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Stalin, Heart Surgeons, and Ben Carson
So as you can imagine, my family has been having a lot of conversations lately about cardiology and cardiac surgery. My father was already quite well-informed about the subject, because his own father suffered from cardiac disease (confirming the well-established wisdom that such things run in the family, and making me think it might be wise one of these days to have my own ticker checked out: What keeps me from doing it is not wanting to know, which I know isn’t the most courageous way to approach these matters. I’ll get around to it. I think I’m okay for now.)
Anyway, we’ve been talking about the personalities of people who go into cardiac surgery as a speciality. There are lots of stereotypes, of course: I liked this blog, written by a woman who in no way would I consult for any medical problem, given that she’s “a physician who is intuitive and a Reiki Master/Teacher discusses healing from ‘the front lines’ of the mind-body connection in the hospital setting.” But her description of the temperaments of cardiovascular surgeons seemed interesting to me:
Cardiovascular surgeons are the last of the “old boys school” for the most part. There are notable exceptions, which I will discuss later. They are emotional, angry titans who split sternums and work on some really sick people. Some contain it better than others. … I have seen patients die from pride of the surgeon and the anesthesiologist and the rest of the team. … Pride is an element in the heart room. Ego reigns. Dominance, aggression, control, continuity. There is no compassion. Not for anyone…
On this blog, Aaron Singh asks why surgeons have such big egos:
[The surgeons] were the ones who walked past you with a sense of purpose, with an expression that sent lesser medical personnel scurrying out of their paths in terror, and with eyes whose gaze could physically melt medical students if you weren’t careful. Several walked past us, instantly recognizable, and those who bothered to look at us did so with a disdainful expression, dismissing our existence as being too trivial to bother their exalted minds. They were Lords of their Domain; entire operating theatres were built as shrines to their greatness. Why shouldn’t they walk around as if they owned the place?
I’ve always wondered why surgeons seem to be more affected by the famous God complex that seems so prevalent in the medical profession. Recently, my cousin brother underwent surgery, as I talked about in my previous post, and the surgeon who operated on him, whilst perfectly competent, also demonstrated this uppity demeanour. She strode into the OT (fashionably late) without seeing him pre-op, and didn’t even check on him post-op. During the surgery she didn’t bother to reassure him; it was the nurses who did this.
Or take this quote from Frank C. Spencer, MD, FACS, Cardiothoracic Surgeon:
“Stepping into the operating room to perform heart surgery on a sick patient, being fully in control of the large team of people who are required to do the procedure, and feeling totally prepared to perform the task at hand is an unbelievable feeling that can barely be described.”
Or this one from Dr. Paul Corso:
Heart surgeons are aggressive, intelligent, driven people who have mental, emotional and physical endurance. We are born with all of these factors, but need to develop them into their highest form. Some people say heart surgeons are jerks, and we’re probably that, too.
“Cardiac surgeons,” writes Kathleen Doheny, “driven and dedicated, tend to see things in yes or no terms, says a physician in another specialty. ‘Fish or cut bait. They tend to be 
pushy.’ When a cardiac surgeon decides it’s time to head to the operating room, stand back.”
Anyway, this morning my brother and I were wondering how this personality type — and it is, it seems, a distinct one — would translate into a politician’s leadership style. We were playing a little game, trying to decide which figures from history would have been good cardiac surgeons. Perhaps Stalin missed his calling: Might he have been a fine cardiac surgeon instead of a bloody tyrant?
What about Ben Carson? I imagine that neurosurgeons and cardiac surgeons share 
similar temperaments, as a rule. Is a neurosurgeon’s temperament the right temperament for the President of the United States?
Are any of you cardiac surgeons? Neurosurgeons? Know any? Are the stereotypes true? Would knowing that surgeons share a personality type seem relevant to you in trying to figure out what kind of politician a surgeon might be? In Carson’s case, after all, knowing that he was a great surgeon is really all we know: So would that kind of personality be an asset in the White House or a liability?
(By the way, although I didn’t get to spend much time with him, my father’s surgeon seemed to defy these stereotypes: He’s a gentle and very devout Catholic who goes to Mass every morning, and seemed in no way a bully or a jerk. So obviously, there are exceptions.)
Published in General, Science & Technology
This is so true. Throughout these past weeks I’ve felt the contrast so intensely. I’ve spent the days at a hospital at which human beings (including Muslims, yes) are gathered to do some of the most complex, intricate work ever done in the history of mankind with the goal of saving as many lives as they can. I’ve spent my nights in a neighborhood where a few weeks ago a bunch of 7th century Islamist goons with 20th century weapons gathered to see how many lives they could end.
That hospital saved more lives this month than the terrorists ended. They do five major cardiac surgeries a day, probably all of them life-saving, and rarely ever do they lose a patient. So on balance, this month, the hospital won.
(I’m reminding myself of this almost hourly, because evil leaves an odious stain. Being close to it makes the whole world feel evil and minatory, when in fact it isn’t. Just some of it is. That hospital is just one of many dozens of hospitals in Paris where every single day, people show up and save lives. It’s very unusual — here — for anyone to think it’s a good idea to kill people. That’s precisely why it’s in the news when people do. It isn’t in the news at all that every single day, doctors and nurses and all the staff who support them go to work and do their best to make sick people well, succeeding at this at rates that even 20 years ago would have been unimaginable. But it’s true.)
Yes, on the one hand, the surgery is amazing — it saved my father’s life. There aren’t words adequate to describe what a blessing that is, are there? On the other, pretty clearly, it was a torturous experience. We (as in humanity, not me, personally) still don’t know how to do this without putting the patient through a lot of pain and suffering.
Just passing on what I was told.
I don’t watch television either. This logic does not yet make sense to me, sorry.
My father (lifetime smoker) also had heart issues and needed by-passes. His surgeon and cardiologists both did not seem to have an once of ego. I did not experience “the rule” people are talking about.
Smoking by the way is the worst thing for you. For the life of me I cannot understand the pleasure. As far as I can see it, the pleasure is just satisfying an addiction.
Same here. I personally like the man. I don’t think he’s got the experience to be president. But he strikes me as an intelligent man with humility. I don’t see any ego in him. And I don’t see any Trump crassness either. I can respect him.
Everyone, and I mean everyone, is weird in his own little, or not so little ways. Many of us are able to keep that weirdness hidden from the general public. Others are not so careful, or not so bashful, and the weirdness pokes its head out now and then.
Some of this weirdness is truly off-putting, such as Donald Trump’s need to constantly praise himself while claiming to be humble, or John Kasich’s constant interrupting as if he owns the floor, or Hillary Clinton’s inability to tell the truth about almost anything, or Barack Obama’s insistence that only he has pure motives while his opponents are driven by crass politics, or Ben Carson’s beliefs in various unusual things that most people find silly.
The question is: Which kind of weirdness, if any, impinges on the ability to be a good president, and ought to cost the candidate your vote?
ps: Cataloguing all of Obama’s weirdness would take me way over the word limit.
The reason WFB was adamant about not being governed by the Harvard faculty is that these brilliant folks have always been the smartest guys in the room and assume that if anything can be done, they are the ones who can do it. So they have little grasp of what can’t be known, let alone done especially done centrally by a vast unaccountable bureaucracy. They are poorly calibrated. Physicians suffer the same syndrome but at least they tend to live in a world where they know their specialty does not transfer to other specialities. They also depend on other specialists whose expertise doesn’t transfer. This doesn’t strike me as true of folks in humanities or social sciences.
I concur. The faculty types think they know enough about everything without having studied it. It’s a kind of contradiction, because they also believe that within their areas of expertise they alone are knowledgeable.
I was once in a meeting of 40 or so department chairmen discussing revisions of the general education curriculum for the university. The chairwoman of the psychology department commented that she did not believe economics should be a required course. She offered as an argument, “I have never taken an economics course.” To which I replied, “And yet for some reason you are allowed to vote.”
Excellent example to understand the medical profession.
Statistically, your wife may not have needed that procedure (and yes, her specific circumstance may have made it necessary—my wife had two, and neither was necessary). The rate of c-sections in America is far higher than anywhere else in the world, which suggests that most are not necessary and are done more for the safety and convenience of the doctor than the health of the mother and child.
Now it’s 30%. So most of the procedures that surgeon’s doing are not medically necessary, strictly speaking. But very profitable.
Perhaps pediatric neurosurgeons are a different category. They know beforehand they’re in for a world of hurt — even for themselves. I think they must choose the profession for the victories, knowing there will be gut-wrenching losses (a phrase used by Kate’s neurosurgeon when she was having complications — he was only willing to share it with another physician, who happened to be my sister).
I categorize them with astronauts — some of the bravest people ever born/made.
Not so much for profit, rather to avoid lawsuits. The bane of obstetrics is fetal hypoxic brain injury which invariably occurs during vaginal delivery. A C-section virtually eliminates the possibility of this happening and has a low morbidity/mortality rate for the mother. If you think surgery is traumatic, try being a fly on the wall for the duration of a lawsuit for a brain-injured infant.
You touch on a critically important issue: “medical necessity.” It is a term of art and means different things to different entities.
Those in the healing professions suffer from a great tendency to “do something” as opposed to refraining from action. Patients, by and large, want something done: demand antibiotics for a cold – where they’re ineffective and contribute to increasing resistance of bacteria to antibiotics. Long story short, there is a symbiosis between physicians and patients which creates a tendency to “medicalize” all of life. Physicians (and government!) bear more of the blame for this, but the public is not blameless. Omitting to do every imaginable thing can easily result in a lawsuit for negligence.
On the other hand, payers use “medical necessity: to decide whether or not to cover a medication or procedure. Their incentive is to define necessity narrowly, though some patients would definitely benefit. Long story.
You are singing my song, Westman.
This is a big and important topic and is found at the cutting edge (no pun) of political philosophy. Milton Friedman said the government will first take away our rights through health policy. In those days they would say who can oppose motherhood and apple pie (today that wouldn’t fly)? Now, the magic words are “scientific studies show,” and if it even remotely involves “health” we must shut up and do as we are told by the authorities; it is good for us (gun in home=”unhealthy”). Of course, many studies supporting progressive “science” are either deeply flawed methodologically or do not show what is asserted in the lay press headline.
Our present health financing system lacks rational incentives. In my ideal world, everyone would save for health costs and carry only catastrophic insurance. Decisions about cost vs. benefit would be at its most sensible locus: doctor and patient. Example – at end of life, do I prefer to use up my savings for a marginal increase in life span of unknown quality? Or, do I leave those resources for my family?
Currently, Medicare beneficiaries may command the expenditure of vast resources (other people’s money) at little or no cost to themselves/families within some limits set by a cold, uncaring bureaucracy in Washington. Either system rations care. I believe the first can be defended as the more just of the two. Of course, it is lethally politically incorrect.
In my wife’s case the baby was breach and several attempts to reverse that were unsuccessful. My wife told her doctor that her grandmother had 4 of her 5 children delivered breach and so wanted to try. Her doctor told her that she refused to deliver breach babies in her practice and that this decision was made after she lost one that way after the mother had talked her into it.
It was a simple statement but it could have hidden behind it the pain and trauma she experienced when she realized after the fact that the mother could be holding a little live baby in her arms instead of dealing with the true tragedy of a healthy baby killed by the birthing process when a more reliable method was available.
Dear Claire, You may have mis-read me (and the excerpt); it was the callousness of the neurosurgeon’s joking about the damage done that I (and the book itself) was highlighting (thereby supporting your original mis-givings). I probably should have provided greater context. In any event, my sympathies about your Mom; mine also passed too young in somewhat similar circumstances. Best, hf
Thanks for your sympathies, and mine for your Mom, as well. I wasn’t offended — I was just agreeing that yes, this sort of thing really happens.
JoALT had both of our children by C-Section. Our son had developed a leak of his amniotic fluid. Nothing urgent at the time, but it was not going to get better and so we agreed to induce. We went 12 hours of labor and she never got a good contraction – not one – then, at 12 hours, her temperature spiked to 104 – so we did a C-section. Healthy baby, healthy wife by the next day.
Four years later (plus a day or so) We were in the OB’s office discussing our daughter. The conversation went something like this:
OB: She is ready to come out – do you want to schedule the C-Section?
JoALT: I want to try the normal way.
OB: There is a risk with normal after you have had a C-Section.
Instugator: What is the risk; I mean, what is the liklihood and consequence of normal?
OB: The risk is 1:1000 and the consequence is life of the child, life of the mother or both.
Thing is, I know what 1:1000 means. When we drop bombs in support of friendly troops, sometimes we have to drop close to friendly positions. There is a distance associated with each weapon that is known as “Danger Close”. When we drop “Danger Close” there is a 1:1000 chance (or greater) that shrapnel from our bomb will hit friendlies. So we only do it in extreme necessity. (There are ways to manage frag patterns with J-series weapons, but that is another post.) 1:1000 is what defines “Danger Close”.
There was no way that desiring a natural childbirth justified 1:1000 odds.
We went with the C-Section exactly 4 years and 1 week after our son. Our daughter was born on Sep 30 (for insurance purposes – that too is for a different thread).
I will try to remember that in the future, and hope I remember to place a higher value on such opinions that you may have. I do not care to evaluate anybody’s personality or character through the lens of television, or even though second-hand television. Television is used to manipulate the perceptions of hundreds of millions of people, including those on Ricochet.
I have known many doctors, and I have never met a single one who would perform any surgery, including a C-section, on a patient who didn’t need it. I think there is something else causing problems to occur that result in C-sections.
My (limited) personal experience agrees with yours. I have had several doctors advise against me having surgeries that my wife thought would be a good idea. (Maybe I should take a closer look at her motives.)
Remember Obama’s comment that surgeons would prefer to amputate a leg or two rather than cure the underlying ailment because doing so would make more money for them? Or his comment about unnecessary tonsillectomies just for the money?
People are quite willing to believe such conspiracy theories.
Although it gets to the same point. Bad for business.
It’s quite clear at this point that there are long-term consequences for the mother, including difficulties in second pregnancies [pdf]. Doctors treat this as a low-risk, no-consequence procedure because that’s what it is for them. For the mother, and as we’re coming to understand for the baby, there can be life-long consequences. (Nice chart in that PDF, c-section rates are up to 40% in some countries!)
That’s for sure. Your antibiotic point is a great one, although this points to a failure for the individual doctors to treat patients appropriately.
I know a lot of surgeons. Much of what Claire writes is amusingly true but not enough to warrant serious consideration of Carson as being unqualified. One look at him onstage and any one, even some one viewing from waaaay off in France, can tell that his ego is not an issue.
Look at it this way. Neurosurgeons, cardiac surgeons, general surgeons treat very sick people with very precise techniques that are very hard to perform. They work very hard to learn and maintain these skills. They synthesize conflicting data and make life and death decisions. They take responsibility for their work.
Dr Carson has never run an organization larger than a medical school department, so he’s not a good candidate for President. But he’s a dam site better than what we have. Give me a neurosurgeon, a heart surgeon (Bill Frist), a gynecologist (Ron Paul), an opthalmologist (Rand Paul) over a community organizer any day.
What about Dr. Jill Biden? She’s a doctor, I’m told.
Re: #83 There are conflicting values here and no easy way to balance them. The decision to perform a C-section is made on the spot with the knowledge of possible future adverse consequences. It is understandable to me as a physician that the potential immediate consequence of a brain-damaged newborn outweighs potential future consequences to mother or baby. There is no easy way of balancing these concerns and obstetricians are not acting out of greed or bad faith.
One thing is certain, however, and it does inform decision making of obstetricians: in the factual setting where a damaged newborn results from failure to perform a C-section, the obstetrician cannot successfully defend him/herself from a malpractice claim by asserting that the mother would be at increased risk of future placenta previa or accreta. The legal system, unfortunately, just does not work that way. One judge put it well: “A lawsuit is a poor way to design health policy.” Yet, the way the medical negligence system works, that is just what happens.
The Big Three are cardiac surgeons, neurosurgeons, and orthopaedic surgeons. All are generally supreme egotists and lords of all they survey. Psychiatrists are in a class of their own, often because they didn’t want to get too involved with really sick people.
I’ve found from my work (which exposes me continuously to all of them) that hematologists are pretty decent.
That’s what evidence-based medicine is all about, guiding these decisions is a way better than just relying on the judgement of a doctor. There are metrics to guide these decisions:
Again, the US rate is 30%. The mortality rate for women who undergo c-section is almost four times that of vaginal delivery. You make the call about “bad faith”.
C-section rates (see second link above) are indeed higher depending on the legal climate. But isn’t that hard evidence of doctors putting their own interests first?
Not if you believe that there is any validity to the legal climate. That is, if OBs are made to pay millions in damages for “wrongful life” (thank you, John Edwards) and thus malpractice rates go shooting up, we all pay for it in higher prices for having a baby delivered. The legal system is signaling to the doctors that we want them to do C-sections when it is a close call.