Consider the "why" factors of some surgeons' criticized behavior in the OR

Regarding "Doctors, nurses link bad behavior in the OR with errors" (Article, Aug. 21): In today's world of "understanding and tolerance," I must attempt to explain the origins of these perceived bad behaviors by surgeons.

In our medical climate, factors such as unforgiving liability, expanding overhead, decreased reimbursements, bureaucratic overregulation, hospital administrative oppression, uncompensated emergency care, Internet-informed pseudo-educated patients, and a generalized de-doctorization, need to be taken into consideration prior to passing judgment.

The perception appears to be that surgeons are simply prone to unprovoked tantrums, and while this is certainly the case on occasion during a stressful operation, fairness dictates that one must evaluate the other inciting factors.

By definition, a surgeon's job requires a degree of precision and concentration unparalleled by most professions. Often a perceived tantrum begins when operating room staff enters the room unprepared both in knowledge of and equipment for a particular planned operation. This angst may progress when the room temperature is magically and uncontrollably locked at 80 degrees Fahrenheit.

This petulance can be heightened further by a staff member's apparent nonchalance, apathy, or more specifically, lack of focus, since the patient who has entrusted you with their well-being really isn't the scrub tech's or nurse's, they're the surgeon's patient.

Combine the aforementioned occurrences with the occasional substandard equipment handed to the surgeon incorrectly. Now further imagine the bewilderment of wondering why the nurse has left the room when you need additional equipment or suture.

Clearly this scenario is not meant to condone dangerous and malicious behavior. But to simply talk about "training on appropriate behavior" and "zero tolerance" ignores the underlying factors, which are all too often ignored by administrators and bureaucrats. The examination needs to go much deeper than just the "what" in these scenarios, but also the "why."

Let's hold all members of the operating room team and administration to the same degree of professionalism and meticulousness inherently required of the surgeon and anesthesiologist. I contend that in the event of actual equality of expectation, the tantrum meter would drop. Until that time, I suggest that more "understanding and tolerance" is afforded the doctors on whom the ultimate weight of responsibility lies.

Devin M. Cunning, MD, Lake Havasu City, Ariz.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/09/25/edlt0925.htm.