I hate bullies ....

“When the power of love overcomes the love of power, the world will know peace.”
~Jimi Hendrix

Everyone has a certain perception of themselves. This perception may not be as others see us. Our perception can be clouded by previous experiences, gender deferences, and/or cultural differences. But as we all know, perception is reality.

The perception I have of myself is that I am a relatively level headed guy, very mild tempered, forgiving, hard working, affable, and loyal person. This perception has been verified by what many people have told me about myself (I do understand people do tend to hold back the bad things, not wanting to hurt feelings. Also, one of these people was my mother). One of my major flaws is my inability to forgive and respect someone I consider a "bully". In my value system, other than someone directly disrespecting me or my family, or blatantly lying to me, this is probably high on my list of things that will get my blood boiling. I lose respect for those that pick on the weaker or less powerful (physical, mental, or political) to get their way or things they want.

I understand my role in my group. I am a grunt. I personally have no aspirations of being famous or politically powerful. I do my work to the best of my abilities. I look at try to do what is in the best interest of the patient. All I ask is that all others do the same.

In the academic medical community, there are many bullies. Residents experience this on a daily bases. As a consult service, orthopaedics is not always but often abused. I am going to list a number of stories of blatant abuse by other attending staff towards residents. This is not to say that orthopaedics does not do it's share of consulting/dumping on other services. We are often the butt of jokes about consulting for things that many feel are routine medical issues, diabetes, hypertension, medications (beyond Ancef, Ibuprofen, and Tylenol). These are also stories of things that I have seen or been a part since medical school. These stories are not to pick on any service in particular or to speak of clinical acumen of the particular specialties. They are just stories from the orthopaedic point of view.

Story #1: An attending abusing status for no particular reason.

Ortho: This is Dr. bone
Dr. Iconsultforeverything: Yeah, this is Dr. Iconsultforeverything. I have a girl down here in the ER with an ACL tear. We would like an Orthopaedic consult.
Ortho: Uh, just put it in a knee immobilizer and send it to clinic.
Dr. Iconsultforeverything: We would like a you to come see the patient now.
Ortho: But, there is nothing to do. I am going to put them in a knee immobilized and have them follow up in clinic.
Dr. Iconsultforeverything: LISTEN, I AM THE ATTENDING AN I WANT YOU TO COME SEE THE PATIENT.
Ortho: Ok ....

(End result is the patient was sent home with a knee immobilizer, crutches, and an appointment for 1 week.)

Story #2: Crying wolf. Calling an emergent consult on something that is not emergent.

Ortho: Hey, this is ortho returning a page.
Dr. Ijustcompletedmyintenship: yeah this is the senior medical resident, Dr. Ijustcompletedmyintenship, and we would like to consult ortho for a possible compartment syndrome.
Ortho: I'll be right there.
(Stryker monitor in hand. Ortho resident runs up to the floor and walks into the Patients room)
Ortho: Hello, I am Dr. Bone, are you Mr. Igetadmittedalot.
(Patient looks up from his full lunch and takes his spoon out of his mouth)
Mr. Igetadmittedalot: Yes, I am Mr. Igetadmittedalot. (He takes another bite of mash potatoes)
Ortho: Does your leg hurt?
Mr. Igetadmittedalot: No.
Ortho: Has it ever hurt?
Mr. Igetadmittedalot: No. But, it is swollen.
Ortho: thank you.
(Resident walks out of the room and finds the senior medical resident)
Ortho: Hey, Dr. Ijustcompletedmyintenship. Why did you think this was compartment syndrome?
Dr. Ijustcompletedmyintenship: Well, his leg was swollen.
Ortho: Was there no other reason for this, like his renal disease, Diabetes, peripheral vascular disease, etc.. Oh, and if you thought it was a surgical emergency, why would you feed him?

(End result, the medical team receives an impromptu lecture on compartment syndrome)

Story #3: Attending trying to get resident into trouble.

Ortho Attending: (ring ring, answering phone) Hello.
Dr. Iconsultforeverything: This is Dr. Iconsultforeverything. I called your resident about a patient with back pain. The radiology report shows a possible coccyx lesion.
Ortho Attending: Well, get a CT scan.
Dr. Iconsultforeverything: Well, he has back pain after being hit in the back with a chair. The radiologist read a possible fracture or lesion in the coccyx. (Then going around in circles about something, ortho attending tunes him out for a bit)
Ortho Attending: What do you want us to do?
Dr. Iconsultforeverything: I just think someone from orthopaedics should see him.
Ortho Attending: Why? What are you concerned about?
Dr. Iconsultforeverything: Well there is a possible lesion or fracture of the coccyx and the patient has back pain.
Ortho Attending: Well what does the exam show?
Dr. Iconsultforeverything: He has back pain.
Ortho Attending: But, does he have @$$hole pain. What does the rectal show?
Dr. Iconsultforeverything: (silence) ... Well, I just think someone should see him.
Ortho Attending: Ok, Dr. Iconsultforeverything, I will send my resident down to do your examination.

(End result, patient was actually examined. He had back pain. Neuro exam negative including negative rectal exam)

Story #4 (Break in Chain of Command)

I really don't have a story I can share. I believe in a chain of command. This probably has to do with my military background. I have been involved with many situations where the chain has been broken. It causes problems that are not needed and situations that are blown out of proportion. It is usually done by people that think they are "above" the chain, or forcing their perceived power.

These are some basic stories that are not to say how good orthopaedics is or how much I am above other services. They are just stories. In residency and in practice, we all have them. I would like to open the comment box for more stories. Orthopaedic patient bashing stories welcome.

“Justice and power must be brought together, so that whatever is just may be powerful, and whatever is powerful may be just.”

~Blaise Pascal

It is an emotional issue ...

“Feelings are not supposed to be logical. Dangerous is the man

who has rationalized his emotions.”
~David Borenstein

Every few months, the residents change services. Regardless of the sub-specialty or residency program, it is required that they get exposure to the different sub-specialty areas and/or patient types in order to have "general" understanding of their specialty of choice. My specialty is orthopaedics. To comply with the requirements of the RRC, residents must rotate on different services and/or physicians. It is this change of service that confuses many of the younger residents and even the more experienced resident. You may say, "Why?" Evey time the residents encounter a new physician, they must learn a whole new set of quirks. It is because we all have our own "Emotional Issues."

Now, my definition of Emotional Issue has nothing to do with the DSM-IV (or V or whatever number they are on now) diagnostic criteria. My definition pertains to a particular thing that you do that has no proven scientific benefit; but by doing it, it provides you a sense that everything will be better if it is done. Now, I am not talking about OCD. I am speaking of the little things that people do because of anecdotal experience but have no literature support.

Here are some examples:

• When I would press fit an acetabular component under reamed by 1 or 2, I would put in at least one screw. My rep said I didn't need it, but it made me sleep better. So, we termed it the "sleep better screw." (for all of you with dirty minds, that would be an orthopaedic device)
• When I use allograft bone, I put gentamicin in it. Why? I have no studies to support it, but it causes no harm and it makes me feel better.
• How about antibiotics in irrigation? I am sure we can find articles for both sides.
  
• Webril under the tourniquet or not?
• To ioban or not?
• Pre clean with alcohol or preop hibiclens shower?

I am sure there are a thousand more that we can list. These are what I term Emotional Issues (EI). Things we do because maybe we had a "bad experience" when we didn't do it or because it helps us sleep better. Every surgeon has them. Sometimes it is seems like OCD. This is what causes residents such anguish when they switch services. What they may do for one surgeon may be a no no for another surgeon and visa versa. It must seem like a moving target.

In the end, we all have these hangups. For me, I realize these EI's are the equivalent of an emotional security blanket. But, they help me sleep better.

“There are moments in life, when the heart is so full of emotion
That if by chance it be shaken, or into its depths like a pebble
Drops some careless word, it overflows, and its secret,
Spilt on the ground like water, can never be gathered together”
~Henry Wadsworth Longfellow