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Private Practice Column

Episode 23: Crossing the Junction: how to work with people who want to see you fail

“Nothing is permanent in this wicked world – not even our troubles” -Charlie Chaplin

This past November I got a particularly bad flu that had been going around.  I was feeling particularly crappy just being sick but also some very difficult times with events around the world.  I got better, of course, just in time to leave town for Thanksgiving.  We tried to work my schedule so that I don’t do anything major before I leave town.  Which is akin to telling a cat to do a crossword puzzle, but I do try.

Even with that, patients have a tendency to have issues right before or right after one leaves town. If I have someone or some issue on the bubble, I am able to call on colleagues and frankly, competitors, who are willing to be there to back me up.  I’m fortunate that I can call on these surgeons to lend a hand. It took years, getting to know these other surgeons, both ortho and neuro, and for them to get to know me. If I have a spine case, I can call either, and obviously a neurosurgeon in another group has been great backing me up for cranial cases.  I am fortunate that I have to pull the favor card rarely, but I have help if I have to go out of town.

When I first started at my hospital, I came in like a bull in a China shop and should have been a little more subtle. It ruffled some feathers – and I ticked one or two people off just my showing up.  Instead of hanging out and meeting some of the other surgeons, I jumped at the chance to start taking call and introduce myself to the ER docs.  I figured it was easier to ask for forgiveness than permission.  Getting fairly busy in a reasonable amount of time, I took a lot of call and saw a lot of cases.  There were better ways, looking back to show up than just come crashing in.

While I did make the effort, introducing myself to the chief of the service.  It was a rocky start, as when he did ask me to come on one night for him (there was no formal call schedule and it was catch as catch can) I couldn’t as my father-in-law was hospitalized having just undergone an emergency cardiac bypass and was on a ventricular pump. It was touch and go for him. 

I kept working, really without much break, for about 5 years.  Relations with the other people on staff got better as I got settled in and folks got to know I tried to work hard, show up when called, behaved as a mensch in the operating room, and offered advice if colleagues ever hit me up.  I covered other colleagues if they left town and their partner could not, or if one of the mid-levels needed some oversight and they were stuck in the operating room and I was around. 

Goodwill is a really good way to build interpersonal capital. During M and M I don’t really chime in on someone else case unless someone asks me.  I present my own cases when they come up with a sense of humility, straightforward, and definitely with a sense of the gravitas. 


For me, things settled down but it took a significant amount of time and change.  New surgeons come on and some go, and I keep my head down and grind on.  12 years on, and I’ve been through my share of crap, but I have also showed my ability to not get into trouble most importantly, but also how to fight my way out of the den of bears when I step in it.  Working alongside other surgeons who do the same thing, and we compete for some of the same patients, I have learned to not take it personally (for the most part), but also to work hard to be better and to build trust and a good reputation out in the community. 

My personal experiences being solo for most of my professional career have been critical life lessons. When others see how you handle not just the easy stuff but when stuff goes left instead of right, either passing in the hall, chatting with the OR front desk staff, or even M and M, your modesty and competence can help you not only mature, but also create a sense of community with your fellow surgeons.

Personal enmity can always get in the way of building relationships with people you need to back you up, but also share patients with. And sometimes, help you out when everyone has been doing fine, and you are on that

plane to visit your mom and suddenly someone’s leg pain came back gangbusters or clear fluid is leaking from their scalp.

Showing your colleagues personal accountability on your own cases but also if you see their patients in clinic, not needing to shove your colleagues under the bus even given the opportunity. Part of being a mature surgeon, and frankly and adult, is being able to express your opinion without putting someone else down or out is one of those Maslow achievements we should all get to.

There is a certain dance we do with people we compete with but also paradoxically rely on.   Abiding respect and basic understanding that we are all good surgeons and decent people is a good start. While we may count on partners, people outside our own practices offer a unique perspective on our own selves. Many times, external colleagues are gracious and even helpful. While you may never “date,” certainly there are good opportunities for collaboration or even helping out in a jam. 

In neurosurgery, we are bred to be fiercely independent and that we are the smartest people in the room. We have to realize that although that may be true, that at one time or another, we may need a friend or two.

And at the end of the day, don’t be a putz. We are all in the same boat, more or less.

Happy Holidays to all, and to all, a good month. And, as my dad used to say: “good luck and good bowling.”

Take care and be well.