Tuesday, January 11, 2005

The Naked Monarch....
The Mad House Madman has put forth an excellent series of posts about his conflict concerning the decline of a giant. His story brought back memories from residency when I (and others) were put in a similar position, the position of keeping the attendings out of trouble.
The trouble was not so much due to senility, as the hospital where I trained would require surgeons to hang up the scalpel at age 65. The trouble we would need to be on the lookout for was due to incompetence and buffoonery.
There were always private attendings who would only perform high-risk surgeries on sick patients at the University Hospital while doing the bread-and-butter outpatient stuff at the community hospital. That was OK as far as I was concerned, the medical care of the very sick is what the University Hospital was for.
A less palatable situation was the CV surgeon who was such an ass that none of the others in his section or their PA's would scrub with him. So a resident, sometimes even a PGY 4 would hold hook for this guy while he insulted them the whole case.
There was the oft-sued specialist surgeon who was on-and-off of double-secret probation for a wide variety of offenses. His wife was a powerful physician at the University hospital who would throw her weight around to keep him on staff. He would perform operations he had no business doing and demand a resident scrub with him. The upper levels would conveniently find something else to do and the hapless intern would find himself in a very uncomfortable situation. After a few months of his latest return to staff we approached our chairman and program director with our concerns. We had short, medium, and long-term concerns.
Short-term was the immediate risk to the patient, medium-term was the discomfort of a M&M presentation (under the rules one could not say "That clown who had no business in the operating room wouldn't listen to me!!"), and long-term was the lawsuit that would follow you around for time immemorial. We told them that we as residents could do little about the first but we could do something about the last. With the support of one of the attendings we took the bold move of telling our chairman the we respectfully refused to scrub with this surgeon again. Our gamble paid off and we avoided both termination as well as avoided participating in his cases.
He later was removed from the staff for more of the same.
Looking back it amazes me that the faculty and hospital would go to such lengths to protect such an incompetent surgeon. They would even go so far as to question our motivation and competence.
Physicians tend to bend over backwards to protect another from the consequences of their actions. We would "cover up" problems with drugs and alcohol, affairs, and issues of competence. Why? It was easy to sweep it under the rug, and mostly, no harm was done. Other physicians, both attending and housestaff, would make sure things were OK.
But the rules changed.
Physicians realize that no one gains from such "enabling" behavior. The patients continue to suffer, the impaired physician does not get the help they need, and the rest of the physicians run the risk of suit as well as increased premiums for themselves.
The "enablers" realize that the cost of their duplicity is too high.
So the tolerance for such behaviors is much less, but pointing them out is no easier.
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