IBC Oxford University Oral Abstract 31 - Dealing with the difficult bariatric surgeon in the operating room—a nursing perspective
Authors: Caurez C , Iannelli A , Amor I Ben , Chieric A 
Published: February 2025

Abstract

Introduction
In the surgical operating theatre (OT), roles are distinct, shaped by personality, professional experience, teamwork, and communication skills. The surgeon is a key figure, often striving for excellence, but their decision-making power can sometimes disrupt team communication, causing divisiveness. Anecdotal evidence of surgeons displaying tantrums towards OT nurses and other healthcare professionals is common. Such behaviours can impact individual and team performance. Despite this, there's limited research on abuse in the OT. This study defines what makes a surgeon ‘difficult,’ examines the incidence of harassment, and explores the consequences.

Methods
A questionnaire was distributed to paramedical (nurses) and medical professionals (surgeons, surgical residents, and anaesthetists) at our tertiary referral metabolic and bariatric surgery centre. The survey included 10 multiple-choice and 4 open-ended questions about surgeons' behaviours, their interactions with OT nurses, and the impact on the working environment and care quality.

Results
A total of 221 healthcare professionals completed the survey, 87.3% of whom were women. Most participants (77.3%) were OT nurses. All participants reported experiencing abuse by a surgeon at least once. Common forms of maltreatment included incivilities (86%), shouts (89%), and sighs (90%). Other significant abuses included intimidations (36%), moral harassment (28%), indecent language (47%), and abrupt gestures (66%). Depending on the abuse type, only 4–32% of victims reported no psychological consequences, with moral harassment having the most enduring effects (39%). Negative behaviours were attributed to stress (79.6%), difficulty managing emotions during surgery (62.9%), and a sense of superiority (57.5%). Most individuals (67.9%) chose to remain silent, while few attempted to clarify after disagreements. Dealing with a difficult surgeon complicated the OT job for 39.4% of participants, whereas only 3.2% were unaffected. Common consequences included team stress (83.3%), increased risk of mistakes (58.8%), and team unease (48.4%). Reduced performance and team involvement were less frequently reported (32.1% and 36.2%, respectively). Women more frequently reported experiencing incivilities (89% versus 69%), sighs (92% versus 76%), and abrupt gestures (69% versus 48%) compared to men. Participants over 40 years old more frequently reported indecent language (52.3% versus 38.2%), moral harassment (34.8% versus 16.9%), abrupt gestures (72% versus 57.3%), and intimidations (40.9% versus 28.1%).

Discussion
This research reveals prevalent surgeon abuses towards the OT team, posing significant challenges for OT nurses. These behaviours impact team dynamics and patient management, with notable differences in reports based on gender and age. The high participation rate among younger professionals may indicate behavioural changes in newer surgeons. However, the gender imbalance among participants and longer exposure of older individuals to various surgeons could introduce bias.

Conclusion
The survey highlights serious concerns about the aggressive behaviour of some surgeons, affecting both the working environment and patient care quality. Addressing this issue is crucial for fostering a respectful and collaborative working environment. Despite challenges, there is a trend towards improved interprofessional relations, suggesting a gradual positive shift in the OT.