On Diplomacy

By history, my father is a general surgeon in a small town in Georgia for his entire life. Currently retired at age 88 but still gets up every morning and goes to work somewhere, volunteering something. He has taken care of patients for 60 years.

From the time I started medical school till the present he has only given me two bits of advice on how to being a doctor. Just two. For what it’s worth, here are those sage bits of advice:

1) “You’ll probably like women but you’ll definitely hate doing pelvic exams. It loses the mystery at eye level under the hot lights”

2) “Don’t ever yell at the nurses. Everything immediately goes from bad to worse”.

I have found both of these tidbits to be true in spades. Of particular note is the admonition about yelling at nurses. In that regard, I have learned over the last 20 years that three laws hold irrevocably true:

1) The short term consequences of yelling at nurses are that you can be sure that anything going bad will instantly and irrevocably get worse. If they couldn’t or wouldn’t do what you wanted before you blew up, the real chances of it happening afterward simply evaporate. They either completely decompensate or run around at a quicker pace trying to look like they’re being more efficient with nothing effective being done. You can take this to the bank.

2) The longer term consequences of yelling at a nurse virtually guarantee that your name will sucked into the pipeline of “problems that need to be addressed” and you will then die the death of 1000 meetings, a painful and debilitating fate.

3) Surgeons who develop a reputation for yelling at people slowly lose repute among their colleagues. The old chestnut of “Lord, Master and Captain of the Ship” has pretty much been replaced by “Lord, Master and Team Player”. Like it or not, there is a lot more team effort involved in patient care than there was in the 50s, and not only are nurses part of that team, they don’t grow on trees anymore. Picture what your life would be like with out trained and experienced NICU nurses.

It has been my experience that these irrevocable laws simply make hassling nurses a lose-lose proposition, not matter how ego satisfying it might be at the time to establish who’s boss. I would suggest that the maximum efficiency possible occurs when you guide events with an even temper, simply emphasizing the importance by tone, and assuming everyone is doing the best they can under the circumstances. Perceived lapses are best handled after the fact.

My humble US$00.02 worth (probably over valued)

David Crippen, MD, FCCM

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