Veith's Views

Witch hunts and hidden agendas


 

References

Witch hunt: An intensive effort to discover and expose disloyalty, subversion, dishonesty or the like, usually based on slight, doubtful or irrelevant evidence, and to punish accordingly.
 - Merriam-Webster Dictionary

Over the years, several excellent vascular surgeons have either lost their jobs or been pressured to resign for reasons that are unclear – although in some instances a few particular cases with bad outcomes have been cited as a reason.

Vascular Surgery is a difficult specialty. If one takes on challenging cases that need treatment – patients with large complex AAAs, extensive foot gangrene, or high-risk symptomatic carotid disease, an occasional poor outcome can be expected even if everything the vascular surgeon does is correct. One, two, or three bad outcomes per year in a busy vascular practice are inevitable, and should not be a reason for a vascular surgeon’s termination. Something more must be involved. Likely it is a hidden agenda.

That something can best be summarized by the term “medical politics.” This term may sound benign. In fact, medical politics are anything but benign. In the case of vascular surgeons, they are often subject to the governance and direction of administrators or senior surgical leaders who have little understanding of the risks of complex vascular surgery, and are interested only in the money generated by vascular admissions and procedures. Quantity and dollars trumps quality most times in the eyes of these administrative leaders.

Moreover, these leaders are not immune from the frailties of bias and jealousy which motivate much of human behavior. Throughout my career I have seen many instances when such administrative leaders resented a vascular surgeon because he or she used many hospital resources for a large practice, was successful academically, but behaved “too independently” from the larger department or its leader. It was one reason, vascular surgery needed to be its own independent specialty rather than a part of general surgery.

In the case of the vascular surgeons facing termination for reasons that they cannot understand, there is usually an administrative superior who is involved. Perhaps the vascular surgeon has questioned the authority or judgment of the superior on the grounds that they do not understand a particular vascular surgery issue. The resulting anger of the superior prompts him to want to eliminate the vascular surgeon who is under his administrative control. The witch hunt begins and may be inflamed by other unjustified motives such as jealousy or other hidden agendas which may never be known.

Once the witch hunt has begun, if the vascular surgeon has one or a few cases with bad outcomes, they make him or her vulnerable to the unjustified attack leading to termination by those who do not understand the nature of vascular surgery. Other factors, e.g., a disgruntled or jealous competitor in vascular surgery, can exacerbate the situation and accelerate the termination. The few bad-outcome cases, however, are the excuse or smoking gun which is used as the reason for termination. What goes unrecognized is the fact that every competent vascular surgeon who treats sick patients has such cases which can be used if uninformed enemies wish to focus on them.

How can a vascular surgeon protect him or herself from such witch hunts? First, they must be aware that the nature of vascular surgery and its requirement for treating challenging patients makes them vulnerable if one or another superior dislikes them or is “out to get them.” Second, if one is dealing with a case likely to have a bad outcome, it should be discussed beforehand with superiors, and it is wise to get help from a colleague who can share responsibility if things go poorly.

Third, try not to make enemies of important administrative leaders by challenging their authority or judgment.

Share successes with them, rather than taking all the glory. It will help to neutralize their jealousy. If possible, be humble. Make as many friends in other specialties as possible. They can sometimes diffuse the intensity of a witch hunt. And lastly be aware that any vascular surgeon, particularly a good one, can be the subject of a damaging witch hunt in the imperfect world in which we function.

Dr. Veith is professor of surgery at New York University Medical Center and the Cleveland Clinic and an associate medical editor for Vascular Specialist.

The ideas and opinions expressed in Vascsular Specialist do not necessarily reflect those of the Society or publisher.

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