Malignant residents

[ArrogantSurgeon]

There has been quite some talk lately about malignant programs, residents, attendings, etc. My question is if having a hostile attitude as a resident can actually be beneficial for the resident in terms of making work easier to get through?

For example, there is a general surgery PGY3 here who has an unbelievably malignant personality (yelling at nurses and even residents who are above him...he even let an attending have it for what he thought was unfair treatment). However, even though he is a PGY3, people here have learned to avoid him and not give him much trouble. Other nurses and residents have told me if they need anything, they go elsewhere and don't deal with him. I'm thus wondering if his malignant attitude makes his time in the hospital "easier" in that people try to leave him alone and nurses do everything they can to avoid him? I don't think the other residents even like him outside the hospital setting.

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[mikecwru]

Originally posted by ArrogantSurgeon
There has been quite some talk lately about malignant programs, residents, attendings, etc. My question is if having a hostile attitude as a resident can actually be beneficial for the resident in terms of making work easier to get through?

For example, there is a general surgery PGY3 here who has an unbelievably malignant personality (yelling at nurses and even residents who are above him...he even let an attending have it for what he thought was unfair treatment). However, even though he is a PGY3, people here have learned to avoid him and not give him much trouble. Other nurses and residents have told me if they need anything, they go elsewhere and don't deal with him. I'm thus wondering if his malignant attitude makes his time in the hospital "easier" in that people try to leave him alone and nurses do everything they can to avoid him? I don't think the other residents even like him outside the hospital setting.

I doubt it is a conscious decision with most residents as much as it is just "**** rolls downhill."

The resident you speak of, though, sounds more like he has a personality defect.

mike

 

[Skylizard]

Originally posted by ArrogantSurgeon
...My question is if having a hostile attitude as a resident can actually be beneficial for the resident in terms of making work easier to get through?

...there is a general surgery PGY3 here who has an unbelievably malignant personality...people here have learned to avoid him and not give him much trouble. Other nurses and residents have told me if they need anything, they go elsewhere and don't deal with him...

I think the answer is closer to you than you know...like in your own question. If your description is accurate, this reported resident's education is being SERIOUSLY & SEVERELY handicapped. He is being ignored and bypassed in the care of his patients. It is likely that those attendings that do not like him allow him a great deal less independence in both the OR and post-op care of patients. So, he may sleep more when on call but he clearly will know a great deal less then those residents that were on the "inside" as opposed to being on the "outside".

I personally do not subscribe to the idea that malignant attendings help your education. However, some may argue this point. I doubt you will find many if any at all who will argue a resident being malignant will in some way benefit said resident's education.

 

[fourthyear]

A bad attitude is unhealthy and makes you unhappy. I'd rather be in a good mood and do more work/sleep less than be in an angry mood, but have more time to sleep. It's not good to walk around with anger in your heart, a scowl on your face, and no friends. That's not good no matter what your job is.

Interesting perspective to ask the question, though - I guess you are looking for some good reason as to why someone would be so malignant b/c to me it's just inexplicable why people would enjoy being like that!

 

[apma77]

arrogant ..are you justifying your malignant personality by posing this question?

 

[ArrogantSurgeon]

Originally posted by fourthyear
A bad attitude is unhealthy and makes you unhappy. I'd rather be in a good mood and do more work/sleep less than be in an angry mood, but have more time to sleep. It's not good to walk around with anger in your heart, a scowl on your face, and no friends. That's not good no matter what your job is.

Interesting perspective to ask the question, though - I guess you are looking for some good reason as to why someone would be so malignant b/c to me it's just inexplicable why people would enjoy being like that!

I completely agree fourthyear.

I don't know him well enough to know why he acts the way he does. Maybe something happened during med school to make him this way, since the residents say he was supposedly even worse during intern year and only toned it down a notch after the nurses and some med students filed a formal complaint or something of that nature against him. Apparently he used to completely ignore med students and pretended not to even hear them when asked questions directly. Even now he only seems to talk to upper level residents and attendings and ignores everybody else. It is pretty damn rude and I'm surprised he's gotten this far with that attitude. Although I will say he is one sharp guy and according to the residents is apparently pretty slick in the OR...maybe that's why they tolerate him.

 

[Skylizard]

Originally posted by fourthyear
A bad attitude is unhealthy and makes you unhappy...

There are a small but growing number of surgeons out there that are being fired and having their opportunities markedly reduced because of "unprofessional" behavior. Surgeons have actually been taken to court for throwing things. During my internship, a chief resident threw something in the trauma bay and was suspended without pay. There was even talk that the nurse in the trauma bay was considering engaging an attorney to obtain a restraining order. Remember, a great deal of the old BS done by surgeons is in fact ILLEGAL and is tolerated less and less. It will be tolerated even less by a resident!

Something to keep in mind; surgeons telling dirty or sexually oriented jokes in the OR are at the discretion of everyone else in the OR and not the surgeon. All it takes is one tech or nurse filing sexual harassment charges and you are toast. Surgeons may understand but the jury of your peers will not be surgeons or even physicians for that matter. And, you wouldn't want everyone knowing you made an off color comment about the nude patient's breast would you? Well, patients would be shocked to know these types of things do occur. Fortunately or unfortunately they occur less and less because it is unprofessional.

 

[womansurg]

Originally posted by Skylizard
During my internship, a chief resident threw something in the trauma bay and was suspended without pay.

Good for the hospital! At our local competitor hospital an orthopedic surgeon lost privileges for squirting bloody lavage fluid in the face of an anesthesiologist. There was also another surgeon who was just a rude jerk, and the anesthesiologists refused to cover his cases, essentially shutting him down. He got to come back after modifying his behavior however.

We're a pretty civilized group here at my neck of the woods. We all play nicely together. I do love a raunchy OR room though...the dirtier the humor, the better.

 

[Skylizard]

Originally posted by womansurg
... I do love a raunchy OR room though...the dirtier the humor, the better.

I am generally with you about the raunchyness. However, surgeons and male surgeons in particular need to tread very lightly in this day and age. It is easy to have a vindictive OR person file a sexual harassment charge. Raunchy and/or off color jokes can be fun but they do represent a certain degree of liability for the surgeon.

 

[womansurg]

Originally posted by ArrogantSurgeon
My question is if having a hostile attitude as a resident can actually be beneficial for the resident in terms of making work easier to get through.

This is known as the John McEnroe method of success. Some of you are probably too young to remember him, but he was a world class tennis pro who was notorious for his on court temper tantrums - throwing rackets, screaming curse words, storming off the court. Went over real well at Wimbledon, as you might imagine.

If a ref made a borderline call against him, he would completely decompensate, stopping the game to scream at the ref and the umpire. The next time a ball was right on the line, the ref - maybe just subconciously - would tend to err in his favor, just because of the negative conditioning he'd had to endure.

Some thought that McEnroe did it purposefully, as a tactic to reduce bad calls against him.

 

[Kammel Jacque']

Originally posted by Skylizard During my internship, a chief resident threw something in the trauma bay and was suspended without pay. There was even talk that the nurse in the trauma bay was considering engaging an attorney to obtain a restraining order. [/B]

absolutely pathetic. this is the death of the profession when doctors are forced to behave like peons. idiots deserve instruments hurled in their direction.

Originally posted by Skylizard
Something to keep in mind; surgeons telling dirty or sexually oriented jokes in the OR are at the discretion of everyone else in the OR and not the surgeon. All it takes is one tech or nurse filing sexual harassment charges and you are toast.

this is what happens when a bunch of wimps and women infiltrate the profession. you lose control

 

[womansurg]

Originally posted by Kammel Jacque'
this is what happens when a bunch of wimps and women infiltrate the profession. you lose control

Translation: my penis is so small....

 

[DrMom]

Please don't feed the troll!

 

[womansurg]

Originally posted by DrMom
Please don't feed the troll!

*crumples up empty bag of peanuts and walks away*

 

[Kammel Jacque']

Originally posted by womansurg
Translation: my penis is so small....

well compared to yours..............

 

[powermd]

Originally posted by Skylizard
I am generally with you about the raunchyness. However, surgeons and male surgeons in particular need to tread very lightly in this day and age. It is easy to have a vindictive OR person file a sexual harassment charge. Raunchy and/or off color jokes can be fun but they do represent a certain degree of liability for the surgeon.

I want to voice a dissenting opinion on this issue. I have a fairly dark, sickening, sarcastic sense of humor- however there is an approprite time and place for everything, and stupid sex jokes come off as unprofessional in the OR. I cringe when I hear an 40+ year old attending talking trash. Instead of being funny, it looks pathetic that the guy is still trapped in sixth grade. Come to think of it, seeing that behavior in surgical residents makes me cringe too. Surgery is supposed to be all about leadership and responsibility. How do you expect people to respect you as a responsible leader if you exhibit infantile behavior in the OR?

 

[womansurg]

Originally posted by powermd
I want to voice a dissenting opinion on this issue. I have a fairly dark, sickening, sarcastic sense of humor- however there is an approprite time and place for everything, and stupid sex jokes come off as unprofessional in the OR. I cringe when I hear an 40+ year old attending talking trash. Instead of being funny, it looks pathetic that the guy is still trapped in sixth grade. Come to think of it, seeing that behavior in surgical residents makes me cringe too. Surgery is supposed to be all about leadership and responsibility. How do you expect people to respect you as a responsible leader if you exhibit infantile behavior in the OR?

Your penis is small too.

No, no, I'm just kidding...just a little raunchy humor...

I don't think surgery is all about being a responsible leader. I think it's about providing safe and appropriate perioperative care, which relies on a team of individuals working in concert. Everyone sharing an occasional moment of lighthearted humor while they perform their jobs is not at all counter to accomplishing this. Being uptight and easily offended probably are however. I don't mean that facitiously, but sincerely. People who take themselves too seriously tend to impair spontaneous input and reactions of their colleagues.

A recent article in Harvard Business Review profiled cardiothoracic surgery teams implementing new technology. The 'old school' surgeons who were stern and acting in a stereotypical dictatorial manner tended to be unapproachable to the OR support staff. It took those teams more than twice as long to learn the new techniques than it did for teams headed by young, open minded surgeons. Some of the most important trouble shooting resulted from the spontaneous input of the ancillary members. Because of the open environment, they felt free to offer their perspectives in ways which they noted that they never would have in a more typical OR atmosphere.

 

[hemoccult]

All of this conversation regarding penis size has me wondering...is there an appropriate, or recommended, penis size for male applicants interested in surgery?

Should this information be included on a CV?

Is there a published or underground list of "cutoffs" for certain programs?

Is it beneficial to do away rotations for comparison?

*Note: These above questions are not real. They are mere merrymaking and joviality with some reference to some of the superficial questions posted recently. I just wanted to "lighten things up" in the surgery forum. Yes, I understand the juvenile nature of these remarks, but lets all regress for just one moment.

Again, I have no intent to overtly criticize or belittle fellow SDN participants. I just saw all of this talk about penis and couldn't resist a little humorous interjection.

P.S. In reply to a prior "Arrogant" question regarding most intense surgeries, I think the most nerve-racking or intense surgery would be anything involving a scalpel and my most prized and medial appendage.

 

[Foxxy Cleopatra]

Originally posted by hemoccult
All of this conversation regarding penis size has me wondering...is there an appropriate, or recommended, penis size for male applicants interested in surgery?

Should this information be included on a CV?

Is there a published or underground list of "cutoffs" for certain programs?

Is it beneficial to do away rotations for comparison?

I've got a question I want to add to ERAS for the aspiring surgeon- best synonym for the word penis? Mine would be wang! LOL

Seriously, when I was a student, the residents and attendings that really wowed me were the ones who were extremely knowledgable, could crack a joke, yet were respectful and inclusive to all members of the team. That's the sort of surgeon I plan to be.

I also found these individulas to be the most respected among the staff and patients as well as the most efficient.

 

[chicagosurgres]

While I would never condone behaving in a malignant manner I do have to say that sometimes one can be too nice. Speaking from personal experience when I was an intern and PGY2 I was always overly nice to nurses and went out of my way to call right back and never get upset even for 2 am calls about temp of 100.0 and blood sugar of 199, and I would even hang out and socialize a little and hover over patients in the ICU while on call. By my PGY3 year I realized I was being paged way more often than anyone else because I was always so "nice and helpful". It finally got to a point where all the interns would be calling me to help with central lines and the sicker patients and skipping calling who their real backup person was, and even the floor nurses would bypass the intern on call and call me. Needless to say I finally realized there is such a thing as being stern but NOT malignant by challenging ridiculous late night pages and snapping a little at someone without totally yelling or going off. Don't get me wrong I can still go ballistic when it is appropriate but when you reserve it for a good reason people respect you more. Now I get very few ridiculous pages, and even though I will be a chief alot of nurses still think I am a decent guy because I did not start out as a malignant personality. The point is that patient care comes first, but do not set yourself up for extra work by going out of your way to take on other people's work.

 

[ArrogantSurgeon]

Originally posted by womansurg
This is known as the John McEnroe method of success. Some of you are probably too young to remember him, but he was a world class tennis pro who was notorious for his on court temper tantrums - throwing rackets, screaming curse words, storming off the court. Went over real well at Wimbledon, as you might imagine.

If a ref made a borderline call against him, he would completely decompensate, stopping the game to scream at the ref and the umpire. The next time a ball was right on the line, the ref - maybe just subconciously - would tend to err in his favor, just because of the negative conditioning he'd had to endure.

Some thought that McEnroe did it purposefully, as a tactic to reduce bad calls against him.

So overall do you think this method is effective womansurg? Do the benefits of having nurses/other residents fear your temper and overreactions outweigh the negative consequences it may have? I'm not implying outright, vengeful hostility...but rather making it a point that everybody who works with you gets the message "Do not bother Dr. X unless it is for a good reason".

 

[powermd]

Originally posted by womansurg
Your penis is small too.

No, no, I'm just kidding...just a little raunchy humor...

I don't think surgery is all about being a responsible leader. I think it's about providing safe and appropriate perioperative care, which relies on a team of individuals working in concert. Everyone sharing an occasional moment of lighthearted humor while they perform their jobs is not at all counter to accomplishing this. Being uptight and easily offended probably are however. I don't mean that facitiously, but sincerely. People who take themselves too seriously tend to impair spontaneous input and reactions of their colleagues.

A recent article in Harvard Business Review profiled cardiothoracic surgery teams implementing new technology. The 'old school' surgeons who were stern and acting in a stereotypical dictatorial manner tended to be unapproachable to the OR support staff. It took those teams more than twice as long to learn the new techniques than it did for teams headed by young, open minded surgeons. Some of the most important trouble shooting resulted from the spontaneous input of the ancillary members. Because of the open environment, they felt free to offer their perspectives in ways which they noted that they never would have in a more typical OR atmosphere.

Who said anything about acting stern and dictatorial? Why are you attibuting opinions to me that I never wrote? I agree that the OR atmosphere should be lighthearted and friendly. I simply said I disagree that the OR is an appropriate place for raunchy sexual humor. Maybe at the bar later on, but not at work. Sex jokes in the OR just seem to make the person telling the joke look like an ass.

As for surgery not being about leadership and responsibility, wow! It blows my mind to hear a surgeon say that! Beneath the technical safe provision of care through a team working in concert, are fundamental elements of leadership and responsibility. Every team has a leader they look to when things go bad, like the patient bleeding out. To take on the job of cutting people is to assume enormous responsibility for one's actions. To deny that seems a bit out of touch with reality.

 

[womansurg]

Originally posted by powermd
Who said anything about acting stern and dictatorial? Why are you attibuting opinions to me that I never wrote?
...As for surgery not being about leadership and responsibility, wow!

Who said anything about surgery not being about leadership and responsibility? Why are you attributing opinions to me that I never wrote? I said that surgery is not ALL about leadership and responsibility (your words, actually). It's also about fostering a work environment that allows members to contribute to their full capabilities. If that means being relaxed enough to laugh at a dirty joke from my anesthesiologist without acting like I've got a poker stuck up my butt...well, works for me.

It's interesting that you don't object to humor, just to humor based on sexual content. Maybe your sexual humor is different than ours. Our jokes are good natured and not meant to target or hurt anyone. I don't see that restricting a group of consenting, approving adults who know each other well from including sexual subjects from their repertiore of jokes does much besides make everyone feel a little bit repressed. Of course, if anyone is uncomfortable with it, then you don't do it - that's just simple good manners for all occasions, as well as protection from misinterpretation from others.

If you come work in my OR, we'll keep it clean for you.

then we'll put in a request that you transfer to the ortho service...

 

[Skylizard]

Originally posted by chicagosurgres
While I would never condone behaving in a malignant manner I do have to say that sometimes one can be too nice...I was being paged way more often than anyone else because I was always so "nice and helpful"...Needless to say I finally realized there is such a thing as being stern but NOT malignant by challenging ridiculous late night pages and snapping a little at someone without totally yelling or going off...The point is that patient care comes first, but do not set yourself up for extra work by going out of your way to take on other people's work.

I would agree. I have seen residents try to play up to nursing and other staff. It creates tension amongst their peers as the ancillary staff start to say "why aren't you nice like XXX". They will start to call everyone thinking it's ok to call when ever they please. Remember it is a team effort and as one of the top-dogs in the pecking order you will actually set a great deal of the "tone" for how things should be run. Nursing turnover is also high. So you will in effect be training nurses to call you to ask stupid things. I have seen nurse call and ask "I am a new nurse, I was told you are really nice, I read this order and I just wanted to know if I should follow it?" You can imagine how you feel at 3am getting a call like this in reference to tylenol or colace etc... Remember there is nice and then there is doing someone elses job.

I do not think you necessarily need to "snap" or "go off" but you should make it very clear that you believe a call is inappropriate. Some nurses or other staff will try to throw out the "you chose this job" or "I am a patient advocate" line. In that occassion acknowledge you undertsand their concern and then discuss why you think it is inappropriate with the charge nurse. Invariably, I have never seen a Charge Nurse back this kind of stupidity. But, be polite when expressing your distress over certain "stupid calls". You can also use the patent high powered load of:

"I am really concerned and the reason I bring this to you is because I am concerned about the patients if our nursing staff is undable to execute written orders without a second verble order. I am also concerned that there may be a break down in communication between the nursing staff if this order was written at 8am and questions regarding its safety are not addressed until 3am"

Charge nurses do not like trying to defend against these kind of concerns. You will not need to be abrassive or sharp. The circumstance itself combined with this nice quote is usually extremely effective.