Why are surgeons such arrogant arseholes

[KirtonandKim]

*not all of them

Seasoned manager of over 25 years. Brought in to manage a team of surgeons who have ridiculous retention of staff (they can’t). Managers, operational, PAs and juniors - they cannot retain anyone.

2 months in and I can see why. They are without a doubt the most arrogant group of people I’ve ever had the misfortune of trying to manage. I’ve managed “bad” teams before - but nothing like this. And it’s just shrugged and accepted as “what surgeons are like”.

They know they are untouchable - they know they have us over a barrel and we can’t sack them. But the constant moaning and bitching and whining and utter lack of any insight into their own behaviour is fucking flabbergasting

God I can’t face work tomorrow

@AColdDuncanGoodhew

I'm surprised at the Orthopaedic reg complaining up thread. When I scrubbed (NHS), we were taught to anticipate every instrument, suture etc and I'd always aim to get through each operation without the surgeon asking for a single instrument. Maybe there's a big turnover of staff in orthopaedic theatres?

Agree with this. When I scrubbed I made it my mission to have everything ready and be ready for any eventuality, good scrub nurses shouldn’t need to be asked for things constantly, same with good circulating staff and anaesthetic nurses. When I trained i’d do a full list in whatever speciality I was in, four hips or ten cataracts or three lap choles, whatever it was i’d put my name down for them all. However now I see brand new nurses standing back and having to be asked to scrub for a case, then it’s all excuses “oh i’ve never scrubbed for them before” “oh I haven’t done this procedure for months”

Just get to the table and learn! Read up on the procedure, double scrub, stand and watch instead of sitting talking about the weekend. Infuriates me. I left theatre for a few years due to family and now i’ve gone back, albeit to a new speciality (and in only anaesthetics rather than scrub and anaesthetics) i’ve seen such a change in the nurses coming through the door now. I’m only qualified 12 years too, not like i’m 30 years in and reminiscing on the training of days gone by. I can see why it’s annoying standing at the table having to ask for every single thing as I see it daily and it boils my piss

I read the same thread on the same forum and could very much identify with it. We have some stalwarts who have been in our trust for decades who know where everything is and how everything works. But for a variety of reasons (Brexit, ridiculous local house prices and crap transport, better offers elsewhere, Covid redeployment...) there is high staff turnover in the junior scrub/anaesthetic nursing/ODP staff. So there just isn't the familiarity with kit or surgeon's/anaesthetists' preferences. And I can see how it would get wearing to have to explain every single step to someone new each time. Simple things like - if you've got the diathermy out, why not make sure it's plugged in and the pedal is accessible to the surgeon before handing the thing to them? I was doing an ENT list not long ago and my anaesthetic nurse didn't know what a particular type of tube I wanted was - fortunately all resolved before the patient arrived but it's the sort of thing that is usually common knowledge in a good ODP (the sort of thing where they'd say "would you like an x tube?" before you even ask about it).

No excuse for incivility though.

@Annietheacrobat why not? She's not using her own name or said enough to identify her hospital as far as I can see. We can all come on MN to anonymously moan about our dickish employers - NHS isn't sacrosanct.

And @darasda, people here on this thread who DON'T work in the NHS know exactly what you meant about "people like this manager." There are incompetent bureaucrats in any sector (not that the OP seems like one in my view) so we don't need your mansplaining for so called balance. On the other hand we've also worked with people like you too, unfortunately.

Saying "I call a spade a spade" is code for "I can be rude and dickish and if challenged say I was just being direct and it's your problem if you can't handle it". Nope, just rude and yes, it is disrespectful. And about as convincing as telling a woman she has no sense of humour whilst 'jokingly' being a misogynistic twat (this is a very 'oestrous' environment - really?!).

@darasda

Not sure I was being disrespectful, I certainly don't mean to be.

This is the thing about some surgeons. They tend to call a spade a spade and be fairly direct and some people don't like to hear it. It doesn't mean it's disrespectful.

People here on this thread who work in the NHS know exactly what I mean about people like this manager. And I must admit her post(s) did rather piss me off so I thought people outside the NHS need to hear some balance.

I do recognise this manager type. I know who the hospital could do without if we had to remove one person and vast majority of times it wouldn’t be a surgeon.

I've definitely met surgeons like OP describes. I've also met the managers daradsa describes. They all exist in the NHS!
Arrogance is not necessary to be a good surgeon but confidence in your own abilities is, as is good decision masking. Empathy and a great bedside manner is a bonus in a surgeon but not necessary. For me, a great surgeon is not arrogant as this implies an unwillingness to listen and learn and would worry me.

Absolutely this. If I had to have an operation I would want a super confident surgeon, not one full of self doubt. I appreciate its hard for you to work with/manage them but it's a job where a certain type of personality is needed

Lots of people saying things along these lines on this thread. But I would not want a surgeon whose behaviour was so infamously bad (and excused) that the other people in theatre did not feel able to raise concerns or escalate if they could see something going wrong. This is basic patient safety stuff.

I have been good friends with a surgeon since university days and I can’t tell you how many times social plans have been disrupted, or he’s too tired or preoccupied to properly enjoy his day off with us. His life seems more balanced these days but on a few occasions he would arrive looking grey with exhaustion after dealing with a complex case for hours. Different specialities no doubt bring different pressures, but from my limited experience surgeons work really hard and usually have sacrificed a lot. By all means be assertive, but as a manager also try to put yourself in their shoes.

@KirtonandKim

Surgeon 2 is wrong - I was bounced between Oz and UK schools my whole education. The Oz schools were always way ahead of the UK ones at the same Grade level. I was able to skip 2 years at secondary school in the UK thanks to that.

Sorry - that should be No 1, not 2! (even though he is talking No 2)

@MontagueLeo

Consultant surgeons are the products of a prolonged and arduous selection process that rewards sharp-elbowed competitiveness above almost all other traits. People who make it through this selection process are often not intrinsically well-suited to the give and take of long term professional relationships.

Surgeons are in the unfortunate position of being held personally accountable for their patients’ outcomes, yet having to work in a progressively deteriorating NHS environment over which they perceive they have ever less control. There can be considerable resentment when managers try and impose their own priorities but are not perceived to have the same level of accountability for outcomes that they do.

Surgeons carry enormous responsibility, and have many responsibilities which they will be unwilling or unable to delegate. There is a social pressure to appear supremely confident but many surgeons are intrinsically very stressed and anxious people, and this can find outlets in perceived bad behaviour.

Most surgeons have made enormous personal sacrifices to get where they are in their careers - their working patterns were much more easily supported in the days when surgeons were men and either remained bachelors or their wives stayed at home and managed the domestic sphere. Everyone has struggled to balance work and life pressures over the last year and it is probably that the OP’s surgeons will not have been immune to this.

As a result of this combination of personalities and pressures, dysfunctional working relationships, feeling hard done-by co-workers, and spectacular bust-ups are not all that uncommon in surgical specialties. The OP’s unit does sound perhaps at the far end of the spectrum, and I wonder if it is more than can be more than reasonably expected for one person to turn this toxic mess around. There will be many sides to this tale of woe.

Perhaps the Trust is going to have to invest in the involvement of mediators and psychologists to find a productive and amicable way forward?

DOI: anaesthetist

Absolutely this! I am a medic and I admire anaesthetists hugely - they are the most skilled in theatre and usually the nicest person as well. When patients ask me is so and so a good surgeon I have sometimes replied that so and so is fine but it is really the person at the top end you need to appreciate. I don’t work on the UK - in the Southern Hemisphere there are increasing women surgeons and as a result I think the culture is slowly changing.

I work in the medical field and have sat in on surgery several times. One particular time I remember sitting in on a triple heart bypass and valve replacement. I remember leaving the theatre thinking they were actual gods and the admiration I have for them is reflective..

However, they absolutely are extremely arrogant. The surgeon that I was sitting in on was playing ‘AWOL nation sail’ on the iPod really bloody loud while operating and the anaesthetist asked the theatre nurse to turn it down which she did, surgeon then pipes up and tells her to turn it back up, gets his own way after a bit of a tantrum and the very rational anaesthetist slunk back in his chair probably thinking you utter wa*ker. Surgeon gave no shits and carried on. This is just one example. I have many more.

Honestly, I think a lot of their ego is earned but yes, they do not have to be quite so obvious and cause other people annoyance at the same time.

@KirtonandKim DH is an A&E consultant. He says the same has happened in his hospital with surgeons doing barely anything during the pandemic.

Was hard enough to get surgeons and orthopaedics down to the ER before pandemic even worse during it. Think there is a lot of resentment among his colleagues. Exposed to Covid with sh** PPE from the beginning and now absolutely overrun with the number of people attending A&E.

Have listened to many conversations in the middle of the night when my DH has had to call the on-call surgeon or ortho to tell them yes they do need to go and see a patient when they have refused to go for a more junior colleague. Incidentally Orthos hate their sleep being disturbed the most! Incidentally I often hear my DH say to whoever wakes him in the night that they are welcome to call him whenever they like, that that is what he is there for. He would rather be woken for a trivial question than risk someone's life.

I had an unfortunate run in with an arrogant arse of a Gynae Consultant. He operated on my Ectopic Pregnancy several years back. When he came to see me on his rounds in front of his team he asked me why I was crying as it wasn't a baby. Complained about him and discharged myself as I didn't want to see him again.

I will also add, after reading the above post, I absolutely agree that most anaesthetists are the nicest people and probably are the ones that put the patient at most ease as well.

I was also unaware of just how bloody skilled they are. They are absolutely amazing and I put them on par with a surgeon. The anaesthetist is who is going to save your life if things start going wrong in surgery.

I'm a PA to an orthopaedic and a colorectal surgeon in the private sector and many others over the last 30 years, medical consultants and surgeons, and the only twattish behaviour I've come across was from a cardiologist! When I worked in a GP surgery on the otherhand.. They weren't easy!

Mine pointed at me, clicked his fingers and said ' lose some weight'.

He did me a massive favour as ive now lost 6 stone....... Fortunately im pretty thick skinned and not offended by the word fat. I was fat and that was my responsibility to change....... Im guessing not many were offended by his blunt approach as he's at least 60 and I doubt I'm the only fatty he's got his hands on.

I was a trainee ODP, and dealt with surgeons like these all the time. Actually, most theatre staff were similar. qualified ODPs were bullies to trainees.

I know a lovely surgeon actually.

I know quite a lot of doctors including surgeons (I don't work in patient care, but my work puts me in contact with many doctors).

Not all of them are terrible but there is a very real cultural issue in many training programmes. Arrogant people run them, pick people in that mould, and train them to be the same. I'm in the USA now (this is not just an NHS problem) and some of the residencies have made real efforts to change this as the sexism and racism have been recognised as real problems for patient care. Surgery is the longest residency and then there are sub-specialty fellowships--the surgeons regard themselves as the top of the crop. It's also still the most male-dominated speciality and

They are paid better here--the best paid specialties in the USA are all surgical as the payment system values procedures over time. The best paid are plastics (including cosmetic surgery) and orthopedics.

I know two breast surgeons and both said their fellowships drilled it into them how important sensitivity was in their line of work.

Rheumatology is a difficult field because there's a great deal of sexism baked right into the history of it. Of course, not all rheumatologists are terrible, but when they are, it's often in certain predictable ways; they dismiss their patients' pain and symptoms.

Just remind them that they are public servants,

My father is a consultant surgeon (and full clinical professor) in one of the surgical specialties with the worst reputation. He pretty much embodies it: his entire life has been one of privilege and entitlement. Yes, he has worked hard in his career, but he has zero concept of the fact that he is in his position of power and prestige because of a combination of luck, the patriarchy, old boys clubs, etc. He has no tolerance for women in surgery, is sexist, racist, homophobic, fattist, and generally intolerant to anyone who isn't a nice rich (thin!) white person. He earns well into seven figures annually and didn't lift a finger to do anything Covid-related. He embodies the old school of surgeons, and I fucking hope things improve with the changing of the guard.

I had the misfortune to be head-hunted by and accept a job with an association that represented physicians.

Don't get me wrong, they work hard for their education and have a lot of responsibility. But never in my career have I listened to more whining and complaining. It was endless. Not enough pay. Have to be on call. It went on and on. I could not get off the phone.

I lasted only a few months.

I used to work with a load and that’s exactly what they are like. We had a joke ‘What’s the difference between God and a Surgeon? God doesn’t think he’s a Surgeon’.

LOL there was one quoted in the local paper who said he was, "the closest thing to God in Oxford"

OP

Psychopaths' make good surgeons.

Surgeons often have no bedside manner.

So the 'nice' Drs go on to specialise in things where they need to engage with people.

Ouch44

A and E staff are often wonderful, I remember one interacting with an absolute arsehole patient, he was so kind and understanding and even said, "my shift ends in 5 mins, would you like me to drive you home?"

I've also met loads of nice cardiologists and physicians.

One general physician was Scottish and lovely, his house officer (most junior in old speak) was convinced we were winding him up when we told him he would be doing an Xmas day ward round.

But we were not, this consultant would dress in his full kilt and sporran, shoes, socks - Scottish MNers I don't know if there is a proper name for the entire ensemble. And then he would visit every one of his patients.

He did used to grumble that the Xmas meal was portioned because when he was younger he got to slice the turkey on the ward.

@darasda I call a spade a spade as well and as I am old and have choices I do not take shit from anyone in the NHS. Least of all from the orthopaedic surgeon who extended a hand and said come in and nice to meet you Cressida, I am Mr Glenlivet. "Well I'm awfully pleased to meet you Mr Glenlivet, I happen to be Mrs Hellebores". "Ooh er, do call me John - blushing slightly", "That's fine Mr Glenlivet, Mrs Hellebores will do".

I think my ire arises more from wishing to see equality stamped through the NHS as Brighton is through a stick of rock but I suppose you'd blame my ire on oestrus rather than a desire to be treated as your equal?

Whilst I do see your point and from a patient perspective have had far fewer communication problems with surgeons than with nursing staff, I still think there are huge structural issues with the NHS that is no longer fit for purpose.

In no other organisation could staff get away with continually whingeing about their employer to their clients.

I recall my last consultation with a surgeon - awfully nice chap who was also a Professor. We had a really interesting chat about research time, publications and the Research Excellence Framework. And when she took my bloods his nurse/chaperone wittered on about the colour of my shoes........................... Strange how he behaved as though I was his equal yet the nurse behaved as though I was a brainless numpty.

One of my closest friends is married to a surgeon and he is really nice. He has avery stressful job and has operated on a few high profile patients. However, I had to help him out as our children had swimming lessons together and his wife was busy. He really struggled getting two kids dry and changed.

@KirtonandKim,

Based on my acquaintance who is a medium senior NHS manager, I agree with PP who described managers as seeing medical personnel as line workers in a factory and medical patients as the product.

You moan above about a surgeon not doing what you tell him for his £100k. This shows a staggering lack of insight. He has trained for decades and his university colleagues with the same degree of education are earning 2-3x more as bankers or consultants (or even super senior NHS managers). He or she is in it as a vocation and to save lives, not for the (relatively) small salary from the NHS.

Now, on the other hand, what are your qualifications, what are you paid and what is your motivation to work?

A stressful day for a surgeon is a patient bleeding out on the table. A stressful day for you is being shouted at by a stroppy and stressed surgeon.

I suggest you think about the replies on here and reflect how you could be grateful for your overpaid, secure job and show more empathy and compassion to those you ‘manage’.

I have met a lot of awful surgeons though. I had an operation two years ago and I wanted to know more details about it (literally a 2 minute chat) and he said he didn't have time. Then he told me he would tell me on the day of the surgery. The day came and he said he didn't have time to tell me. I said I wasn't prepared to go ahead and he said I was wasting his time. I said I had been very clear and he had wasted my time! In the end a nurse managed to convince him to answer the very simple questiin I had but he was just awful.The operation went ok but, like a pp said, someone like that who doesn't listen to others who express concerns are ultimately dangerous.