Maggie Mahar’s recent post, Surgeons and Other Physicians: A Cultural Divide, has prompted me to do something that I have never done before, defend my profession in writing.

The stories about abuse of medical students and nurses make it seem like the profession attracts only one type of personality, the tyrant.

I wrote in the comment field:

As a general surgeon, who trained at the Harvard Surgical Service affiliated with the New England Deaconess Hospital, I did not face the humiliation that others have decried.

My chairman, Bill McDermott embodied the gentleman surgeon and hired people who behaved respectfully toward their teams. I felt the same way at Roosevelt Hospital in NY where I did my surgical subinternship during medical school.

Caring for surgical patients with teams is a long and proud tradition that continues to this day, with surgeons thanking the nurses and anesthesiologist at the end of the procedure. 

I know that I will be drowned out by the voices of many others who feel that they have been abused. I do not deny that surgery has abusive people. I just wanted to say that my memories remain full of the camaraderie of taking care of patients under trying circumstances, such as multiple admissions, long nights and weekends, and dynamically changing physiology. 

For those convinced that there are two distinct camps of surgeons and cognitive physicians, please comment on my post, Collaborative Distinction.

 I think that part of the problem we face is that, until recently, we received no formal instruction in communication, negotiation, and conflict resolution; we merely emulated attending surgeons who were our clinical role models.  If we developed good communication skills, it was by parental supervision, a nurse taking us aside during training,  or serendipity.

The problem we face is that although we may outsource billing to office staff and some clinical care to nurses, we cannot outsource interpersonal communication. 

I was pleased to read a comment in Maggie’s post from a female general surgeon that highlighted the availability on which our profession prides itself:

I am a surgeon, a woman, and a human being. Your RANT is why I am unwilling to ‘come out ‘ in public with my profession away from the hospital. Sometimes I tell people at parties I am a gardener, so I can have a peaceful social evening. There are as many reasons to become a surgeon as any other profession.
I am lucky to work in a group (Kaiser Permanente) where my colleagues are people I deeply admire, doing very hard, necessary work to keep people alive.

Someday you or someone you love will need surgery. It is likely to be 2AM, you may be in excruciating pain and no other treatment will be effective. Remember, a third of people with appendicitis died a century ago. I or one of my colleagues will be there for you. Am I a bully? Is that what you want to call individuals strong enough to step up to this type of challenge? With the fortitude to hold life and death in our (nearly) bare hands? The integrity to do whatever it takes alone in an operating room to solve a problem? The commitment to put our personal lives aside at a moments notice for the endless emergencies. The strength to face a family when we come out of the operating room with bad news. Think about it. Could you do it?
Keep your heart and mind open.

What do you think?

• Do you believe, as I discussed in Collaborative Co-mentoring that we are not stupid and just need to be trained
• Will the recent JCAHO mandate to develop zero tolerance for intimidating and/or disruptive behaviors make a significant difference
• How will those physicians who have not received formal training in interpersonal communication train or outsource the training of our country’s future residents and medical students

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn