List Archives

Tue Dec 30 19:14:28 GMT 2008

From: Angela (angie504 at hotmail.com)  > I work with a particular trauma surgeon... loses his temper easily... yelling and screaming... until his orders are done... walking on egg shells... no one knows what will upset him

--> I assume from your e-mail, reading between the lines, especially when you refer to "my" trauma team, that this is something you and your team have significant experience with. It also seems to be clear that this is ONE surgeon who stands out from among others for, unfortunately, negative reasons.

Although I agree fully that having the topic raised on this list is not anonymous enough and that this may well get back to that surgeon.

My first thought, therefore, is that you should bear this in mind and probably do your absolute best to discuss this issue URGENTLY with your top senior (or whatever you call the person to whom you answer and with whom the buck lies) and alert him/her to the possibility. I seriously doubt that any solutions you read here should involve you coping with this alone!

Regardless of whether the cat is now out of the bag, I doubt further discussion will make this issue any worse...

> And he never says ,"sorry for acting out of line."

--> So I will choose now to assume that he is not aware that he should apologise. I assume this because I would consider this a problems of IGNORANCE and that's the easier stuff to fix. I am an optimist and always would rather give a fellow professional the benefit of the doubt. Having seen EXACTLY this sort of situation with a previous colleague (a senior ED nurse) in whom the yelling appeared and was "tolerated" until she attempted to take her own life, I will choose to assume ignorance until proven otherwise.

As has been stated by others, if the surgeon IS aware, then this is no longer ignorance. Bullying and intimidation in the workplace which are NOT through ignorance are an offence. That's less easy to fix...

From: McSwain, Norman E Jr. (nmcswai at tulane.edu)  > "A surgeon never yells or throws instruments...

--> I hope no-one throws instruments!

> It is a sign of one who has lost control

--> Bearing in mind the potential for injury to others, damage to property not owned by the surgeon, the risk of droplet spread and problems with infection control, this is also a sign of worse things i.e. assault (with a weapon?)

From: Ross Hofmeyr (wildmedic at gmail.com)  > There is one time that yelling (actually, I prefer 'raising your voice') is acceptable...

--> Hey, Ross. The other time is when you are all the way out in Antarctica, trying to make yourself heard in the blizzards ;-)

From: Gordon Doig (gdoig at med.usyd.edu.au)  > in OZ we call that 'bullying'

--> Same langage here in the UK.

From: Ken Harrison (Kenh at careflight.org)  > It also is a sure sign of an immature and insecure man

--> It MIGHT be. On the assumption that a surgeon would not make it through whatever training system y'all have out there in the USA without someone noticing this before, I'd say it's a sign of
1. Immaturity/insecurity AS WELL AS a gross failure of training and selection systems

OR, more likely,

2. A recent (?when) CHANGE and/or alteration in previously normal behaviour & social interaction. These may be brought on possibly by psychological issues, paranoia, stress, substance issues, etc... All of these need investigtion and possibly treatment. Here in the UK, the employer owes the surgeon employee all the care required for this condition...

I have worked with surgeons (and also other professionals, but not as many as surgeons) who have, at some time or another, done a bit of yelling in my ED... Some stress is generally discovered at the root of this and I am aware of not a single episode where this was appropriately addressed and NOT resolved!

From: Gross, Ronald (Ronald.Gross at bhs.org)  > I have seen physicians just like this receive suspensions and even lose privileges

--> What about corrective measures and a return to productive work?

From: Bjorn, Pret (pbjorn at emh.org)  > ... should be referred to the Program Director, in writing and in detail, as guided by hospital policy

--> Sounds good, but I'd BEGIN with a confidential chat with this Director to look for advice even on how to phrase the written statement...

> careful verbal de-escalation in real time ("Doctor, let's work on accomplishing your objectives less dramatically.")

--> That's lovely!

> hopefully some days before publishing one's concerns complete with hospital identifierson an international list server

--> You mean NEXT TIME... ;-)

> Surely the List has not contributed substantially to any local solutions

--> Unless YOUR excellent advice above is followed... In which case the "list" (with you on it) will have helped a lot ;-)

> the best trauma providers (at every level) engage in a subtle and constant competition to be the coolest player in the room. It's a game that always serves the patient and the process

--> I doubt anyone would ever accuse me of being "cool", so I think I'd lose the competition... At my ED (only a few dozen miles East of the ORIGINAL Bangor, by the way) the "game" is sort of a team sport, so that any individual's lowering of core temperature is of less significance than the "heat" of the action generated by the whole team... ;-)

From: KMATTOX at aol.com  > acceptable to "yell" at a person a block away that you see is about to be hit by an unseen and unheard 18 wheeler

--> Acceptable? Sure!
But what's the use of yelling from a whole block away if he can't hear an 18-wheeler about to impact??? 
;-)

> In an operating room, shock room, ICU...

--> What's a "shock room"? Google says it's something to do with horror films...

> Yelling is a symptom of a number of other diseases... a sign that the leader never was in control...

--> A sign that the person yelling is NOT ACTUALLY the leader. Although he/she might have been expected to be or used to be... While yelling, that person is more of a scarecrow...

> ...or has other unmet needs which need to be identified and treated

--> Yes!

> Just listen to the classical (or C&W) music...

--> Speaking of which... The one recent time I recall yelling in an operating theatre myself is about 18 months ago (I rarely find myself in operatingtheatres), when I helped push into the theatre a victim of blunt trauma who was wayyy too unstable to deserve to retain the integrity of his abdominal wall. The good news is that the surgeon was right there with the patient, as he helped me push the trolley from the ED. The bad news was that our arrival surprised the staff and there was a radio there, playing some horrible Britney tunes far too loudly (and tastelessly, if you ask me) and we all had to yell to get it turned down. I believe we almost got to yelling again when the debate began about whether Britney was appropriate at all in the first place... ;-)

From: Bjorn, Pret (pbjorn at emh.org)  > Beware empathy for the sake of empathy

--> It is not mere empathy, but rather the assumption of the presence of an occult cause which requires identification.

> If the report is truthful, the behaviors are unacceptable and the history and motivations are irrelevant

--> I would not agree with "irrelevant" - I'd opt for "do not justify bullying", but they ARE relevant if one aims to get to the bottom of the issue and assist the surgon - our colleague - with whatever ails him...

I'm not giving up on him, yet!
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Is yelling accepatable?? ever??