Editor’s Note: This storyteller told me I was catching her on a “down day.” Based on the description of the contributing issues, I suspect this is not an uncommon feeling among those who practice orthopaedic surgery at present.
“I am feeling ‘under’: underappreciated, under-respected, underutilized, under compensated and undervalued. The struggle is real and becomes more challenging each day.”
In my work, I try to teach patients to take care of their bodies and to stay accountable for their own health and wellbeing. I also reassure them, that in most cases, their worst fears about their conditions will not materialize. My words appear to go nowhere. I feel like a hamster on a wheel, day after day, having the same conversations.
Patients who have pain in the anatomic area of my practice focus and who don’t require surgery, often struggle caring for themselves. They may resist trying the corrective measures suggested to improve their pain and disability. Instead, they want me to say something that will “fix” them, for me to prescribe something “to take” and/or for me to order an MRI scan so a diagnosis can be made. They Google their symptoms and come up with a list of entities to fear and diagnoses that might be negatively affecting their bodies.
The patients described above often disregard a clinical diagnosis that I give them based on history, physical exam, radiographs and my years of experience. “How can you say that without an MRI scan?” They doubt, they cajole, and they seem to disrespect clinical science. Most don’t require surgery, but sadly, will find someone to do an operation if they leave my care. There are many “bad” and unethical surgeons out there.
In addition to the patient’s fear of potential diagnoses, they often exude negative energy. They come in with a negative perspective, a life with negative relationships, negative attitudes about health, exercise, food and even their own bodies. This state of mind makes it hard to educate them and often my treatment plan goes nowhere.
I do have success with the people I operate on. My mantra is “the right surgery at the right time for the rightreason by the right surgeon.” Most importantly, say no when it is the wrong time. Don’t be talked into something you do not agree with, even if the patient will may go off to a competitor.
Social media-based diagnoses and theories take away respect for a physician’s expertise, and use of evidence-based treatment. This is especially true if conservative care is not instantaneously successful. There is a common misperception that joint degeneration and pain brought on by years of sedentary lifestyle, obesity and poor nutrition can be reversed with rapid action of some sort. Individual responsibility for health has gone by the wayside and the burden is on health care providers. This parallels other aspects of modern life.
Where do I find the joy in my practice? During the post-op visits with patients who have gotten “better”. It is nice to feel like I am doing something good. It leaves me with a sense of being useful and brings contentment.
I also enjoy meeting and examining patients I know I can make better. Time is required to gain a patient’s trust; it starts with listening, conversing and not running for the door. I educate patients about their conditions, the options they have for treatment and describe what they can expect in recovery. It can lead to a pleasing partnership.
There is another area that must be mentioned. This issue is decades old and continues to persist: the sizing up of a female surgeon’s personality by operating room staff and how that assessment affects how she is treated and the help she is given. I don’t make small talk. I don’t gossip. I go to surgery to deliver the best care possible to my patient. Despite this, I have been told I am not nice; I am intimidating and even that no one wants to work with me. I was once “written up” for asking a clarifying question during surgery. This occurred even though my male colleagues may yell at the staff and even throw things during an operation yet somehow avoid being reported.
The dilemma, of course, is that we all have different styles of relating to each other and expectations of efficiency. If I am not given a consistent staff to operate with, the cases will not go smoothly. It won’t be fun for anyone and certainly is not good for the patient. Now, after years have passed, I finally have “earned” a consistent surgical staff for my cases, and we do good work together. I am mindful that my long cases can be physically hard on the staff, so I encourage individuals to take breaks at appropriate times. This is appreciated. We are a great team. Why did it take this long?
If I ignored “the gender thing”, I’d be putting my head in the sand. Men and women are different beings with different personal styles, and they often are treated differently within the small culture of a surgical center or hospital operating room. Men and women bond differently, have different senses of humor and speak using different tones of voice. Why is it necessary to be brought to your knees to get the help that you need? Especially when it is not for personal gain but to do good work for the patient.
Editor’s Note: Just like a how professional football quarterback tries to bond with his linemen so they protect him from being repeatedly sacked, maybe female surgeons need to “team build” with the OR coordinators, schedulers, nursing staff and surgical techs BEFORE walking into the OR for the first time. This would mean meeting under conditions where there is no patient to worry about. The meeting could even be done with a group of surgeons together. Could this prevent misunderstandings and promote more fairness and harmony in the OR?