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

Do you have a reasoned, sensible and rational response rather than the snide dismissal? One that addresses my points? Can you actually make a rational defence of the current management system in the NHS? (In contrast to some other countries where people are promoted based on merit and qualifications and new ideas and a deep understanding of the complexities of modern healthcare and surgeons' role in them?)

Hah bless you. You not only assume management is a glorified admin job you don't even understand that its a highly skilled job in its own right and that you would retain better managers if you worked with them. Do you not see why patronising and arrogant assumptions make you less effective overall? Less able to contribute to the big picture which is not actually about you - its about effective patient care and outcomes.

My senior managers who have dealt with much of the daily pain could write books on issues in NHS structure and organisation. The cultural resistance to any change, learning from outside, even from another NHS fiefdom regarded as heresy. Dear gods you still work on paper records in most places. This is all often against the wishes of the wider medical staff (or more accurately, those lower down in the hierarchy).

The hierarchical and patriarchal structures create too much deference and a reluctance to rock a boat - too much at risk for the individual. Its a massive weakness in the overall structures.

I've met many good, capable managers who have quit the NHS in frustration because of that resistance to change - good managers don't stay where they cannot be effective. Senior staff get the managers they deserve so if you don't like them one place to look is in the mirror.

Your arrogant dismissal of management skills as jumped up electricians, or fruit and veg salespeople says a lot about your attitudes to anyone with different expertise. I employ expert senior managers because then mine and the rest of my specialists' time can be expended on what we do best. They are highly skilled, freeing us up to focus on what I do. I listen to them and don't always agree with them but we work together for overall better results because we all have a respect for each other.

Your inability to recognise the skills of others or consider that in their area they have more expertise will limit your own potential - the sad thing is that will limit what you can do for your patients and you will probably never even realise it.

And remember surgeons have a very strong inbuilt bullshit detector, so please don't come out with management-speak because that we hear it everyday and roll our eyes every time

You tell yourself that hun. In my field bullshit detection is a core survival skill. Its amazing how often it comes in the same shape and form, irrespective of subject domain .

We have a visitor this week relative a renowned surgeon. Discussed this thread with her. She laughed and said that the relative is amongst her extended family a psycho. But bloody good at their job. They're also an amazing host as long as no-one interferes

Used to be a nurse ..once watched a terminal patient discuss his case with the consultant.. Patient digested bad news and then said very loudly.."well Ive had bad news delivered with more sensitivity and compassion by a Quik Fit Fitter...you need to hire an actor to deliver the news and stick to the operations mate "
How right he was.

Medical secretary here for last 43 years (one of the "old school" ones that one of OP's consultant remembers fondly). Yes, lots of consultants (surgeons and physicians) are arrogant but you don't have to take any rudeness from anybody. Anyone chucking notes around in my days in the NHS or even now, when I work in private practice, would have got very short shrift from me. I don't understand why people don't challenge them. I worked for lots of doctors and liked most of them. We worked as a team and in those days in the NHS we secretaries were allowed to use our initiative so were able to be a valuable member of that team. I always found that newly qualified junior doctors were some of the most arrogant (with admin staff at least). They were always quite surprised when they discovered I was treated as an equal by the rest of the team. I can remember one junior doctor being AMAZED that I had an A-level in Zoology ("Why are you doing this? You could have done medicine" - no, I couldn't with one A-level and I didn't want to and my job is nothing to be ashamed of). After a bit, they settled down and were OK.

I would quite like to know what speciality OP's surgeons are in (?Orthopaedic, perhaps?) - she might have said but haven't RTFT (shameful) and need to get back to work (at home).

PS. The doctors I work for generally ask me if I'd like them to make me a cup of tea/coffee rather than the other way round.

I always found that newly qualified junior doctors were some of the most arrogant (with admin staff at least). They were always quite surprised when they discovered I was treated as an equal by the rest of the team.

This ^^

With bells on.

I spent a couple of years in Oxford so all the junior Drs are Oxford grads.

They have always been the cleverest at school and the cleverest at uni and they do a second degree alongside medicine.

They are not used to being on the lowest rung of the ladder.

I once bleeped a house officer to attend a stress test, he said he was busy and would get there when he could so I bleeped the SHO.

The consultant answered as the SHO was on a course and carrying his bleep so he came down for the stress test.

The look on the face of the HO when he arrived well into the test with his consultant taking the BP was priceless.

Arrogant junior Drs who try to lord it over nurses do so at their peril. Arrogant Drs often get bleeped at 3.00 or 4.00 am because a patient needs pain relief and the nurse can't give it without it being 'written up'.

Nice junior Drs are quietly reminded before they leave the ward that patients X Y and Z might need pain relief so would they mind writing them up? That way they won't need to call you in the middle of the night.

On the subject of Junior Doctors - my friend (who has always been the lovely sort - spent all night with a dying man who had no family near him when she was a student - still a lovely consultant now) did feel pushed around quite a bit by the nurses - from the junior doctors perspective there is a power struggle (mind you I saw that power struggle played out first hand with the midwives and the obstetricians too)...I remember one Ward Sister telling my friend that her DM boots were not appropriate footwear for a Doctor - I think that was the final nail in the coffin and that Ward Sister got told very sharply that what my friend wore was her own business and if she wasn't happy with that - she was welcome to speak to the consultant. She had no more bossy nurses trying to push her around after that!

I once bleeped a house officer to attend a stress test, he said he was busy and would get there when he could so I bleeped the SHO

So they were busy doing their job probably looking after a sick patient, said they would get there as soon as they could (for an elective procedure) and you feel that is arrogant?

@sashh why would you do that? Why would you purposefully bleep at 4am if you know there's no pain relief? Its such a dickhead thing to do, how would you feel if doctors purposefully tried to inconvenience nurses like that. At the end of the day there's a patient who needs pain relief, the junior doctor could easily be busy at the planned bleep time and the patient ends up with no pain relief. Patients aren't weapons to be used to antagonise junior staff.

And the HO was busy. They were likely dealing with another patient who is more acutely unwell and they were perfectly right, they would get there when they can. Just as nurses often have many tasks to complete before they get to yours so do junior doctors.

I was working for 8 surgeons last night.

1. Wanker
2. Wanker
3. Absolutely lovely I hadn’t a break and he bought me a slice of cake
4. Gentle giant (once saw him lift a older woman from the floor like a baby) Universally adored.
5. Very intense (and slightly demanding) but really care for his patients.
6. Female one. Absolute grafter. V.polite.
7. Softly spoken Asian doctor (hides from the nurses but patients love him).
8. Aggressive arsehole who shouts in nurses faces.

My point is they’re all different, some good ones, some excellent ones and some you wouldn’t piss on if they were on fire.

Nice junior Drs are quietly reminded before they leave the ward that patients X Y and Z might need pain relief so would they mind writing them up? That way they won't need to call you in the middle of the night.

Why on earth wouldn't you try to quietly remind all junior Drs of this? (althoughI get that you may have tried it and got a mouthful) Doesn't seem fair on the patients, for one thing.

Feasabily the reason the consultant came to do the stress test is because he knew his juniors were very busy. The HO clearly didn't leave it too long to attend to the patient given they turned up midway through.

There are junior doctors who are arrogant, but in my experience most of them are actually just a bit scared. Its a steep learning curve, and they will soon get over themselves. And at the end of the day they have worked incredibly hard to get there, and are skilled and knowledgeable even if they are junior. People treating juniors like they are bottom rung and insignificant is part of what leads to arrogant consultants! Yes of course all patients should have pain relief written up but I don't see why you wouldn't help someone who's learning. I would never treat a nurse like that, even if they were rude to me (and they have been - everyone's under pressure)

agree with Nutterfly.

Also with Silvery - you can totally see why put-upon staff would take their revenge any way they can but it must make working life miserable.

@TwoYearsSince that’s what working in the NHS drives you to. Rather than working as a team everyone is so exhausted they not pick at other departments for not working hard enough.

The NHS always feels like they operation on the edge of bullying and resentment while being told to care...but not really feeling it.
Someone recently told me of a surgeon they knew who had a miscarriage and while they were in hospital it occurred to them for the first time that patients just wanted someone to be nice to them.

"operate on the edge" - sorry! And no pun intended with the "operate" thing either!

So they were busy doing their job probably looking after a sick patient, said they would get there as soon as they could (for an elective procedure) and you feel that is arrogant?

Yes.

That was a scheduled part of the job, there are times Drs are supposed to be in certain places whether that is for a test, in theatre or in clinic. It applies to all Drs from the most junior to the most senior just as it does to other staff.

Why on earth wouldn't you try to quietly remind all junior Drs of this? (althoughI get that you may have tried it and got a mouthful) Doesn't seem fair on the patients, for one thing.

I'm not a nurse and never have been a nurse. It isn't part of a nurses job to tell Drs what their job is, they should be working as part of a team,

Another NHS bashing thread.

" @TwoYearsSince that’s what working in the NHS drives you to. Rather than working as a team everyone is so exhausted they not pick at other departments for not working hard enough."

I can totally imagine it. I have seen a miniature version of it in a school. When people are not empowered to say yes, they can only empower themselves by saying no.......

I don't think the criticisms of either the OP or the doctors sometimes being nobs are fair really. If you set up a system like this, everyone will behave like this unless they are fortunately enough to be in an "island of sanity".

V interesting anecdata.
Even though I have dealt with twatty surgeons, I’ll never forget my very highly regarded and gorgeous obstetrician (both inside and out) who delivered my boy. I lost my first child and got pregnant 2 years later. The ob. showed me so much kindness and care throughout. He flew into London from a conference the night before my c-section to deliver DS and asked his close friend anesthetist to be there for the delivery. He told me how beautiful my boy was - I said all babies were and he replied by saying they were not . I have tears writing this. He had so much humanity.

Anaesthetist here.

My first thought reading the OP is that there has been a tonne of bad management of this little group of surgeons over the years which has probably contributed to this situation.

I also don't think OP understands consultant job planning. If I were being asked to change my jobplan in a way that I didn't want to by someone who didn't seem to understand the rules I would also refuse. Job planning should be by mutual agreement.

There are other indicators of issues - where I work the senior surgeons led by example during Covid they helped on ICU during the pandemic - turning teams, doing obs etc. They readily adapted to online consultations, they rationalised and re-rationalised their waiting lists multiple times to prioritise the patients who stood to lose the most be being delayed. The fact that this didn't happen suggest that there are significant culture issues in that hospital. Tackling this will be a huge job.

There was lots of publicity in our insitutation about the ICU redeployments. Surgeons are pretty competitive and don't like to think that X specialty is doing better than theirs which definitely helped with engagement. Some senior colleagues acted down to free their juniors to go elsewhere (anaesthetics did this too) and one particular team of surgeons decided that as the anaesthetic consultants were now acting as registrars and insanely busy they were going to be our wellbeing support - they made sure that we got lunch / breaks etc which was hugely appreciated by me as I was apart of the theatre based anaesthesia cohort.

I know from my colleagues who redeployed to ICU that they redeployed surgeons there were also generally really lovely, helpful and humble. Ttypical quote from one of our registrars "I only realised on night 3 the person who was doing HCA nights was - it was Prof X. They are SO senior but were in there in full PPE doing basic jobs to free up nursing time and made me a cup of tea.

I am an established NHS consultant (9 years) - I work full time and don't earn 100k - people have some very funny ideas about NHS pay. I also don't have adequate desk space to do any non clinical work in the hospital (e.g on the day I do an MDT held over an online platform I essentially have to do so from home as I cannot find a quiet space with a functional PC in the hospital - and even if I do I need to take in my own headphones...) My workplace lacks other basic amenities that my colleagues who don't work in medicine are constantly amazed at. Friends who work in the city send me pictures of big communal spaces with stocked fridges and I fantasise especially when I'm trying to persuade the vending machine to sell me a twix and diet coke at 3am having been in theatre since 19:00 and having managed to miss dinner completely.

Sometimes these little things become really big e.g the office chairs.

"Sometimes these little things become really big e.g the office chairs."

A friend of mine manages patent attorneys in several different countries - highly paid highly trained staff.
On our last night out he told me he'd spent a day going round the shops in Geneva for the Swiss staff buying things like better pens (!) better science textbooks (for citations) - even paper - because those things were the top of the list of complaints. Once he had satisfied that need the other complaints faded.

I very much doubt the OP has that kind of liberty though :(

I think if the public understood these things we would be much more receptive to campaigns about resourcing doctors (different from the whole salary thing - not trying to get into that I promise)

@sashh

So they were busy doing their job probably looking after a sick patient, said they would get there as soon as they could (for an elective procedure) and you feel that is arrogant?

Yes.

That was a scheduled part of the job, there are times Drs are supposed to be in certain places whether that is for a test, in theatre or in clinic. It applies to all Drs from the most junior to the most senior just as it does to other staff.

Why on earth wouldn't you try to quietly remind all junior Drs of this? (althoughI get that you may have tried it and got a mouthful) Doesn't seem fair on the patients, for one thing.

I'm not a nurse and never have been a nurse. It isn't part of a nurses job to tell Drs what their job is, they should be working as part of a team,

The trouble is, @sashh, that while you may think that doctor is scheduled to be in your exercise test clinic, junior doctor rotas/job plans often don't acknowledge all these different demands. So they may be scheduled to attend a test clinic, but also expected to be seeing their patients on the ward, or helping in theatre. I used to have days when I was supposed to be seeing patients in a pre-op clinic, but also doing a ward round, and whichever place I wasn't in would be bleeping me repeatedly. They almost certainly were "doing their job" somewhere else, not sitting on their arse drinking coffee. I don't think their response is arrogant at all, just indicative of the multiple demands on their time.

It's very hard to tread the right line as a junior doctor - if you act too confident, you're "arrogant;" but if you're too hesitant, you don't know what you're doing, shouldn't be in the job, etc. You're constantly told to respect the nurses (/midwives/physios etc), they know more than you, they've been around longer than you and will be here long after you've gone, but then something happens and everyone is like "You're the doctor. You decide." For everyone bleeping you, their patient/job is their priority, and juggling all those demands means inevitably someone is going to be disappointed, and may pin your refusal to come immediately as arrogance or laziness. Soooo often nurses etc assume that you're not on their ward because you're in the mess/coffee shop, not realising that you're actually covering 4 other wards and A&E referrals, and so they speak to you more rudely than they otherwise might, and get a snappy response in return. Civility works both ways.

@MauveMavis That’s true about nhs facilities for staff being pretty poor.

My lawyer relatives car was a bit snug in her companies car park so they hired her a space in a very expensive car park each year and pay for it.

Me
Why on earth wouldn't you try to quietly remind all junior Drs of this? (althoughI get that you may have tried it and got a mouthful) Doesn't seem fair on the patients, for one thing.

sachh
"I'm not a nurse and never have been a nurse. It isn't part of a nurses job to tell Drs what their job is, they should be working as part of a team"

While this is true about nurses' jobs, the PP I quoted stated that they did give the heads up about night medication, but only to nice junior doctors.