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Dealing With A Difficult Surgeon

Dealing with a Difficult Surgeon

What’s the difference between a surgeon and a two-year-old?... The two-year-old eventually stops whining.

Surgeons come in all forms. Some are friendly and outgoing, others are cordial and introverted, and some are absolutely hell to work with. Dealing with a difficult surgeon as a CRNA is very different than dealing with an attending physician in the ICU or the ED. The dynamics are different in the OR, where as a CRNA you aren’t the surgeons “subordinate”, taking orders and carrying out tasks, rarely being afforded the opportunity to question the doctor. As a CRNA you are an independent practitioner in many states, and possibly the sole anesthesia provider in other locations. The dynamics between you and the surgeon, especially a difficult one, take on a whole new dimension, and you must adjust your reaction and language accordingly.

I’ve mentioned before that the OR can be a very stressful workplace; not just because of the demanding nature of surgery, but also because of OR dynamics. When you throw in a surgeon that questions your judgement and speaks nasty to you and the rest of the staff, things can get even more challenging. It’s very important to know how to argue your point credibly. It is important to use proper language and terminology when sternly defending your point of view or actions in the OR. It’s not enough to know that you are right, it’s your obligation to portray an understanding of the topic being discussed or contested by the surgeon. As a CRNA you have to be the expert about everything during a particular surgery. You need to know the medications you are giving and their respective side effects, you need to be an expert in the Anatomy and Physiology pertaining to the case, you have to know everything about the procedure short of actually doing it yourself. When a surgeon starts questioning your actions or demanding certain orders you don’t agree with, you must portray this expert knowledge in order to get your point across. Again, knowing how to handle difficult surgeons is sometimes a part of our job and you must know how to do this properly.

Of course, sometimes emotions get the better of us. We’re all human and have our breaking point. It’s important to remember that your first obligation is to the anesthetized patient on the OR table. If a situation gets out of hand you must call for assistance. As a colleague of mine did when a surgeon actually became physically hostile during a procedure, because of patient positioning. This particular CRNA handled the situation like a total pro. The attending was called in and the CRNA excused themselves from the room. I’m not sure I would’ve handled it so well.

Here are a few suggestions to keep in mind when dealing with a potentially difficult surgeon:

  1. Have a preop discussion with your attending and surgeon about the procedure, the surgeons’ expectations/ requests, and what you as anesthesia are going to do

  2. Be knowledgeable about the case more than anyone else in the room.This way you can be confident about your actions and able to defend them should they be questioned

  3. Use professional medical language that doctors use when talking to each other. Elevate your language and sound like the professional that you are. Remember you are no longer a bedside nurse.

  4. And most importantly: DRAPE HIGH.Put your drape as high as possible so that the surgeon doesn’t see you and you don’t have to see them.It works, I promise.

Surgeons can make or break an entire day in the OR. Your job as a CRNA is to provide excellent, safe care to your patients. One way to do this is to have a good command of your OR and be able to communicate effectively with the entire staff, including the surgical team. As a professional anesthesia provider, you do not need to go through the day justifying or arguing everything you do, you are afforded the autonomy to intervene as you see fit. That being said, make sure you can defend your interventions at all times, should they come into question. If all else fails, refer to #4 above, and turn the volume up on the Pandora station.

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