I’ve known surgeons who were censured for verbally abusing subordinates, belittling other doctors and throwing surgical instruments. I’ve stood toe to toe with more than one.
The stereotype of the abrasive but gifted surgeon is ubiquitous, and I shrugged off those unpleasant encounters. It never occurred to me that tantrum-throwing surgeons could endanger their patients – until I read a recent NPR report about an article in a prestigious medical journal.
The authors found that patients of surgeons who engaged in unprofessional behaviors, such as disrespectful communications, suffered significantly more complications.
A surgeon who wasn’t involved in the study thinks it’s likely many such complications occur because a surgeon’s abusive behavior undermines the performance of the surgical team.
“Nurses may be more likely to speak up about (problems in the operating room) if the physician is more receptive to them speaking up,” he says. But if the surgeon is “yelling all the time,” the same nurses might say nothing.
I witnessed exactly that scenario as a medical student.
“Dr. Lang” unleashed his temper on everybody. Other doctors referred patients to him because of his superb surgical skills, but even his peers treated him with kid gloves.
I was assigned to “Dr. Brown” when a middle-aged woman came to his office with symptoms typical of gallbladder disease. The test of gallbladder function used back then indicated the organ wasn’t working. Brown referred the patient to Lang, who scheduled an operation.
I’d never seen surgery before, so Brown said I should attend.
On the morning of the operation, the anesthetist and an operating room nurse cautioned me to stand quietly and say nothing. Taking my place beside the anesthetist, I vowed not to move a muscle.
I’d read about gallbladder surgery the previous evening and knew the procedure was performed through a diagonal incision about 5 inches long that parallels the border of the ribs on the right side.
As nurses draped sterile cloths over the unconscious patient’s body and swabbed her abdomen with antiseptic solution, I saw just such a scar in just the right place. What gives? I wondered, as nurses and the anesthetist exchanged nervous glances.
At that moment, Lang, gowned, gloved and masked, strode into the room. He held out his hand; a scrub nurse slapped a scalpel into his palm. Leaning over the patient, he did a double-take. “What’s this scar?” he snarled.
A technician grabbed the patient’s chart and ruffled through it. “It says she had kidney surgery.” More nervous glances flew around the room.
“Damn strange approach for a kidney,” Lang muttered. He paused, then made an incision parallel to the scar.
As he pawed around in the woman’s belly, the anesthetist leaned toward me and, lips almost touching my ear, whispered, “He can’t find it.”
My God, I thought, her gallbladder was taken out before. That explains the test result. She had this surgery for nothing.
Lang closed layers of tissue with quick, precise stitches, stripped off his gloves, threw them on the floor and stomped, wordless, out of the room to a collective sigh of relief.
Most of the blame was Lang’s. He should have noticed the scar before surgery. He should have questioned the test result and clarified the patient’s history before operating. But he didn’t.
And because they were so afraid of him, nobody on the surgical team questioned the scar’s significance and warned him to reconsider. Had anyone done so, the fiasco would probably have been averted.
Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland. Reach her at firstname.lastname@example.org.