Why Are So Many Surgeons Assholes? - Pacific Standard

Why Are So Many Surgeons Assholes?

And how can we make them nicer?
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(Photo: cjmacer/Shutterstock)

(Photo: cjmacer/Shutterstock)

First and foremost: No, not all surgeons are assholes. There are plenty who are amazing and generous people. As is the case with any stereotype, there are exceptions to the "rule." This rule, in fact, isn't even that literal of a rule.

But.

While there are no scientific stats on just how many surgeons are assholes—imagine that survey—the reputation exists. A Google search for "why are surgeons assholes" currently spits back over 80,000 results, only a few of which are listings for proctologists. This nebulous intuition even checks out when speaking to those in the profession. Every single person I spoke to has a story (or a dozen) about being berated by a surgeon, paying witness to said verbal takedown, or overhearing surgeon-spewed inappropriate jokes laced with sexist overtones.

"What kind of pass was that?" the incredulous surgeon hollered. "What are we, two kids playing on the playground with Play-doh? Ridiculous!"

One friend-of-a-friend, a nurse—who, for obvious reasons, wished to stay anonymous—told me about a time she passed an instrument to her surgeon. The asshole in question, for whatever reason, didn't appreciate the maneuver.

"What kind of pass was that?" the incredulous surgeon hollered. "What are we, two kids playing on the playground with Play-doh? Ridiculous!" And then, to bold and italicize the point, he threw the instrument back at her. "I was horrified, and didn't know how to react, so I just kept quiet," says the anonymous nurse. "But no one ever stood up for me, no one ever reprimanded this surgeon for talking to me like that, or throwing an instrument."

"I learned real quick that surgeons get away with this behavior all the time."

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When I threw the "surgeons as assholes" query into the world, the auto-response was one of excuses. Surgeons are that way because it's a demanding job that doesn't always go right. Surgeons are that way because they literally have lives in their hands. Surgeons are that way because medical schooling gives them a God complex, purposefully putting them on a pedestal above the rest of society, so they can more easily lead the chaotic and bloody goings-on in the operating room.

"I don't think that's true," retorts one surgeon who, again, asked to be kept anonymous. (He did allow me to say he works in pediatric orthopedics which, after noting his own bias, he claims tends to draw fewer asshole than other specialties.) "What you're told is that you're the captain of the ship. From the time that patient enters the operating room, you're in charge."

While ship captains can, and probably should, be demanding, there is no formula for how to lead. If someone's slacking at their job, it's certainly the captain's duty to inform them how to properly act. If the slacker doesn’t take instruction properly, then it's the leader's responsibility to either get them to do so, or nudge them in the direction of a different career. Nowhere is it instructed to throw equipment at a team member.

"There are people who decide to lead by fear," the surgeon says. "But there's no reason for it."

Another possible reason/excuse for the rep is the brewing culture clash between old-school surgeons (and medicine in general) and current social norms. For most of our society's history, surgery and medicine has been a boys' club. It wasn't until the 1970s that women were welcomed as doctors—due, in part, to legislation like Title IX, which banned medical schools from discriminating on grounds of gender. This means that surgeons taught during the male-dominated era still practice today. "Certain behaviors are allowed to persist," as the surgeon tells me.

There's a chicken-and-egg element to consider as well: Surgeons are assholes, or assholes are surgeons. The high-stress-and-adrenaline environment of surgery attracts a certain personality that perhaps isn't so great at interacting with other people. The profession's financial rewards also may lure a particularly frosty type. "You can track how well the economy's doing by how many people are going to med school," the surgeon says. "During the tech bubble, no one was going into med school. When the economy crashed, it became impossible to get into medical school. People go into it because it's a great living."

If your singular goal in any field is the accumulation of wealth, chances are other skills and focuses of that job—in the case of surgeons, we're talking about communication—are seen as secondary, or a means to the end of making money. (I can't imagine, for example, that wealth managers are great communicators and then decide that they want to start handling money, as much as they need to hone the communication skill to effectively handle money.) But surgeons who are bad communicators? They're often deemed "successful" by the health industry, regardless of their ability to communicate with patients. There is, in other words, no incentive to be nice.

Surgeons who are bad communicators are often deemed "successful" by the health industry, regardless of their ability to communicate with patients. There is, in other words, no incentive to be nice.

Another possibility at play: the inherent competition of medical school. It's tough to get in, and that atmosphere breeds a callused personality. "The more competitive the field, the more likely you are to get that personality," the surgeon explains. "A lot of people feel they have to step over their own grandmother [to get in]."

As an example, the surgeon mentions Duke University's infamous doctor divorce rate. A story persists of a (now-former) head of Duke Medical School claiming that their residents have an over "100 percent divorce rate." That is, students showed up married, got divorced, got re-married, and then divorced a second time. The reason being that they were over-worked and lived a life where work came first, everything else a distant second. And that claim was made as a boast to prospective students.

The person who reads that kind of story as I-don't-care-what-it-takes-to-get-the-job-done is, perhaps, not the type of person you'd want dictating the care you receive. "Maybe that personality grows into an asshole," adds the surgeon. "Well, probably he or she already is one."

But the question persists: Are asshole surgeons better at their jobs than non-asshole surgeons? At the end of the day, the most important thing is the well-being of the patient, and if for some reason this dictatorial atmosphere achieves that goal, then maybe it's worth it.

Of course, this isn't the case at all.

"When the surgeon is a total d[ick], it makes the room tense and toxic," says the anonymous nurse. "It's hard to breath because you're just waiting for them to yell."

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At the turn of the millennium, the Institute of Medicine released a pair of companion reports. The first, 1999's "To Err Is Human," announced a problem: Between 44,000 and 98,000 people die in hospitals every year due to preventable medical errors. If the deaths themselves weren't bad enough to garner attention, also at stake was the medical industry's bottom line:

They have been estimated to results in total costs (including the expense of additional care necessitated by the errors, lost income and household productivity, and disability) of between $17 billion and $29 billion per year in hospitals nationwide.

The second report, 2001's "Crossing the Quality Chasm" tried to solve the issue by broadly changing the environment of medical care. Among other things, this meant shifting from a top-down dictatorial approach to a team-centered dynamic.

"In the past, medical knowledge reigned as the most important thing, and the other aspects of the skills they needed were left as more implicit or devalued," says Susan Masters, the associate dean for curriculum at the University of California-San Francisco. "But it's more and more evident that the hero Marcus Welby physician is not going to be able to solve the problems. The health-care team has to work together."

This new focus manifests itself in a variety of ways: The first is by tweaking the way school is taught. At UCSF this means a shift from a lecture-heavy curriculum, where students sit silently and listen, to more group exercises, where they not only have a participatory role in class, but also learn how to work in teams.

"Being an asshole is much more common in the older rank and file than it is in the younger. Like most problems in this country, things are going to get a lot better as that generation dies off."

There's also a focus on teaching students how to interact with patients, best exemplified by the Professional Patient program, a national exam where students interact with actors pretending to be patients. Students are graded not only on whether or not they correctly diagnosis the faux patient, but also how well they interacted with them. "We videotape the students, the patient gives the student feedback about the care they received, if they asked the right questions, washed their hand," Masters explains. "There's always a personal satisfaction question: 'Will you see this person again?'"

(Mount Sinai Hospital, in New York, took an entirely different approach by being one of the first—if not the first—to recognize the importance of personalities in addition to medical knowledge. In 1987, it made the decision to accept students without the usual scientific pre-med requirements, as long as they studied humanities or social sciences. A 2010 study into the program found that humanities-first students at Mount Sinai had an academic performance equivalent to the standard medical student track.)

All that said, whatever's taught in school doesn't always stick around after graduation. "In the classroom, things are much more controllable and we're able to teach students in a consistent way," Masters says. But when students end up in the real clinical environments, "some of the work done is undone in terms of role models. There are people who have trained in a different era and believe different things."

And while systems are in place—now more than ever—to allow nurses and students to speak up if they're being mistreated, there's still a long way to go. The stories and anecdotes I collected were from a wide-range of medical professionals, from the newly retired who have been working for decades to current students. But despite the timespan, the similarity between the stories is disheartening. Regardless of whatever attempts schools might make to tourniquet this behavior, the only real solution may be to simply watch that clock tick, tick, tick away.

"[Being an asshole] is much more common in the older rank and file than it is in the younger," the anonymous surgeon says. "Like most problems in this country, things are going to get a lot better as that generation dies off."

The Sociological Imagination is a regular Pacific Standard column exploring the bizarre side of the everyday encounters and behaviors that society rarely questions.

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