Surgeons: the hospital’s nomads

Surgeons lead nomadic lives in hospitals. Nomads have no fixed habitation and regularly move to and from the same areas (special thanks to Wikipedia for this non scientific definition, but for this purpose it will do). Surgeons travel between places that are run by nurses, in order to service their patients. Interestingly this type of nomadic life – travelling to where clients are – is seen among gypsies or Roma people, but these are not the first kind of people you think about when doctors are concerned. However, unlike nurses who mostly work from a fixed home base, surgeons move around the hospital. The only thing that comes close to home is perhaps the outpatient department.

In the social network of surgeons this nomadic way of life is not visible, as these networks do not take place and time into account. But you can see something else here. In contrast to nomads, we see in these networks that surgeons do not act as a group. Below you see the social network of one eye surgeon (left) and one general surgeon (right). The eye surgeon clearly has a different social network from the general surgeon. Surgeons do not travel in groups, but alone.

Netwerk oogartsNetwerk chirurg

Another contrast to nomads* is that wherever the surgeon lands he is the ‘primus inter pares’ or ‘the boss’ if you like, when it comes to treatment policy, whether to discharge a patient or how to care for the patient. This can cause an interesting tension between the people who run things at home (nurses) and those who walk by giving the orders (surgeons). From what I have seen in the hospital this appears to be an accepted and natural division of roles (this also includes making jokes or mocking about each other).

What intrigued me when observing these surgeons and analyzing their working schemes was the complete lack of a repetitive rhythm in it. Below you can see three graphs of three weeks. On the X-axis are the days and times of one week. The Y- axis represents doing surgery (1) or doing something else (0). The different colours represent the 5 different surgeons. Each week is different for each surgeon, both in number of surgeries as well as at what time and frequency they do surgery.

Rhythm surgeons

So, not only do surgeons travel all the time, they do so in a variable rhythm. Once on their destination they have to focus on complex tasks, having full responsibility for most of what happens in places they stay in temporarily.

As a consultant I have been involved in many building projects where the personal room of doctors was to be replaced by something like a shared backoffice. Even though it is true that outpatient rooms generally have low occupancy rates, I must admit I now much better understand the doctor’s resistance against losing that space. Without that – or some kind of informal group space – he or she could feel like a real nomad, belonging nowhere.

* I don’t know much about nomads but it is my impression that they do not particularly rule the place they stay in, in contrast to surgeons who (have to) take the primary responsibility and medical knowledge to treat patients.

 

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