Disruptive behavior (September 2007)
Our predicament in the operating room (OR) reminds me of an analogy I heard many years ago about a chicken and a pig who wish to reward their farmer for taking such good care of them. "Let's make him breakfast," suggests the chicken, "perhaps some bacon and eggs." "Bacon and eggs!" exclaimed the pig. "You are offering a donation, but from me you want a commitment!"
Each time a surgeon takes responsibility for a patient in the OR, he makes just such a commitment. Infinitely more than any malpractice burden, it is the level of commitment wherein he lives and dies with the success and failure of each patient. While we work as a "team" in the OR, surgeons stand alone when facing a heartbroken family to answer not only for our own errors but also for the errors of others.
It is truly an insult to equate this commitment to the donation offered by the ancillary services in the OR. They do not, nor can they ever, understand the responsibility the surgeon takes upon himself with each case. When has any circulating nurse explained to a patient's family that he or she caused a procedure to be delayed because of opening the wrong instruments or because he or she was on break? How many OR administrators visit the wards to follow up on patients postoperatively? How many scrub nurses lay awake at night worrying about a patient's outcome?
Until the day comes when all members of the OR team carry the same burden as the surgeon, I reserve the right to express myself. If I demand bacon for my patients, it is because eggs just won't do.
Danny A. Sherwinter, MDVia e-mail
Our profession is sinking, and it seems that little that can be done to reverse the descent. Dr. Jaffe discusses contrived and fictitious reports, often unverified and undiscoverable, that are generated by unidentified sources and used by hospital administrators to enforce "corporate compliance." The shared goal of physicians and hospitals is purportedly excellent patient care, and we are supposedly symbiotic partners. Unfortunately, [hospital administrations are] strengthened by financial advantage, legal apathy and support, organizations such as JCAHO, state and national medical societies, and fellow physicians whose only allegiance is to their own advancement. Those individual physicians who sincerely attempt to fulfill their sworn oath are easy prey.
Individuals who feel they are being victimized unfairly should consider contacting the Semmelweis Society (www.semmelweis.org). The only alternative may be to move one's practice to another facility or community.
Craig Schaefer, MD Via e-mail
Your editorial was very insightful. The subject of "sham peer review" is well reviewed on Wikipedia at en.wikipedia.org/wiki/Sham_peer_review. This fascinating subject is an indicator of what has happened to medicine now that lawyers and politicos have replaced physicians in the mechanics of medicine.
Habermas Jurgen, MD Via e-mail
You really hit the nail on the head. A physician or surgeon is now presumed guilty until proven innocent after any accusation. Only the lawyers win, and the patients suffer. This philosophy holds true for the Texas Medical Board, where many good doctors are being found guilty or paying a fortune in legal fees to prove their innocence. This secret, negative approach must be stopped or it will ruin medicine.
Look at the socialistic countries; innovation will stop, and high quality medical care will disintegrate. We have already seen this in our clinic. It is extremely difficult to find people who strive for quality and will work hard enough to maintain it. We have several generations to re-educate in quality care and top flight medicine and surgery.
William J. Rea, MD Dallas, TX
As an example of why Dr. Jaffe stresses the importance of documenting claims of disruptive behavior, I will recount a Kafkaesque incident from a few years ago, when I was called before the Chairman of Surgery and the OR Nursing Director for an investigation into my disruptive behavior. After greeting my two grim-faced inquisitors and inquiring as to the nature of my disruptive behavior, I was told that I had used "obscene language" in the operating room (OR). This complaint originated from an anonymous "TIPS" report to the medical staff from an OR nurse. I asked for the specific obscenity alleged and was told that it was "the C-word." A quick mental search through my extensive vocabulary of salty language could match only one crude term, which referred to the female anatomy. Puzzled, I stated that, to the best of my knowledge, I had never used that particular C-word inside the OR and again asked for the specific word in question. The OR Director became flustered and would not speak the word. I then asked whether the anonymous complaint had specified the exact nature of the putative C-word, and she admitted that it did not but that it was "clear" what it must have been. I asked her to find the nurse who initiated the complaint and determine precisely which C-word I had used. The OR Director returned, red-faced, a few minutes later to inform me that the C-word in question was "crap." (Pardon my French.)
The meeting ended, and I hope that the allegation of obscene language and disruptive behavior was expunged from my personnel file. I certainly learned a valuable lesson regarding the importance of documenting disruptive behavior.
Frederic W. Grannis Jr., MD Duarte, CA