified in cardiothorasic medicine and trauma surgery. I have been awarded citations from seven different medical boards in New England and I am never, ever sick at sea. So I ask you; when someone goes into that chapel and they fall on their knees and they pray to God that their wife doesn't miscarry or that their daughter doesn't bleed to death or that their mother doesn't suffer acute neural trauma from postoperative shock, who do you think they're praying to? Now you go ahead and read your bible-Dennis --and you go to your church and with any luck you might even win the annual raffle. But if you're looking for God, he was in operating room number two, on November 17, and he doesn't like being second guessed. You want to know if I have a God complex? Let me tell you something--I AM GOD, and this side show is over.
posted by IvyMike at 11:28 PM on August 24, 2007 [1 favorite]
Or, maybe Alec Baldwin's monologue in the movie Malice covers it:
The question is, "Do I have a God complex?" Which makes me wonder if this...lawyer, has any idea as to the kind of grades one must receive in college, to be accepted to a top medical school? Or if you have the vaguest clue about how talented someone must be to lead a surgical team? I have an M.D. from Harvard. I am board certified in cardiothorasic medicine and trauma surgery. I have been awarded citations from seven different medical boards in New England and I am never, ever sick at sea. So I ask you; when someone goes into that chapel and they fall on their knees and they pray to God that their wife doesn't miscarry or that their daughter doesn't bleed to death or that their mother doesn't suffer acute neural trauma from postoperative shock, who do you think they're praying to? Now you go ahead and read your bible-Dennis --and you go to your church and with any luck you might even win the annual raffle. But if you're looking for God, he was in operating room number two, on November 17, and he doesn't like being second guessed. You want to know if I have a God complex? Let me tell you something--I AM GOD, and this side show is over.
posted by IvyMike at 11:28 PM on August 24, 2007 [1 favorite]
A research doctor friend of mine, when I asked him this question a while ago, told me that surgeons are the jocks or fighter pilots of the medical world: not necessarily as smart or thoughtful as the rest, but highly trained in demanding physical practices. My neurosurgeon cousin agreed with him.
And I'd imagine that literally holding the power of life and death in your hands would give anyone a bit of a God-complex, as others have noted.
posted by J-Train at 4:05 AM on August 25, 2007
And I'd imagine that literally holding the power of life and death in your hands would give anyone a bit of a God-complex, as others have noted.
posted by J-Train at 4:05 AM on August 25, 2007
Another thing to keep in mind: When a surgeon is working, the clock is ticking pretty fast. Someone has their body opened out in front of them, their organs supported by machine, and every minute is another minute closer to something unintentionally going wrong.
For the surgeon in that position, indecision or self-doubt can be infinitely more harmful than a mistake or an incorrect procedure.
posted by NotMyselfRightNow at 5:36 AM on August 25, 2007
For the surgeon in that position, indecision or self-doubt can be infinitely more harmful than a mistake or an incorrect procedure.
posted by NotMyselfRightNow at 5:36 AM on August 25, 2007
Best answer: There's just always more work then there is time.
I think this hits a key aspect, as well: even moreso than other doctors and medical professionals (and that's saying something), the entire system is set up to keep surgeons fully utilized because they are a limited and thus expensive resource. There are offices full of people who work to make a surgeon's schedule runs as smoothly as possible and that all resources the surgeon needs to do his/her work are in place at exactly the right time.
Being such a key employee will always feed someone's ego, and it may lead to a complex. However, this aspect is not unique to surgeons -- for example, the stereotypical IT support jerk who everyone in the office dislikes but can't function without falls into the same category.
Anecdote: my orthopedic sugeon has a reasonable bedside manner, but he is also hyperefficient. I've had two consults with him. Both were under five minutes; he walked in, checked a few things, looked at the file, and said "you have X; they'll explain what it is and how to fix in in physical therapy, so don't ask me about that." He gave great, thorough answers to any other questions I had, but he was not going to waste his time with a canned response that could be delivered just as well and at a tiny fraction of his per-minute cost by a PT. His most recent diagnosis (delivered at 6:15AM; his appointment schedule starts at six) led to a 20-year-old problem caused by a much nicer surgeon and that a series of other nicer surgeons said couldn't be fixed without likely ineffective surgery with a long, painful recovery to be solved nonsurgically.
If he has a god complex, well, I guess I have a disciple complex....
posted by backupjesus at 5:42 AM on August 25, 2007 [1 favorite]
I think this hits a key aspect, as well: even moreso than other doctors and medical professionals (and that's saying something), the entire system is set up to keep surgeons fully utilized because they are a limited and thus expensive resource. There are offices full of people who work to make a surgeon's schedule runs as smoothly as possible and that all resources the surgeon needs to do his/her work are in place at exactly the right time.
Being such a key employee will always feed someone's ego, and it may lead to a complex. However, this aspect is not unique to surgeons -- for example, the stereotypical IT support jerk who everyone in the office dislikes but can't function without falls into the same category.
Anecdote: my orthopedic sugeon has a reasonable bedside manner, but he is also hyperefficient. I've had two consults with him. Both were under five minutes; he walked in, checked a few things, looked at the file, and said "you have X; they'll explain what it is and how to fix in in physical therapy, so don't ask me about that." He gave great, thorough answers to any other questions I had, but he was not going to waste his time with a canned response that could be delivered just as well and at a tiny fraction of his per-minute cost by a PT. His most recent diagnosis (delivered at 6:15AM; his appointment schedule starts at six) led to a 20-year-old problem caused by a much nicer surgeon and that a series of other nicer surgeons said couldn't be fixed without likely ineffective surgery with a long, painful recovery to be solved nonsurgically.
If he has a god complex, well, I guess I have a disciple complex....
posted by backupjesus at 5:42 AM on August 25, 2007 [1 favorite]
Best answer: It's definitely changing. It has grown unacceptable to, say, throw things in the OR. The only MAJOR arrogant misconduct that I heard of recently was indeed an older guy (believe the sponge count, asshole). It will vary by institution as the senior people and chiefs have a good deal of latitude in setting the tone. If you want to see surgeons own up to mistakes, go to M&M rounds (if you can).
HuronBob: Where? Check my profile, is it near me? They're trying to achieve a delicate balance of getting the kids to take it seriously and believe the professionalism bullcrap while not inflating their egos.
LN: I got that too. As best I can figure out, admissions people want incoming students to be filled with idealism so that they can then crush that idealism in the palm of their hands and drink the sweet milk of their tears. Actually the idea is that those "true believers" (or those who can fake it) will engage in less misconduct later.
posted by a robot made out of meat at 7:16 AM on August 25, 2007
HuronBob: Where? Check my profile, is it near me? They're trying to achieve a delicate balance of getting the kids to take it seriously and believe the professionalism bullcrap while not inflating their egos.
LN: I got that too. As best I can figure out, admissions people want incoming students to be filled with idealism so that they can then crush that idealism in the palm of their hands and drink the sweet milk of their tears. Actually the idea is that those "true believers" (or those who can fake it) will engage in less misconduct later.
posted by a robot made out of meat at 7:16 AM on August 25, 2007
It's not just surgeons, it can be generalized to most medical doctors. I deal with a ton of them for both of my children and the medical profession has an unusually large population of arrogant pricks.
posted by mattholomew
I've had the exact opposite experience. I have worked with a ton of doctors over the years (hundreds), and have found the majority to be kind and intelligent. Their lack of time often comes off as curtness, and you do find a few that are truly awful and help paint the others with negative connotations.
I've has patients complain to me about some of the most wonderful doctors I've worked for. Most of those that 'generalize' simply come into doctor/patient relationships with biases already set into place.
posted by gtr at 10:01 AM on August 25, 2007
posted by mattholomew
I've had the exact opposite experience. I have worked with a ton of doctors over the years (hundreds), and have found the majority to be kind and intelligent. Their lack of time often comes off as curtness, and you do find a few that are truly awful and help paint the others with negative connotations.
I've has patients complain to me about some of the most wonderful doctors I've worked for. Most of those that 'generalize' simply come into doctor/patient relationships with biases already set into place.
posted by gtr at 10:01 AM on August 25, 2007
You see it in investment bankers and corporate lawyers as well.
Fatigue and situationally constructed edifices of functional egocentrism have a lot to do with it. But for some who are motivated by materialism, I suspect that the a dawning realisation occurs during the grind of 4 years of undergrad med school and then endless years of badly paid residency. They see similarly dedicated, driven individuals they know from school, or home, or similar, go through a much shorter, less intense grind and become lawyers, bankers, and consultants. And then start earning significant money much earlier, and with more controllable hours. And then they begin to realise that although there is a high "floor" for surgery wages, the ceiling is relatively low compared to some other professions. By then, though, it's usually too late to back out.
Aside: "Type A" - do people who self-identify or label others as this really see use it to frame "anxious" types predisposed to cardiac arrest and self-esteem pathologies? I suspect that the vernacular of this phrase has drifted greatly from its origins. I certainly never heard it much except as a historical curiosity within psychology until I came to the US, and it seems to be differentially deployed within specific groups and classes.
posted by meehawl at 11:24 AM on August 25, 2007
Fatigue and situationally constructed edifices of functional egocentrism have a lot to do with it. But for some who are motivated by materialism, I suspect that the a dawning realisation occurs during the grind of 4 years of undergrad med school and then endless years of badly paid residency. They see similarly dedicated, driven individuals they know from school, or home, or similar, go through a much shorter, less intense grind and become lawyers, bankers, and consultants. And then start earning significant money much earlier, and with more controllable hours. And then they begin to realise that although there is a high "floor" for surgery wages, the ceiling is relatively low compared to some other professions. By then, though, it's usually too late to back out.
Aside: "Type A" - do people who self-identify or label others as this really see use it to frame "anxious" types predisposed to cardiac arrest and self-esteem pathologies? I suspect that the vernacular of this phrase has drifted greatly from its origins. I certainly never heard it much except as a historical curiosity within psychology until I came to the US, and it seems to be differentially deployed within specific groups and classes.
posted by meehawl at 11:24 AM on August 25, 2007
It's not just surgeons, it can be generalized to most medical doctors. I deal with a ton of them for both of my children and the medical profession has an unusually large population of arrogant pricks.
posted by mattholomew
Some patients can bring the most benevolent physicians to a point of barely contained hostility. I hope that doesn't come as a shock.
posted by docpops at 11:46 AM on August 25, 2007
posted by mattholomew
Some patients can bring the most benevolent physicians to a point of barely contained hostility. I hope that doesn't come as a shock.
posted by docpops at 11:46 AM on August 25, 2007
Best answer: I've seen a number of shy and unconfident friends and colleagues undergo radical personality changes as they went through med school. They now stand taller, are more assertive, and in some cases, have become completely insufferable.
But I think it really misrepresents what has happened to them to simply say that they've developed god complexes simply because they've studied a lot, have a small clique, and save lives. Here's my hypothesis: med school implicitly (or maybe sometimes explicitly) teaches and encourages people to act in an overconfident way for a good pragmatic reason. To be a good doctor, you need to communicate to your patients that they are in infallibly safe hands, and the best way to communicate this is to actually believe it. Not only does this assuage the patient, it actually improves their chances of getting better.
I recommend this episode of Radio Lab on the placebo effect -- particularly the segment called "The White Coat". It has to do with the placebo effect from the doctor's perspective, and how the personality of the doctor influences the likelihood that a patient will get better.
posted by painquale at 1:11 PM on August 25, 2007
But I think it really misrepresents what has happened to them to simply say that they've developed god complexes simply because they've studied a lot, have a small clique, and save lives. Here's my hypothesis: med school implicitly (or maybe sometimes explicitly) teaches and encourages people to act in an overconfident way for a good pragmatic reason. To be a good doctor, you need to communicate to your patients that they are in infallibly safe hands, and the best way to communicate this is to actually believe it. Not only does this assuage the patient, it actually improves their chances of getting better.
I recommend this episode of Radio Lab on the placebo effect -- particularly the segment called "The White Coat". It has to do with the placebo effect from the doctor's perspective, and how the personality of the doctor influences the likelihood that a patient will get better.
posted by painquale at 1:11 PM on August 25, 2007
Y'know, at the table, surgeons are suprisingly powerless. No one operates in a vacuum, and even the most talented surgeon can be derailed by a crappy scrub nurse who passes the wrong instrument, a first assist who clips sutures too short, a circulating nurse who's too slow or too inexperienced to anticipate what's going to happen next, or an anesthesiologist who's struggling to keep the patient down far enough to prevent movement.
And once the surgeon's scrubbed in, there are a very limited number of things they can physically touch in order not to break the sterile field. Need to call the blood bank for blood because the patient's bleeding? Oops, can't touch the phone. Need another suture immediately? Oops, can't walk over to the cabinet and grab one. Drop an instrument? Can't pick it up--someone else has to go get you another one. Heck, they can't even adjust their own masks or scratch an itch on their shoulder.
I think the attitude some surgeons display outside the OR might be an overcompensation for how much of their performance in the OR, in matters both big and small, depends on others. Maybe the surgeon was the one to physically patch up a patient's ruptured aneurysm before the patient bled to death (and I don't at all mean to belittle the enormous amount of talent and sheer grit required to do that), but the surgeon is also totally dependent on every other person in the OR in order to do it.
posted by jesourie at 3:25 PM on August 25, 2007
And once the surgeon's scrubbed in, there are a very limited number of things they can physically touch in order not to break the sterile field. Need to call the blood bank for blood because the patient's bleeding? Oops, can't touch the phone. Need another suture immediately? Oops, can't walk over to the cabinet and grab one. Drop an instrument? Can't pick it up--someone else has to go get you another one. Heck, they can't even adjust their own masks or scratch an itch on their shoulder.
I think the attitude some surgeons display outside the OR might be an overcompensation for how much of their performance in the OR, in matters both big and small, depends on others. Maybe the surgeon was the one to physically patch up a patient's ruptured aneurysm before the patient bled to death (and I don't at all mean to belittle the enormous amount of talent and sheer grit required to do that), but the surgeon is also totally dependent on every other person in the OR in order to do it.
posted by jesourie at 3:25 PM on August 25, 2007
It's not just surgeons, it can be generalized to most medical doctors. I deal with a ton of them for both of my children and the medical profession has an unusually large population of arrogant pricks.
posted by mattholomew
Some patients can bring the most benevolent physicians to a point of barely contained hostility. I hope that doesn't come as a shock.
posted by docpops at 11:46 AM on August 25 [+] [!]
I should explain, in the hopes of illustrating for the purposes of this thread what I mean by arrogance. Sitting in a doctor's office discussing surgery with my son, my wife crying next to me, and the doctor taking a cell phone call from his travel agent for his trip to Bermuda. Or another doctor questioning why we wanted to get a second opinion, pointing to his med school diploma on the wall and telling us that was all we needed to know. Some people people bring Doctors to a point of barely controlled hostility? Well, that happens to fast food workers, janitors, cashiers and countless others and many of them seem to deal with it more or less without the smugness. I could understand if doctors came across as just irritated but it is this arrogance and smugness on top of it that I think is the sticking point and the topic of this thread. I understand that there are physicians who are wonderful people and very down-to-earth, but what's being asked here is why the attitude. Reading back over the question that started this post, there is nothing mentioned about hostility; rather it was about a God complex which is something different. In my example, it's fair to ask why a doctor feels that it is OK to take a cell phone call that is obviously not an emergency in the middle of an emotional session with a client.
posted by mattholomew at 3:50 PM on August 25, 2007
posted by mattholomew
Some patients can bring the most benevolent physicians to a point of barely contained hostility. I hope that doesn't come as a shock.
posted by docpops at 11:46 AM on August 25 [+] [!]
I should explain, in the hopes of illustrating for the purposes of this thread what I mean by arrogance. Sitting in a doctor's office discussing surgery with my son, my wife crying next to me, and the doctor taking a cell phone call from his travel agent for his trip to Bermuda. Or another doctor questioning why we wanted to get a second opinion, pointing to his med school diploma on the wall and telling us that was all we needed to know. Some people people bring Doctors to a point of barely controlled hostility? Well, that happens to fast food workers, janitors, cashiers and countless others and many of them seem to deal with it more or less without the smugness. I could understand if doctors came across as just irritated but it is this arrogance and smugness on top of it that I think is the sticking point and the topic of this thread. I understand that there are physicians who are wonderful people and very down-to-earth, but what's being asked here is why the attitude. Reading back over the question that started this post, there is nothing mentioned about hostility; rather it was about a God complex which is something different. In my example, it's fair to ask why a doctor feels that it is OK to take a cell phone call that is obviously not an emergency in the middle of an emotional session with a client.
posted by mattholomew at 3:50 PM on August 25, 2007
Best answer: The way I've always liked to put it is: Surgeons are cowboys, and if you're not careful they'll ride off into the sunset on your patient.
I spent enough time as a med student trying to find out if I wanted to be a surgeon that a number of surgeons let me operate on their patients. I have removed appendices and a gall bladder and once did a frontal lobectomy (traumatic clot evacuation on a homleess person who'd been hit by a bus) nearly alone, getting as far as achieving hemostasis before I needed help. I have held a person's beating heart in my thinly gloved hand because it was too fragile to arrest it for the coronary bypass operation; and felt it contract more and more strongly with every beat, as one by one the bypass vessels were attached by the surgeon, infusing a full supply of blood to the oxygen-starved muscle.
What these experiences and others with surgeons taught me is that operating on people is a venue where there is a great deal of uncertainty. To add insult to this injury, there is a great deal you can be certain about before entering the operating theater; there may be more to know than one person could realistically learn in a lifetime. No surgeon I've ever met has told me they felt they knew too much about their art.
And yet they have to operate. At some point in time, scheduled or unscheduled, they have to call for the blade and incise and carry out the operation: even if they don't know everything they could about the 11 common anatomical variants of the bile duct; even if they can't predict the cursed moment when the hose on the heart-lung perfusion machine is going to spring a clamp, spraying arterial blood onto the (nonsterile) ceiling, which then slowly drips back into the wound, contaminating it, as the patient loses blood pressure.
Yeah, I saw that happen. The surgeon, who was the best surgeon I've ever seen, immediately re-obtained control of the situation like nothing had happened. Within 10 seconds of the calamity there was no doubt who was in command of that operating room and there was no doubt what the correct task of every person in the room was going to be at that moment.
If you do not have the attitude that you are confident to deal with this, you will freeze up and not deal with it right. While you are dithering, trying to regain control of the situation, the patient will die. i have seen that happen too.
It is not enough for a surgeon to put on a cocky front of attitude for others to see, while inside he is whimpering with fear and uncertainty.
It is not even enough to truly believe that you are confident to handle this kind of situation.
Not only do you have to believe truly in your own confidence and your own ability; but also you have to be absolutely correct in your belief. Experience must bear this out, every time. You have to have what people see in Steve Jobs and call his "reality distortion field," something that allows you to interpret your reality in the only way that is going to permit you to perform at that highest level.
Otherwise you sit there and look at the proposed incision and think to yourself, "No, this isn't right. I'm not the guy who's supposed to do this." You then either go on to have a half-assed surgical career, trying not to mangle too many people; or you do what I did and bow out gracefully before you get into trouble.
As it turns out, my personality is much better suited to what I ended up choosing to do. And I never choose to joust at the ego of the surgeon I'm talking to, no matter how inflated. I respect what they do too much to do that.
posted by ikkyu2 at 10:41 PM on August 25, 2007 [6 favorites]
I spent enough time as a med student trying to find out if I wanted to be a surgeon that a number of surgeons let me operate on their patients. I have removed appendices and a gall bladder and once did a frontal lobectomy (traumatic clot evacuation on a homleess person who'd been hit by a bus) nearly alone, getting as far as achieving hemostasis before I needed help. I have held a person's beating heart in my thinly gloved hand because it was too fragile to arrest it for the coronary bypass operation; and felt it contract more and more strongly with every beat, as one by one the bypass vessels were attached by the surgeon, infusing a full supply of blood to the oxygen-starved muscle.
What these experiences and others with surgeons taught me is that operating on people is a venue where there is a great deal of uncertainty. To add insult to this injury, there is a great deal you can be certain about before entering the operating theater; there may be more to know than one person could realistically learn in a lifetime. No surgeon I've ever met has told me they felt they knew too much about their art.
And yet they have to operate. At some point in time, scheduled or unscheduled, they have to call for the blade and incise and carry out the operation: even if they don't know everything they could about the 11 common anatomical variants of the bile duct; even if they can't predict the cursed moment when the hose on the heart-lung perfusion machine is going to spring a clamp, spraying arterial blood onto the (nonsterile) ceiling, which then slowly drips back into the wound, contaminating it, as the patient loses blood pressure.
Yeah, I saw that happen. The surgeon, who was the best surgeon I've ever seen, immediately re-obtained control of the situation like nothing had happened. Within 10 seconds of the calamity there was no doubt who was in command of that operating room and there was no doubt what the correct task of every person in the room was going to be at that moment.
If you do not have the attitude that you are confident to deal with this, you will freeze up and not deal with it right. While you are dithering, trying to regain control of the situation, the patient will die. i have seen that happen too.
It is not enough for a surgeon to put on a cocky front of attitude for others to see, while inside he is whimpering with fear and uncertainty.
It is not even enough to truly believe that you are confident to handle this kind of situation.
Not only do you have to believe truly in your own confidence and your own ability; but also you have to be absolutely correct in your belief. Experience must bear this out, every time. You have to have what people see in Steve Jobs and call his "reality distortion field," something that allows you to interpret your reality in the only way that is going to permit you to perform at that highest level.
Otherwise you sit there and look at the proposed incision and think to yourself, "No, this isn't right. I'm not the guy who's supposed to do this." You then either go on to have a half-assed surgical career, trying not to mangle too many people; or you do what I did and bow out gracefully before you get into trouble.
As it turns out, my personality is much better suited to what I ended up choosing to do. And I never choose to joust at the ego of the surgeon I'm talking to, no matter how inflated. I respect what they do too much to do that.
posted by ikkyu2 at 10:41 PM on August 25, 2007 [6 favorites]
Response by poster: Thank you to everyone who answered my questions. I'm going to go back and mark as "best answers" some of the ones which really focused on the "why" of the questions, although I appreciate every response.
I asked the questions after a particular experience my partner had meeting a certain surgeon here in Houston last Friday to discuss a hernia surgery. Although the diagnosis had been confirmed already by the GI specialist and endoscopy, the surgeon said flat-out, "You don't have a hernia, you're fat." In addition, the surgeon tried to explain his reluctance to take the case by saying, referring to himself, "These are the hands of God. Sometimes God plants watermelon seeds and you get weeds." Of course, what he meant was that surgery might make things worse, but the way he said it... Going further into the particulars would get me into GYOB territory, but it's enough to say that my partner felt like he was being addressed like a child.
To the extent that I feel that patients, as consumers and as adult responsible people, are the ones ultimately in charge of our own health, I look for practitioners who will act as our partners in healthcare, not as our superiors. I don't desire to be told that everything will be all right. I know that every human makes mistakes, and that there are almost always circumstances beyond human control. And of course, I know that the desire to have someone "do something" to "make things better" cannot always be fulfilled.
What I do want is enough information and facts to make rational decisions based on probabilities. I expect uncertainty, even embrace it, because it is the truth. I simply expect to be allowed to choose how to face the uncertainties when it's my health in question, or that of my partner.
posted by Robert Angelo at 7:01 PM on August 27, 2007
I asked the questions after a particular experience my partner had meeting a certain surgeon here in Houston last Friday to discuss a hernia surgery. Although the diagnosis had been confirmed already by the GI specialist and endoscopy, the surgeon said flat-out, "You don't have a hernia, you're fat." In addition, the surgeon tried to explain his reluctance to take the case by saying, referring to himself, "These are the hands of God. Sometimes God plants watermelon seeds and you get weeds." Of course, what he meant was that surgery might make things worse, but the way he said it... Going further into the particulars would get me into GYOB territory, but it's enough to say that my partner felt like he was being addressed like a child.
To the extent that I feel that patients, as consumers and as adult responsible people, are the ones ultimately in charge of our own health, I look for practitioners who will act as our partners in healthcare, not as our superiors. I don't desire to be told that everything will be all right. I know that every human makes mistakes, and that there are almost always circumstances beyond human control. And of course, I know that the desire to have someone "do something" to "make things better" cannot always be fulfilled.
What I do want is enough information and facts to make rational decisions based on probabilities. I expect uncertainty, even embrace it, because it is the truth. I simply expect to be allowed to choose how to face the uncertainties when it's my health in question, or that of my partner.
posted by Robert Angelo at 7:01 PM on August 27, 2007
It's too bad about the surgeon you spoke to. I have no idea what it means that God's hands plant watermelon seeds but weeds come up. That doesn't make any sense to me.
posted by ikkyu2 at 1:04 AM on August 28, 2007
posted by ikkyu2 at 1:04 AM on August 28, 2007
If your surgeon said anything remotely like what you describe then the best thing you could have done was ask him to get psychiatric help and then request a new consultant. What a tool.
posted by docpops at 2:35 PM on August 28, 2007
posted by docpops at 2:35 PM on August 28, 2007
Response by poster: If your surgeon said anything remotely like what you describe then the best thing you could have done was ask him to get psychiatric help and then request a new consultant.
My partner told him to confer with his primary care physician. When he came home and told me about it, I had three reactions:
1 - I said he should have laughed in his face.
2 - I said he should have said, "Well, hail You and praise your Name! Touch me and I shall be Healed!"
3 - I waited several hours, wrote this AskMe, deleted most of what I said and rewrote the rest, posted it and walked away for a few days.
Thanks again to everyone who responded. Most of the doctors we deal really are wonderful, but we deal with enough of them that every once in awhile there is one who boggles the mind.
posted by Robert Angelo at 5:44 PM on August 28, 2007
My partner told him to confer with his primary care physician. When he came home and told me about it, I had three reactions:
1 - I said he should have laughed in his face.
2 - I said he should have said, "Well, hail You and praise your Name! Touch me and I shall be Healed!"
3 - I waited several hours, wrote this AskMe, deleted most of what I said and rewrote the rest, posted it and walked away for a few days.
Thanks again to everyone who responded. Most of the doctors we deal really are wonderful, but we deal with enough of them that every once in awhile there is one who boggles the mind.
posted by Robert Angelo at 5:44 PM on August 28, 2007
This thread is closed to new comments.
It wasn't a sweeping generalization, he was more or less sharing personal experiences he has had.
posted by JaySunSee at 3:44 PM on August 24, 2007