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'You’re Too Nice to Be a Surgeon'

Discussion in 'General Surgery' started by Hadeel Abdelkariem, Jun 23, 2019.

  1. Hadeel Abdelkariem

    Hadeel Abdelkariem Golden Member

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    As a medical student, anytime I told anyone that I wanted to be a surgeon they would give a similar reply:

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    “You’re too nice to be a surgeon.”

    I never really understood what that meant since most of my mentors were reasonable people. Sure, they got mad or frustrated, but since I was never the object of those sentiments, it was easy for me to write those emotions off as wanting optimal patient care.

    Sometimes, I would even reply back, “someone has to break the mold,” implying that someone could be me. But is this really the endpoint we want?

    During my fellowship, people even went so far to tell me that I am too nice and that I should be more assertive and stand my ground, particularly when it comes to patient care. But I persisted, wanting to maintain a collegial and easygoing attitude. This proved to be easier said than done.

    I did pretty well for the first several years as an attending. My goal was not really to be the best technical surgeon (since I know I’m good at what I do), but to have the best room in the OR. I wanted to be in the room everyone wants to be in. Maybe it was the chronic New York City grind or the continued frustrations with logistics, but eventually, I was having some “moments” while still being very much easygoing, collegial, and friendly. So, I reassessed and reigned it back. But the real question remains: Why did it happen?

    One of the operating room staff told me that they noticed this change in my practice style over the first few years when I started. I kept tight-lipped, but I wanted to say that it was not on purpose; it was a reaction to circumstances, many of which were in that person’s control. That’s when I realized what happened.

    Prepare yourself: I’m about to reveal the best-kept secret about surgical personalities. Surgeons aren’t born angry and yelling. But if they do yell, it is not typically for lack of reason.

    Why does it happen and what can be done to prevent it? I mean, is it even possible to keep a surgeon happy at all times? Most likely, the answer is no, but here is my short list (eight pieces of advice) to serve as a starting point:

    1. Start time — Surgeons don’t want to be at the hospital forever. We want to leave. We enjoy being at home, spending time with friends, or underwater basket weaving or whatever. Start us quick. Start the day right. Set the tone.
    2. Case-blocking — I get it. Some patients just should not get surgery. Some aren’t ready. Some days there is no time. But if you’re going to cancel, delay, bump, take away the surgeon’s second room, or otherwise impact their case-flow (be it for anesthesia reasons, OR logistic reasons, or whatever), please tell us early. Allow us to modify our day or maybe even go home early.
    3. Keep the day moving — This is critical. Turnover times can be unnoticeable or they can be long enough to hold congressional hearings. One day, my first case ran long. When we finally finished, the anesthesiologist decided that the patient needed repeat bloodwork. Of course, I wasn’t told and when I finally found out, an hour had passed and now it was late enough that the anesthesiologist had gone home. The bloodwork could’ve been drawn at any point that morning while the patient was waiting, but no one thought of that. Or maybe it was a stall tactic till that physician could clock out? I leave that to your judgment.
    4. Communication (even over-communication at times) — Keep your surgeon in the loop. I drove in to do an emergent surgery not long ago and, despite being told the patient was en route, I arrived with no patient in the OR. I waited for a little while until finally, I asked an hour later why we hadn’t started. I was told anesthesia had blocked patient transport while waiting for repeat bloodwork (which seems like a common theme). When I spoke to the anesthesiologist, it became clear that there was no good reason for the delay. Of course, I became frustrated because instead of waiting around at the hospital, I could have had breakfast with my family, dropped them off where they were going instead of leaving them to struggle with cabs and subways, and had an extra hour with them during the weekend. Instead, I had the privilege to stare at the OR lounge wall for that time. So when I “re-educated” the anesthesia resident that had made this decision, I “reminded” him to communicate. My issue was not with waiting; my issue was rather with the location in which I was waiting because no one communicated.
    5. Don’t string us along — One of the people I really appreciate is a night nurse who was always direct with me – if I asked for a second room or if my add-on will go early, her response was usually to laugh (respectfully, but still laugh). I appreciated how frank she was, even though sometimes it meant I had to wait or reschedule cases.
    6. Realize your surgeon is captive — Surgeons are at the mercy of the OR. At our ambulatory surgery center, things move. Everyone’s interests are aligned – the day must get done and preferably fast because the place can’t stay open after 5 pm. But at the main center, everyone changes shifts, including many of the physician staff, except the surgeon. Obviously, the case length and time is mostly controlled by the surgeon, but the rest of the day is out of our control. And that can be scary and frustrating, especially when it seems like no one else cares if you finish early or late.
    7. Surgeons hate waiting — For the reasons outlined above, you can clearly infer this one on your own. But I write this explicitly because the corollary is true – if you want to make sure you generate angry, spiteful surgeons, make them wait around.
    8. Don’t compromise the quality of patient care — This is self-explanatory. Be multidisciplinary, don’t be obstructive. This is intimately related to numbers two and four listed above.
    I like to think that I still to this day have not been a jerk, that I have maintained my composure and only rarely expressed frustration to advocate for my patients or my family and their rights on me and my time. But these issues can wear a person down. So I caution all those out there who interact with surgeons – if you want happy surgeons, just communicate, respect their time (and time away), and show them that their interests are your interests.

    Doing these things will produce incredible results with your surgeons. Try it. I dare you.

    Issam Koleilat, MD is a vascular surgeon at Montefiore Medical Center/Albert Einstein College of Medicine in the Bronx, NY. He is also the proud father of a wonderfully curious five-year-old daughter and bright-eyed five-month-old son, and the husband of a breast cancer genetic epidemiologist. He enjoys traveling with his family, and as the kids get older he hopes they will hike, ride horses, and rock-climb more.

    Dr. Koleilat is a 2018–2019 Doximity Author.

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