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Toxic work culture in surgery: Can it be fixed?


After destroying a light fixture in the OR and being written up for another episode of disorderly conduct, John was at the end of his wits.

His marriage, profession, and self-respect were all on the line, and in the eyes of everyone around him, he was another surgical monster.

But little did he know – none of this was his fault. (We’ll get there in a moment.)

The outburst came in a fit of anger. He was just two years into his career as an attending surgeon, and it was not going well. It wasn’t about his surgical skills; those were top-notch. It was his time outside of the OR (mainly) that was the problem. Dealing with nurses, negotiating for OR block time, and managing patients dissatisfied with their wait times for non-urgent procedures. That’s where things went sour. That’s when he snapped one day and said to a nurse, “Just do what I said and do it now!”

John didn’t enter his surgical journey so irritable and reactive. And yet two years out of training, that’s where he found himself. From where he sat:

“The nurses were a pain in the you-know-what, always bugging him to rewrite orders, follow-up on wound management, get a patient discharged…”

“The non-clinician administrators were equally challenging, booking block time at inconvenient times, not following his instructions for add-on cases, hounding him when his charts weren’t done…”

“The patients, well, where did all these non-compliant, entitled people come from anyway?”

He had little patience for any of it. After all, he was the boss, the captain of the team, the one who was supposed to be in charge.

And this is the drill for nearly all of the dozens of surgeons I have coached over the past 14 years. Different characters in the same story. An unenviable pattern, a sad picture. An excellent surgeon, on top of his clinical game, struggling to fit in a system where the very behavior that was drilled into them in their training was found unacceptable.

While the symptoms of this phenomenon for female surgeons are different, they are largely the opposite side of the same coin. Imposter beliefs and an unrelenting need to prove oneself manifest as anger and outbursts for male surgeons and fear and self-doubt for women.

Of course, this doesn’t impact all surgeons. But a significant enough portion that this is relevant.

The fact is that much of the toxic residue left by our medical training—perfectionism, a need to always “captain the ship,” a deep-seated fear of failure, and a sense of “special,” or feeling above the crowd—is amplified in how we treat and train surgeons.

After all, what do surgeons learn in training?

As one surgeon put it: “I learned to be a monster, Gail.”

“I learned that all that mattered was getting the job done and flying under the radar of yet another punitive attending. An attending who was all too ready to throw me under the bus, whether I did something wrong or not. And the worst words I could utter were that I hadn’t gotten the job done. Whatever the task, whatever stood in my way of getting it done didn’t matter. Call someone on the team for help? Heaven forbid. Call the attending? Forget it.

The biggest lesson was to never ask for help. No matter what.”

And another lesson: kind and strong never go in the same sentence. In other words, your strength lies in being tough. Always. And never showing weakness of any kind. Be perfect, or you’re a failure. Another surgeon put it this way: “Gail, I was trained to be a bulldog, plain and simple. Don’t stand in my way, or you’re going to be plowed over.”

Coaching is a constructive intervention in unlearning these beliefs, and that’s the journey that John and I were on. And we had our work cut out for us. There was much he needed to unlearn if he wanted a successful, harmonious career and, beyond his career if he wanted to get along and live well with his wife and kids.

And over the subsequent six months – unlearning (and learning) is exactly what we did.

John learned that the perfectionism that was essential to earning his MD and completing years of training was actually deleterious to building the life and career that he wants today.

He learned that there are more effective ways to self-motivate than harsh inner criticism. He internalized the paradox of motivation—that the more we focus on what we haven’t accomplished or where we are coming up short, the less energy and motivation we have. But the more we can center our sights on what we are doing well and what we have done, the more energy we have to achieve more.

John also learned that it was okay to ask for help. That in his personal life, he could let his wife and children “in” to his inner world more, and that he didn’t have to have all the answers.

He developed a mindful awareness of his emotional triggers, so he is now able to anticipate when storms are coming. He can also mindfully redirect instead of having outbursts in the OR.

Going through coaching, John was able to see just how much his reactivity was costing him. Of course, the external pressures remain. Understaffing, challenging administrators, difficult patients

But much internally has been right-sized, and John is now able to skirt the shortcomings of his training and let go of the “monster-like tendencies” he adopted. His mastery in the OR now extends to the rest of his life. As he put it, “I am now both strong and kind, and I can see that this is the secret to my success, both as a surgeon and as a person.”

Gail Gazelle is an internal medicine physician, physician coach, and the author of Everyday Resilience: A Practical Guide to Build Inner Strength and Weather Life’s Challenges and Mindful MD: 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout.


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