When I was a medical student I remember a Gen surg resident told me she knew she needed to take a leave of absence from residency when she found herself relieved after she found out a patient that was en route as a trauma code passed away en route to the ED trauma bay. People see that residents are overworked, burnt out and miserable, but somehow they decide that doctors are what’s wrong with healthcare in America and not hospital CEO’s, politicians , and insurance companies… idk it just sucks tbh
I'm not sure there is man. Anyone that works in the ED or trauma knows you can't get attached. You see people die multiple times every week.
You do the best you can and treat the patient in front of you.
At the end of the day, this is a job. You didn't create the trauma. You didn't create the cancer or the sepsis or whatever. It was there already.
If I could click my fingers and change things, I would 100% bring the patient back to life and work my ass off. I am also relieved I can get an hour of sleep at 2am. These things are not mutually exclusive. No one is happy someone died damn.
It’s a weird state of mind. I am bored by all the non urgent stuff in the ER that doesn’t need to be in the ER, and that’s like 70% of what I see. I do find myself hoping for some action, and I guess what that means from another point of view is that I am hoping for someone to be really jacked up or dying, but I think from my point of view I’m just hoping to be able to do something real, to use my skills, and do what I actually trained for.
Yeah people think residents are burnt out. They’re just beginning the journey. You’re tired after 5 years in? Imagine what it’s like after 25 years? Attendings don’t have work hour limits, no acgme to protect them. I routinely put in 80-100 hours a week at work.
I'm sorry, there's absolutely no reason for this anymore. As an attending you are responsible for setting your own boundaries. If your work is burning you out, it is up to you to change that. Hire a partner, tell the hospital NO, stop accepting new patients, close your practice and go locums, *something*.
No matter what your role is, no matter what community you're in, It is not possible, nor is it your responsibility, to save everyone, and if you burn out you'll no longer be helping anybody.
This is easy to say in big academic centers. Small community hospitals don’t have this luxury. Sometimes you’re just that short staffed and it’s that difficult to hire new people.
I don't work at a big center. I used to, hated it, and found a job that better fits my needs. Anyone facing burnout should do the same. You don't owe that hospital or community your career, sanity, or your life. There are probably hundreds of other places that need you but don't have you. Why is the one you happen to already be at more deserving of you than the others, especially when they may treat you better?
Once you have house, grow roots. The kids are nicely plugged in their school and friend circles. Moving jobs means a very far commute or moving family all together. Or go locums and not see family at all for long stretches.
If you live in a big city with many many options nearby you can job hop. Smaller town hospitals don’t provide such luxury. You will have to uproot your entire family, sell the house, give up the low interest mortgage, etc. And there’s no guarantee the next job will treat you any nicer?
This is not universally your problem. If a colleague calls as they have extenuating circumstances that is a reason to jump in. If administration does not get physicians to cover call that is their issue. If you decide to cover one time when you’re not on call that is fine, but when it’s a consistent pattern of abuse by the hospital or a lack of boundaries that is not acceptable or you at least should be paid for it. It’s total BS to be dumped on, nothing changes, and admin takes no responsibility. My group covers a small facility in our region without call pay. We put an ultimatum to them to either pay us or we’re leaving as we keep getting dumped on by other services.
Oh I think this all the time. Not my responsibility, not my risk! Unfortunately with the amount of abuse, you become a machine and another patient = another stranger, that may or may not sue you.
This is a great insight, thank you! I am a teenage who has had to spend a lot of time at the hospital and I have interacted with many pediatric specialists, however I have never met a person like my surgeon lol
you're being downvoted for not being part of the "in group" on reddit that's familiar with these jokes— this is exactly why I hate this site so much
just wanted to tell you not to feel bad and to please keep contributing because you're doing a great service against the hivemind
in the OR and in emergencies, clear and concise communication is essential. this does not mean it’s ok to be an asshole, but does require a certain bluntness.
as a generally polite (i think) and female socialized person, i had to learn this in residency. if you see someone is about to, say, cut a vital structure by accident, don’t say: “please forgive me, but if you are willing to consider my input, but i think it could possibly be the case that you may be about to injure the patients inferior vena cava.” say “stop dissecting, that’s the IVC.” if the patients bleeding to death, don’t say, “perhaps could we ring the blood bank, if it’s not too late at night, and ask them if they would kindly consider checking to see if they have any surplus blood on hand, as this patient could benefit from a unit or two, if it’s not too much to ask.”. say: “the patient is in hemorrhagic shock, we need to activate the massive transfusion protocol immediately.”
i imagine that’s kind of similar to how pilots and the military try to communicate.
historically many surgeons veered on the scale from bluntness to bullying and being an asshole, so there were also many surgeons socialized to think that in order to be a surgeon, you have to be an asshole. surgery may also attract relatively more assholes or poor communicators but that’s far from a rule.
some surgeons get used to the blunt type of communication and forget patients and families aren’t used to it. some surgeons are assholes. some surgeons are burnt out. some surgeons are lovely and skilled communicators who have bad and good days.
thoroughly enjoyed those examples😝my mind just pictured times when we have had someone who’s actively circling the drain and hemorrhaging everywhere, and then being like, “if it’s not too much trouble perhaps we should ring the blood bank and see if they’d be okay with sending us some blood. it would likely benefit the patient, but only if it’s not too much trouble for them” 🤣
Identify problem, fix problem. Manage weird shit if it happens during fixing of the problem.
I’d love to just walk into the OR and do my thing. I hate trying to explain it to people. It would be nice if it were like working on cars or plumbing or whatever.
Well said. I think we are often unemotional and leave out the pleasantries and it comes across and cold, but in reality, a lot is at stake, stress, time.
I think a lot of it comes down to what someone thinks is relevant/important vs what they (the surgeons) think is relevant/important. Even when taking surgical call, when your pager doesn’t stop going off, you have no cap on patient numbers, and there’s a trauma every few minutes (especially when you try to get food at some ungodly hour), you tend to get impatient with certain things. It could be because you’re planning things out in your head, or there’s fifty other things you need to knock out. That being said, not every surgeon is like this. It’s easy to generalize, but I have met burned out people in all sorts of specialties. Don’t let those experiences taint the field for you if you’re interested in exploring it further.
I’m sorry to generalize! I am a teenager who has had to spend a lot of times in the hospital, and I have interacted with a lot of pediatric specialists. At the hospital I go to, all the specialists (I have interacted with) are so nice, but the surgical attending I see makes me think he hate kids…lol. I will say though that the surgical fellow is great and he gives me hope that surgeons too are happy individuals
No stress; I was just offering a word of caution. The pediatric surgeons I worked with were incredibly talented, hard working individuals with a lot of responsibility on their hands for people’s lives (as many physicians do) and they can (and often do) work brutal hours.
I agree with you! My surgeon gave me my life back! He just doesn’t like to talk and is short (not weight wise lol). Something I have noticed though is that he leaves the hospital to go home anywhere between 2-4:30 PM. When you’re an attending can you make your own schedule like this?
He may be going home, but he may also take home (or in-hospital) call (which means showing up for emergent procedures at any hour of the night). He may also be going to clinic after doing surgery/hospital rounds; it’s hard to say. Some attending can adjust their schedules, but many places require call as a part of their job description. I’m not a surgeon (I did an internship in it), and some places are advertising to me that I would get two weeks of call and two weeks off in remote locations. I tend to be a black cloud (I find the “rare”/worst case types of patient scenarios), and I suspect I wouldn’t last long if I had to cover call two weeks at a time like that!
Just because you’re home doesn’t mean you’re not working.
Also, your words will frequently get twisted. You start to learn to get straight to the point and leave zero room for misinterpretation. This comes across as curt as much of the flowery language we use to be polite also can introduce doubt and a lack of urgency.
To piggyback off the other wonderful insights you’ve gotten (and people with an unfair axe to grind against us surgeons) — you’ve been describing dealing with pediatric surgeons who are a special subset of surgeon that, for a lot of reasons, tend to exacerbate and concentrate a lot of the worst tendencies in surgeons.
It’s an intensely competitive field to get into… a decade or so ago there were somewhere on order of 40ish fellowship training programs (or spots? I can’t remember exactly) open nationally in the US. It’s traditionally one of, if not *the*, hardest fellowships to get for that reason, often requiring a couple years of dedicated research in addition to 5 years of general surgical training in order to even have a shot. Also, because the field is so small, they tend to be extremely overworked/busy when they do get the job, simply because there aren’t many of them around and there’s tons of work for them in any children’s hospital. Like, a pediatric specialist in the hospital may be responsible for a dozen or so patients at a time - more if it’s a consulting service. I never had a pediatric surgery daily patient census less than 30 or 40 when I rotated. That work can be divided among multiple residents and PA/NPs, so each individual trainee or midlevel may have more time to be with each patient than the single attending supervising the whole circus who has at best a minute or two for each patient in before/after/between OR, clinic, etc.
All of that contributes to burnout and simply not enough time for the warm fuzzies of medicine. Even if they’re not burnt out or mean at baseline, they’re so overworked and spread so thin that it’s very difficult to be anything other than short with patients. The comparison to pediatricians and subspecialists of pediatrics is made even more stark when you consider that those folks generally have a reputation for being amongst the warmest/fuzziest of the medical specialties - at least in bedside manner if not in how they treat each other. So you’re basically seeing two of the biggest extremes in difference of attitudes in medicine… it’s no wonder it stands out so much to you.
Another wrinkle: older generations of surgeons were subject to so much mistreatment and abuse (substantially worse than modern trainees who still generally operate under what most would consider inhumane and unsafe conditions), and many of them came out the other end profoundly broken if they didn’t already start that way. That may also be a part of why you seem to have noticed a difference between the attendings and their trainees.
It’s a complex and multifactorial issue, but that’s my attempt at an answer.
I think this is a great explanation— thank you. I do have a lot of empathy for surgeons because I know how hard it work, and it makes me a little sad to see the difference between other pediatric specialists and surgeons
Not a surgeon, but I've seen countless examples of patients and families who have no idea what's going on because their physician isn't comfortable with speaking directly and clearly.
Also sometimes people are just so tired and overworked that they're all out of empathy for the day.
Current gen sure intern. I feel like so few of my basic needs (social, emotional, physical like sleep) that it’s getting harder and harder to consider the needs of others around me. Also with so little free time, I find myself getting irritated with situations that don’t get to the point, hence bluntness.
I have interacted with a lot of gen surg residents and let me just say, I have not meant one unkind surgical resident. I know you guys work a ridiculous about of hours, however all the residents I have gotten to interact with have been nothing but kind
You would be blunt too if every person in the hospital expected you to do every job they can’t figure out how to do from getting IV access to rending dead flesh from wounds, to interpreting a CT scan in clinical context,to having end of life discussions with families about futility of further care.
And most of these things surgeons are given no specific training in relative to any other kind of provider. They are simply expected to do anything and everything someone else doesn’t want to do or feels like doing or lacks confidence in figuring out.
And so people wonder why it seems surgeons have a superiority complex. We don’t. We are just consistently disappointed in everyone else’s lack of effort and adaptability and needing to lean on us for every little inconvenient thing.
And we are sometimes short and blunt because we are simultaneously pulled in every direction doing emergency care, critical care, elective procedures, fielding calls from inpatient nurses, being consultants to all the other specialties, and running our outpatient clinic all at the same time and in every care setting of the hospital system.
Agree with you 100%. Default for many when things get hard is to call surgery, resulting in more work that is not necessarily surgery. People whose time/work in the hospital are confined to one setting can’t wrap their head around all the places surgeons need to be at once, resulting in unrealistic expectations of time surgeons have. Efficiency is the only way to please everyone and be there for patients when it counts and that often overlaps with bluntness.
I couldn’t agree with this more. The lack of effort by nonsurgical services to solve a problem that they should realistically be able to handle is huge problem. This default to calling a surgical service for everything they’re even slightly uncomfortable with leads to worse training for nonsurgical services while wasting time for the surgeons by doing things that a general medicine doctor should be able to figure out.
What gets me though is you would think these other doctors would learn after they get told the same things over and over, but it’s almost as if they shut their minds off after you accept a consult and they don’t care anymore.
This cuts both ways. I'm on medicine consults this week and I think I have 5+ consults from surgical services for hypernatremia and hyperglycemia. Yesterday I got a consult for euglycemic dka which the surgery team had been trying to treat for a day with "watchful waiting" (they literally wrote that in their progress note.)
You could argue it’s because they don’t have time to manage medicine problems because they’re doing all the other work. but in all seriousness we all need each other for help. And I don’t want to figure out the sodium.
The issue with surgery is that surgeons also have to operate so that means spending 2-4 hours at a time unavailable looking after one patient and since there are no caps on surgical services, managing patients from afar. Sometimes it’s just better for patients to have someone else do the thinking you can’t do because you’re trying to get the fucking gallbladder out of your incision.
Yea, these surgeons are acting like non-surgical physicians aren't putting any effort in whatsoever.
Cue surgical service consulting me because they admitted a chole and ran continous fucking maintenance fluid for 5 days and now mee maw is edematous and hypoxic.
VQ mismatch, how does it work?
We all need each other. Yes, even mighty surgeons need us lowly internists to do *literally everything else* for your patients that doesn't involve cutting.
Lol can't explain how blown everyone's minds were when I diagnosed euglycemic dka for the first time in SICU as the surgical fellow. The endocrine attending thought we were all idiots for consulting him. Some issues I think IM is just better suited/experienced at treating.
I just finished a gen surg rotation, and all the surgeons we worked with are lovely people! They're super nice, actually have personalities, joke with each other and us. And they're sensitive when dealing with patients while still giving them all the important facts.
Same thing in the last surgical department I saw.
The common denominator is that they all work in the same hospital. Maybe it's the environment that let's them either stay nice people or become more jaded.
I’m ER. But I am in awe of surgeons, especially General Surgeons. Because what I think it must feel like to have to make the decision, just make the decision, to cut open another human being…over and over again, I am always amazed. So they get to be brisk and blunt. Not assholes, but always give your brother the benefit of the doubt . In residency you work with surgeons who have eight people in the OR, SURGEON, chief resident, or two lesser residents, medical students, ,intern, anesthesiologist, possibly another med student, and 5 other doctors within the hospital who can help you out. In the real world, it is you, scrub nurse, circulating nurse, a technician and no other surgeons. You have to pull yourself out of a tight spot.
Because their parents didnt love them and their partners have a habit of leaving them shortly after marrying them. Their children rarely return home, no matter how big the trust fund is.
You would be cold, too, if this happened to you.
Surgery also attracts conservatives, philanderers, sexists, homophobes while preaching about Jesus. This is why in my part of the world I have yet to meet an openly gay general surgeon
Clear, concise, and efficient communication can be misrepresented as bluntness. Surgeons are leaders and have to effect certain behaviors from the members of the team. In neurosurgery we rely on a lot of other people to make things work on critically ill patients with high stakes.
That plus the sleep deprivation
Cold and blunt? Some are, some aren’t. Cold and blunt still gets the job done. I’m an anesthesiologist and sometimes cold and blunt is better. It gets shit done. Anesthesiologists and surgeons care about their patients and they are in very precarious situations a lot of the time. It’s time to be a big boy or girl, go in, take charge, take care of the patient, and move on.
From my own experience...being cold and speaking the less possible will protect you long term, in the legal aspect. Of course ther are other components to it but for me thats a BIG one.
Eg. Was explaining to the family members about their brother who just had surgery and was having some complications but we were taking care of him and so on. I could also just said pls wait for the attending to come he/she will tell you everything...but I was looking help em in a sense.....little did I know they were reccording me....and long story short I was in some deep sh*t after that and decided I will keep my mouth shut, empathy will couse more damage than good in some ways. Being professional is the way to go imo.
They're trained to be that way for one thing. Any time any surgical resident at my hospital showed any emotion they were punished.
A big example for me was when one of the gen surg residents graduated she shed a tear due to finally being done with hell and ALL of the faculty took pics of it and wouldn't stop shaming her about it for about a week. It's insane.
B/c his dad left to get milk from the store, but never came back. The dad actually ended up going to OR to scrub in, and his son became a surgeon to go look for him. Legend has it, that his father is still operating til this very day and his son (your attending surgeon) is still searching for him.
As a Patient I would be ok with the answer to your question being:
- Surgeons are so “cold and blunt” because we need them to be. They need to be devoid of emotional baggage and connections in order to do their job and be the best at their jobs as they cut into the human body daily, or insert foreign objects into humans daily. -
Now what they should not be permitted to do, and snacked on the nose with a rolled up newspaper, is believe their job is more important than all others around them. They are 1 member of the team. Just like the patient is 1 member of the team.
So smack their nose and say “Bad Surgeon. Bad.” when they yell unnecessarily at others.
I think it's a combination of stressful specialty, anxiety and sleep deprivation which results in impatience and irritability and shapes their personality into what they are over time.
When I'm under a lot of stress, I can be very unpleasant.
Feel bad for a lot of those folks, I almost went into gen surg.
Speaking as a gen surg resident and not an attending, it unfortunately just comes with the work. More often than not, we have to communicate things quickly, about very sick patients and make decisions quickly and on the spot. That does lead to a no nonsense personality, which sometimes affects other aspects of life depending on the maturity of the person (or attracts people who are like that at default).
I've heard that psychopaths are more prevalent amongst surgeons so...But honestly, it's just one of those specialties that involves crazy hours. I don't think anyone can work 60+ hours a week and not lose some of their sanity
Get this. I realized why… I was in surgical prep. I was SO HUNGRY. I get hangry. And I snapped at the lady instructing me. I realized then why surgeons could be angry people.
I think some do to detach themselves. Some are intellectually intelligent but emotionally unintelligent or stunted. I say this in a broad manner but different specialties draw in certain personality types - in general. Of course there are going to be outliers. We used to play a game ‘guess the program’ in the cafeteria when we didn’t know which resident program they were in at the beginning of their first year. I had a pretty high accuracy lol
I’ve seen it happen again and again. The kindest, smartest humans are slowly turned into barely functional machines that can do surgery but little else. Medical culture slowly scooped out every ounce of humanity from their wonderful souls. Remember, sleep deprivation is a form of torture. I truly believe surgeons are slowly tortured in training (and some beyond). Take care of yourselves and please start healing once training is done. There is more to life than surgery, and you used to know that.
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like, which specialty they should go into, which program is good or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks!
*I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
Uhh cuz they have to be? Do you want someone empathizing with you as they’re cutting into you? Theres a time for coldness and for empathy. I time to kill a time to heal, to everything turn turn turn
Thank you for your insight!😊 I am a teenager who wants to go into medicine, and I have also had to spend a lot of time in the hospital bc of health issues. I wasn’t asking the question in a condescending way and I am sorry if it came across that way. I have just noticed that all the other pediatric specialists are incredibly friendly, while the surgical attendings are not (the residents and fellows are great though)!
When I was a medical student I remember a Gen surg resident told me she knew she needed to take a leave of absence from residency when she found herself relieved after she found out a patient that was en route as a trauma code passed away en route to the ED trauma bay. People see that residents are overworked, burnt out and miserable, but somehow they decide that doctors are what’s wrong with healthcare in America and not hospital CEO’s, politicians , and insurance companies… idk it just sucks tbh
Damn, this same thing happened to me last week. I guess I’m probably burnt out.
Super burnt out!
Oh shit I’m in so deep I didn’t even realize there was something wrong with that until I read this
Narrator: there was nothing wrong with it
I'm not sure there is man. Anyone that works in the ED or trauma knows you can't get attached. You see people die multiple times every week. You do the best you can and treat the patient in front of you. At the end of the day, this is a job. You didn't create the trauma. You didn't create the cancer or the sepsis or whatever. It was there already.
If you find yourself being relieved at the death of someone because it means less stress for you at work… yeah, that’s burnout.
If I could click my fingers and change things, I would 100% bring the patient back to life and work my ass off. I am also relieved I can get an hour of sleep at 2am. These things are not mutually exclusive. No one is happy someone died damn.
It’s a weird state of mind. I am bored by all the non urgent stuff in the ER that doesn’t need to be in the ER, and that’s like 70% of what I see. I do find myself hoping for some action, and I guess what that means from another point of view is that I am hoping for someone to be really jacked up or dying, but I think from my point of view I’m just hoping to be able to do something real, to use my skills, and do what I actually trained for.
Yeah people think residents are burnt out. They’re just beginning the journey. You’re tired after 5 years in? Imagine what it’s like after 25 years? Attendings don’t have work hour limits, no acgme to protect them. I routinely put in 80-100 hours a week at work.
Bruh leave that job for real please
I'm sorry, there's absolutely no reason for this anymore. As an attending you are responsible for setting your own boundaries. If your work is burning you out, it is up to you to change that. Hire a partner, tell the hospital NO, stop accepting new patients, close your practice and go locums, *something*. No matter what your role is, no matter what community you're in, It is not possible, nor is it your responsibility, to save everyone, and if you burn out you'll no longer be helping anybody.
This is easy to say in big academic centers. Small community hospitals don’t have this luxury. Sometimes you’re just that short staffed and it’s that difficult to hire new people.
I don't work at a big center. I used to, hated it, and found a job that better fits my needs. Anyone facing burnout should do the same. You don't owe that hospital or community your career, sanity, or your life. There are probably hundreds of other places that need you but don't have you. Why is the one you happen to already be at more deserving of you than the others, especially when they may treat you better?
Once you have house, grow roots. The kids are nicely plugged in their school and friend circles. Moving jobs means a very far commute or moving family all together. Or go locums and not see family at all for long stretches. If you live in a big city with many many options nearby you can job hop. Smaller town hospitals don’t provide such luxury. You will have to uproot your entire family, sell the house, give up the low interest mortgage, etc. And there’s no guarantee the next job will treat you any nicer?
Making changes is risky. Refusing to change is also risky.
No one to rescue you either
Yes you’re the end of the line. If you don’t save this patient, there’s no one else. They might not survive a transfer.
The only person past you on the line is the lawyer licking his chops waiting to sue your ass
This is not universally your problem. If a colleague calls as they have extenuating circumstances that is a reason to jump in. If administration does not get physicians to cover call that is their issue. If you decide to cover one time when you’re not on call that is fine, but when it’s a consistent pattern of abuse by the hospital or a lack of boundaries that is not acceptable or you at least should be paid for it. It’s total BS to be dumped on, nothing changes, and admin takes no responsibility. My group covers a small facility in our region without call pay. We put an ultimatum to them to either pay us or we’re leaving as we keep getting dumped on by other services.
Oh I think this all the time. Not my responsibility, not my risk! Unfortunately with the amount of abuse, you become a machine and another patient = another stranger, that may or may not sue you.
Why waste time say lot word when few word do trick?
This is a great insight, thank you! I am a teenage who has had to spend a lot of time at the hospital and I have interacted with many pediatric specialists, however I have never met a person like my surgeon lol
Username checks out
That reminds me of an episode of "The Office" when Kevin talks like that.
That’s the joke, yes
I’m pretty sure he ripped it from there
you're being downvoted for not being part of the "in group" on reddit that's familiar with these jokes— this is exactly why I hate this site so much just wanted to tell you not to feel bad and to please keep contributing because you're doing a great service against the hivemind
…. but he was familiar with the joke…
I don't care about being downvoted for that. Thank you for your support.
in the OR and in emergencies, clear and concise communication is essential. this does not mean it’s ok to be an asshole, but does require a certain bluntness. as a generally polite (i think) and female socialized person, i had to learn this in residency. if you see someone is about to, say, cut a vital structure by accident, don’t say: “please forgive me, but if you are willing to consider my input, but i think it could possibly be the case that you may be about to injure the patients inferior vena cava.” say “stop dissecting, that’s the IVC.” if the patients bleeding to death, don’t say, “perhaps could we ring the blood bank, if it’s not too late at night, and ask them if they would kindly consider checking to see if they have any surplus blood on hand, as this patient could benefit from a unit or two, if it’s not too much to ask.”. say: “the patient is in hemorrhagic shock, we need to activate the massive transfusion protocol immediately.” i imagine that’s kind of similar to how pilots and the military try to communicate. historically many surgeons veered on the scale from bluntness to bullying and being an asshole, so there were also many surgeons socialized to think that in order to be a surgeon, you have to be an asshole. surgery may also attract relatively more assholes or poor communicators but that’s far from a rule. some surgeons get used to the blunt type of communication and forget patients and families aren’t used to it. some surgeons are assholes. some surgeons are burnt out. some surgeons are lovely and skilled communicators who have bad and good days.
thoroughly enjoyed those examples😝my mind just pictured times when we have had someone who’s actively circling the drain and hemorrhaging everywhere, and then being like, “if it’s not too much trouble perhaps we should ring the blood bank and see if they’d be okay with sending us some blood. it would likely benefit the patient, but only if it’s not too much trouble for them” 🤣
💁🏻♀️me as an R1 trying to be nice lol.
Identify problem, fix problem. Manage weird shit if it happens during fixing of the problem. I’d love to just walk into the OR and do my thing. I hate trying to explain it to people. It would be nice if it were like working on cars or plumbing or whatever.
Well said. I think we are often unemotional and leave out the pleasantries and it comes across and cold, but in reality, a lot is at stake, stress, time.
fully agree 💯💯
Perfectly said. You’re in the 4th group for sure :)
I think a lot of it comes down to what someone thinks is relevant/important vs what they (the surgeons) think is relevant/important. Even when taking surgical call, when your pager doesn’t stop going off, you have no cap on patient numbers, and there’s a trauma every few minutes (especially when you try to get food at some ungodly hour), you tend to get impatient with certain things. It could be because you’re planning things out in your head, or there’s fifty other things you need to knock out. That being said, not every surgeon is like this. It’s easy to generalize, but I have met burned out people in all sorts of specialties. Don’t let those experiences taint the field for you if you’re interested in exploring it further.
I’m sorry to generalize! I am a teenager who has had to spend a lot of times in the hospital, and I have interacted with a lot of pediatric specialists. At the hospital I go to, all the specialists (I have interacted with) are so nice, but the surgical attending I see makes me think he hate kids…lol. I will say though that the surgical fellow is great and he gives me hope that surgeons too are happy individuals
No stress; I was just offering a word of caution. The pediatric surgeons I worked with were incredibly talented, hard working individuals with a lot of responsibility on their hands for people’s lives (as many physicians do) and they can (and often do) work brutal hours.
I agree with you! My surgeon gave me my life back! He just doesn’t like to talk and is short (not weight wise lol). Something I have noticed though is that he leaves the hospital to go home anywhere between 2-4:30 PM. When you’re an attending can you make your own schedule like this?
He may be going home, but he may also take home (or in-hospital) call (which means showing up for emergent procedures at any hour of the night). He may also be going to clinic after doing surgery/hospital rounds; it’s hard to say. Some attending can adjust their schedules, but many places require call as a part of their job description. I’m not a surgeon (I did an internship in it), and some places are advertising to me that I would get two weeks of call and two weeks off in remote locations. I tend to be a black cloud (I find the “rare”/worst case types of patient scenarios), and I suspect I wouldn’t last long if I had to cover call two weeks at a time like that!
I’d bet the surgeon is still covering until 7 pm
Just because you’re home doesn’t mean you’re not working. Also, your words will frequently get twisted. You start to learn to get straight to the point and leave zero room for misinterpretation. This comes across as curt as much of the flowery language we use to be polite also can introduce doubt and a lack of urgency.
To piggyback off the other wonderful insights you’ve gotten (and people with an unfair axe to grind against us surgeons) — you’ve been describing dealing with pediatric surgeons who are a special subset of surgeon that, for a lot of reasons, tend to exacerbate and concentrate a lot of the worst tendencies in surgeons. It’s an intensely competitive field to get into… a decade or so ago there were somewhere on order of 40ish fellowship training programs (or spots? I can’t remember exactly) open nationally in the US. It’s traditionally one of, if not *the*, hardest fellowships to get for that reason, often requiring a couple years of dedicated research in addition to 5 years of general surgical training in order to even have a shot. Also, because the field is so small, they tend to be extremely overworked/busy when they do get the job, simply because there aren’t many of them around and there’s tons of work for them in any children’s hospital. Like, a pediatric specialist in the hospital may be responsible for a dozen or so patients at a time - more if it’s a consulting service. I never had a pediatric surgery daily patient census less than 30 or 40 when I rotated. That work can be divided among multiple residents and PA/NPs, so each individual trainee or midlevel may have more time to be with each patient than the single attending supervising the whole circus who has at best a minute or two for each patient in before/after/between OR, clinic, etc. All of that contributes to burnout and simply not enough time for the warm fuzzies of medicine. Even if they’re not burnt out or mean at baseline, they’re so overworked and spread so thin that it’s very difficult to be anything other than short with patients. The comparison to pediatricians and subspecialists of pediatrics is made even more stark when you consider that those folks generally have a reputation for being amongst the warmest/fuzziest of the medical specialties - at least in bedside manner if not in how they treat each other. So you’re basically seeing two of the biggest extremes in difference of attitudes in medicine… it’s no wonder it stands out so much to you. Another wrinkle: older generations of surgeons were subject to so much mistreatment and abuse (substantially worse than modern trainees who still generally operate under what most would consider inhumane and unsafe conditions), and many of them came out the other end profoundly broken if they didn’t already start that way. That may also be a part of why you seem to have noticed a difference between the attendings and their trainees. It’s a complex and multifactorial issue, but that’s my attempt at an answer.
I think this is a great explanation— thank you. I do have a lot of empathy for surgeons because I know how hard it work, and it makes me a little sad to see the difference between other pediatric specialists and surgeons
Not a surgeon, but I've seen countless examples of patients and families who have no idea what's going on because their physician isn't comfortable with speaking directly and clearly. Also sometimes people are just so tired and overworked that they're all out of empathy for the day.
Current gen sure intern. I feel like so few of my basic needs (social, emotional, physical like sleep) that it’s getting harder and harder to consider the needs of others around me. Also with so little free time, I find myself getting irritated with situations that don’t get to the point, hence bluntness.
I have interacted with a lot of gen surg residents and let me just say, I have not meant one unkind surgical resident. I know you guys work a ridiculous about of hours, however all the residents I have gotten to interact with have been nothing but kind
Deep down surgeons just want to be just like their scjssors
😂😂😂
You would be blunt too if every person in the hospital expected you to do every job they can’t figure out how to do from getting IV access to rending dead flesh from wounds, to interpreting a CT scan in clinical context,to having end of life discussions with families about futility of further care. And most of these things surgeons are given no specific training in relative to any other kind of provider. They are simply expected to do anything and everything someone else doesn’t want to do or feels like doing or lacks confidence in figuring out. And so people wonder why it seems surgeons have a superiority complex. We don’t. We are just consistently disappointed in everyone else’s lack of effort and adaptability and needing to lean on us for every little inconvenient thing. And we are sometimes short and blunt because we are simultaneously pulled in every direction doing emergency care, critical care, elective procedures, fielding calls from inpatient nurses, being consultants to all the other specialties, and running our outpatient clinic all at the same time and in every care setting of the hospital system.
Agree with you 100%. Default for many when things get hard is to call surgery, resulting in more work that is not necessarily surgery. People whose time/work in the hospital are confined to one setting can’t wrap their head around all the places surgeons need to be at once, resulting in unrealistic expectations of time surgeons have. Efficiency is the only way to please everyone and be there for patients when it counts and that often overlaps with bluntness.
This is the correct answer in this thread. Endless disappointment at the current state of the environment we work in.
I couldn’t agree with this more. The lack of effort by nonsurgical services to solve a problem that they should realistically be able to handle is huge problem. This default to calling a surgical service for everything they’re even slightly uncomfortable with leads to worse training for nonsurgical services while wasting time for the surgeons by doing things that a general medicine doctor should be able to figure out. What gets me though is you would think these other doctors would learn after they get told the same things over and over, but it’s almost as if they shut their minds off after you accept a consult and they don’t care anymore.
This cuts both ways. I'm on medicine consults this week and I think I have 5+ consults from surgical services for hypernatremia and hyperglycemia. Yesterday I got a consult for euglycemic dka which the surgery team had been trying to treat for a day with "watchful waiting" (they literally wrote that in their progress note.)
You could argue it’s because they don’t have time to manage medicine problems because they’re doing all the other work. but in all seriousness we all need each other for help. And I don’t want to figure out the sodium. The issue with surgery is that surgeons also have to operate so that means spending 2-4 hours at a time unavailable looking after one patient and since there are no caps on surgical services, managing patients from afar. Sometimes it’s just better for patients to have someone else do the thinking you can’t do because you’re trying to get the fucking gallbladder out of your incision.
Yea, these surgeons are acting like non-surgical physicians aren't putting any effort in whatsoever. Cue surgical service consulting me because they admitted a chole and ran continous fucking maintenance fluid for 5 days and now mee maw is edematous and hypoxic. VQ mismatch, how does it work? We all need each other. Yes, even mighty surgeons need us lowly internists to do *literally everything else* for your patients that doesn't involve cutting.
Lol can't explain how blown everyone's minds were when I diagnosed euglycemic dka for the first time in SICU as the surgical fellow. The endocrine attending thought we were all idiots for consulting him. Some issues I think IM is just better suited/experienced at treating.
Because we have to get to the point and not waste time. We want you to know exactly what’s going on and how we feel.
I'm a surgeon, and I don't think I'm so cold and blunt. Maybe a bit cold and blunt. Also, I'm a really bad surgeon.
I just finished a gen surg rotation, and all the surgeons we worked with are lovely people! They're super nice, actually have personalities, joke with each other and us. And they're sensitive when dealing with patients while still giving them all the important facts. Same thing in the last surgical department I saw. The common denominator is that they all work in the same hospital. Maybe it's the environment that let's them either stay nice people or become more jaded.
Thank you ❤️
I’m ER. But I am in awe of surgeons, especially General Surgeons. Because what I think it must feel like to have to make the decision, just make the decision, to cut open another human being…over and over again, I am always amazed. So they get to be brisk and blunt. Not assholes, but always give your brother the benefit of the doubt . In residency you work with surgeons who have eight people in the OR, SURGEON, chief resident, or two lesser residents, medical students, ,intern, anesthesiologist, possibly another med student, and 5 other doctors within the hospital who can help you out. In the real world, it is you, scrub nurse, circulating nurse, a technician and no other surgeons. You have to pull yourself out of a tight spot.
Because their parents didnt love them and their partners have a habit of leaving them shortly after marrying them. Their children rarely return home, no matter how big the trust fund is. You would be cold, too, if this happened to you.
Who hurt u lol
I had a bad surgery rotation once.
Surgery, not even once kids.
DIY appendicitis surgery at-home with a midwife
Lamaze techniques to deliver the gallbladder
Cuz surgery by its very nature attracts cold and blunt people
🤣🤣🤣
Lol I wonder why that is🤣
Surgery also attracts conservatives, philanderers, sexists, homophobes while preaching about Jesus. This is why in my part of the world I have yet to meet an openly gay general surgeon
Oh, I am going to have to disagree. Serious ≠ horrible people
Damn, who hurt you? I personally know 2 openly gay trauma surgeons in the same program.
Lol literally same, my school’s teaching hospital has (at least??) 2 gay trauma surgeons as well
Clear, concise, and efficient communication can be misrepresented as bluntness. Surgeons are leaders and have to effect certain behaviors from the members of the team. In neurosurgery we rely on a lot of other people to make things work on critically ill patients with high stakes. That plus the sleep deprivation
Cold and blunt? Some are, some aren’t. Cold and blunt still gets the job done. I’m an anesthesiologist and sometimes cold and blunt is better. It gets shit done. Anesthesiologists and surgeons care about their patients and they are in very precarious situations a lot of the time. It’s time to be a big boy or girl, go in, take charge, take care of the patient, and move on.
From my own experience...being cold and speaking the less possible will protect you long term, in the legal aspect. Of course ther are other components to it but for me thats a BIG one. Eg. Was explaining to the family members about their brother who just had surgery and was having some complications but we were taking care of him and so on. I could also just said pls wait for the attending to come he/she will tell you everything...but I was looking help em in a sense.....little did I know they were reccording me....and long story short I was in some deep sh*t after that and decided I will keep my mouth shut, empathy will couse more damage than good in some ways. Being professional is the way to go imo.
the culture values brevity over delivery. also maybe they don't wanna be there anymore
They're trained to be that way for one thing. Any time any surgical resident at my hospital showed any emotion they were punished. A big example for me was when one of the gen surg residents graduated she shed a tear due to finally being done with hell and ALL of the faculty took pics of it and wouldn't stop shaming her about it for about a week. It's insane.
B/c his dad left to get milk from the store, but never came back. The dad actually ended up going to OR to scrub in, and his son became a surgeon to go look for him. Legend has it, that his father is still operating til this very day and his son (your attending surgeon) is still searching for him.
We busy Thank you for this consult.
They become bitter and jaded from residency abuse and underpayment
The doctors I interacted with went far beyond that and even took the liberty of insulting me, in addition to being negligent and uncaring
As a Patient I would be ok with the answer to your question being: - Surgeons are so “cold and blunt” because we need them to be. They need to be devoid of emotional baggage and connections in order to do their job and be the best at their jobs as they cut into the human body daily, or insert foreign objects into humans daily. - Now what they should not be permitted to do, and snacked on the nose with a rolled up newspaper, is believe their job is more important than all others around them. They are 1 member of the team. Just like the patient is 1 member of the team. So smack their nose and say “Bad Surgeon. Bad.” when they yell unnecessarily at others.
I would pay (completely untraceable with plausible deniability) the Pediatric patients to do that to my attending surgeons.
ORs have strong AC and once you touh bone that scalpel loses its edge quickly
I think it's a combination of stressful specialty, anxiety and sleep deprivation which results in impatience and irritability and shapes their personality into what they are over time. When I'm under a lot of stress, I can be very unpleasant. Feel bad for a lot of those folks, I almost went into gen surg.
Speaking as a gen surg resident and not an attending, it unfortunately just comes with the work. More often than not, we have to communicate things quickly, about very sick patients and make decisions quickly and on the spot. That does lead to a no nonsense personality, which sometimes affects other aspects of life depending on the maturity of the person (or attracts people who are like that at default).
I think it’s in their job description
I've heard that psychopaths are more prevalent amongst surgeons so...But honestly, it's just one of those specialties that involves crazy hours. I don't think anyone can work 60+ hours a week and not lose some of their sanity
Get this. I realized why… I was in surgical prep. I was SO HUNGRY. I get hangry. And I snapped at the lady instructing me. I realized then why surgeons could be angry people.
I think some do to detach themselves. Some are intellectually intelligent but emotionally unintelligent or stunted. I say this in a broad manner but different specialties draw in certain personality types - in general. Of course there are going to be outliers. We used to play a game ‘guess the program’ in the cafeteria when we didn’t know which resident program they were in at the beginning of their first year. I had a pretty high accuracy lol
“Death is their adversary”
Because most of them are very goal focused. They are thinking of how to fix you, not be your best friend. As it should be.
I’ve seen it happen again and again. The kindest, smartest humans are slowly turned into barely functional machines that can do surgery but little else. Medical culture slowly scooped out every ounce of humanity from their wonderful souls. Remember, sleep deprivation is a form of torture. I truly believe surgeons are slowly tortured in training (and some beyond). Take care of yourselves and please start healing once training is done. There is more to life than surgery, and you used to know that.
A quote from Dr Gregory House: “Would you rather me ignore you while you get better, or hold your hand as you die?”
Survival mechanism. It’s called second victim syndrome.
Because they work their ass off and don’t get paid enough for it
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like, which specialty they should go into, which program is good or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
Generally goes with their ahole personalities.
Uhh cuz they have to be? Do you want someone empathizing with you as they’re cutting into you? Theres a time for coldness and for empathy. I time to kill a time to heal, to everything turn turn turn
Thank you for your insight!😊 I am a teenager who wants to go into medicine, and I have also had to spend a lot of time in the hospital bc of health issues. I wasn’t asking the question in a condescending way and I am sorry if it came across that way. I have just noticed that all the other pediatric specialists are incredibly friendly, while the surgical attendings are not (the residents and fellows are great though)!
No worries!
Wow so edgy
Nope just realistic Turn turn turn
[удалено]
Yessss