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Send to a FriendCollegiality can be defined as respect for one's colleagues and for their professional endeavors. During my year as President of The Society of Thoracic Surgeons and as a current member of its Standards and Ethics Committee, I have become aware of situations which suggest that collegiality, as we have come to understand it, is disappearing from our specialty. Let me cite a few examples.
A senior cardiothoracic surgeon, well established and recognized in his community, permits the hospital in which he works to publish, in local newspapers, the mortality statistics for cardiac surgical procedures of his hospital as compared to a hospital located thousands of miles away. The only apparent relevance of the other hospital's data is that its former Director of Cardiac Surgery has relocated to the advertising hospital's community and now works at a competing hospital. A senior cardiothoracic surgeon, experienced in a complex and infrequently performed cardiac surgical procedure, serves as a plaintiff's witness against at least three other surgeons in cases that involve this same surgical procedure.
A respected cardiothoracic surgeon, opposed in principle to a national randomized clinical trial that compares medical and surgical therapy, states in a newspaper article that "the surgeons who are participating in the trial are acting unethically." He is also quoted as stating: "I don't how they can look themselves in the mirror."
A young cardiothoracic surgeon, appearing on a major television network, labels the use of cardiopulmonary bypass for coronary artery bypass grafting "dangerous" and, in an article in a national magazine, terms its use "barbaric", thereby publicly impugning the competence of cardiothoracic surgeons who use cardiopulmonary bypass, and who continue to believe that it is safe and essential for the performance of this procedure.
A group of highly successful and respected general thoracic surgeons advertises in their local daily newspaper that: "Thoracic surgery is not work we dabble in; we do it full-time", thus implying that surgeons or groups of surgeons who do not do general thoracic surgery exclusively (and they are clearly the majority), may be providing inferior care. No data are presented to support this statement.
These examples are not fabrications, but real events. While they are not illegal and at least several of them may not represent unethical behavior in the broadest sense, they are not, in my opinion, examples of collegial behavior, and they certainly do not reflect positively upon the individuals who are responsible for them or upon our specialty. Is such behavior necessary? Does it provide the claimant with a competitive edge or some other advantage that he or she does not already have? Is it worth the enmity that inevitably results? Does it send the right message to our patients, and to our trainees and younger colleagues?
Lack of collegiality amongst surgeons in our specialty is not a new phenomenon. However, I sense a declining sensitivity to this issue in these increasingly troubled times. Unquestionably, there are wonderful examples of cardiothoracic surgeons working together to advance our specialty and our profession, and they should be applauded. My fear, however, is that these positive endeavors will be overshadowed by the negative images that are generated by the types of behavior I have cited above. I hope I am wrong.
Advertising in the media is becoming more prevalent among cardiothoracic surgeons and this practice will continue and likely increase. Currently (and fortunately), we lag behind the plastic and reconstructive surgeons and the ophthalmologists in the magnitude of our promotional advertising activities. I hope we will remain so. Although advertising can not be prohibited, we should not tolerate advertising or any other public activity which disparages a colleague. Unless we openly confront and criticize the individuals who engage in this type of activity, it will continue. We must not be reluctant to do so.
These are extraordinarily difficult times for the practitioners of our specialty. We face considerable adversity on many fronts. We are at risk for fragmentation, which will dilute our strength and our ability to deal with the critical issues that threaten to weaken our specialty and our ability to provide optimal care to our patients. The types of behavior cited above will only increase this fragmentation. It is thus more important than ever before that we treat our colleagues with respect, and that we be honest and forthright in our dealings with one other. This is an essential component of professionalism, a credo that must never be compromised.