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Archive July 2016 XVII, No. 7

Cutting Remarks: Stressed Surgeons Gone Bad

When cases go south, do your docs go down the rabbit hole with them?

John Kelly, IV

John Kelly, IV, MD


surgeon gone bad

Every surgeon and scrub nurse has been there. A seemingly straightforward case commences smoothly, only to turn into a hellish nightmare in seconds: the stubborn bleeder, the rotator cuff tear the size of Brooklyn or the two-part fracture that becomes the four-part fracture after failed reduction attempts. In times of surgical strife, surgeons may morph into one of several dysfunctional patterns:

  • Blame game. Many surgeons have the blame game as their default option when under duress. The bleeder is everybody else's fault: the nurse for not picking the appropriate instruments, anesthesia for not keeping the BP down or yours for not telling the patient to stop aspirin. Emotions are contagious, and a few negative accusations can drag the entire OR culture into a large abyss.
  • Panic attack. Some surgeons morph into panic mode and enter into a convulsive state of hurried and sometimes illogical motions, feeling that if they move fast enough, the solution will somehow appear. But hurried and uncalculated motions invariably exacerbate the problem. The 6-inch incision is now double the size with no bleeder in sight. The humerus resembles popcorn after the desperate strong-arm attempt to reduce the fracture.
  • Woe is me. Some surgeons, even seasoned ones, have PhDs in self-reproach, and surgical complications result in a volley of self-castigation and self-flagellation. One can actually palpate the loss of confidence that ensues after a surgical misadventure presents. Some may be paralyzed by fear, immobilized with the prospect of doing even more harm. Thankfully, many find ways to snap out of the confidence vacuum and find the strength to complete the task. Others are less fortunate. After several minutes of aimless activity (or inactivity), some will do the prudent thing: Call for help.
  • Mood disorder. Many in medicine suffer from mood disorders and just enough stress can trigger a manifestation. Next time you see a surgeon scream, yell or throw instruments, recognize that there is either a borderline personality or bipolar sufferer present. Ironically, some of the most brilliant and gifted who wield a knife also often carry the most psychological baggage. Mercurial moods indicate a labile psyche with an underlying (often undiagnosed) mental illness.
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