When skill isn’t enough!
Walk into any spine operating theatre and you’ll feel the tension before the first incision is even made. The stakes are high: one slip of the scalpel, one misjudged angle of a screw, and the consequences can be devastating. It is precisely this environment—where technical mastery, unwavering focus, and absolute precision are demanded—that makes spine surgery such a fascinating but unforgiving specialty.
Yet there’s a quieter threat to patient safety and surgical excellence that doesn’t appear on MRI scans or intraoperative neuromonitoring readouts. It’s disruptive behaviour—the angry outbursts, the dismissive silences, the belittling comments, the slammed instruments—that can fracture trust within the team and undermine the very foundation of safe surgical practice.
The paradox is striking: spine surgeons are often some of the most skilled, intelligent, and innovative practitioners in medicine. But the same intensity that fuels our technical excellence can sometimes manifest as behaviour that alienates colleagues, silences junior staff, and even compromises patient care.
This is not a comfortable subject to explore. After all, no one likes to picture themselves as the problem. Yet the profession can’t afford to look away. The culture of surgery has for too long tolerated disruptive behaviour under the guise of brilliance. And it’s time to ask: does saving lives excuse destroying morale?
A Tale from the Theatre
Consider this scenario, drawn from a composite of real experiences many of us have witnessed.
Dr. X was a brilliant spine surgeon, admired for tackling the most complex deformities with elegance. On one particular morning, as he scrubbed for a high-stakes scoliosis correction, the theatre buzzed with quiet anticipation. Everyone wanted to be on his team; the operation was expected to last eight hours.
Two hours in, a technical glitch with the navigation system stalled the case. A nurse, new to spine theatre, struggled to recalibrate the device. Dr. K’s voice rose sharply: “How hard is it to get this right? Do you even know what you’re doing?” His words cut across the sterile air like a scalpel. The nurse froze. The anaesthetist avoided eye contact. The registrar, who had noticed the device wasn’t plugged properly into the power source, stayed silent, afraid of becoming the next target.
The mistake was eventually corrected, but the mood had changed. The nurse’s confidence was shaken, the registrar missed a teaching moment, and the team, once cohesive, now worked in guarded silence. The patient did well, but the hidden cost—the erosion of trust and communication—was significant. I have seen spine fellows who learn from surgeons who are disruptive and thinks that it is the way to get things done in OT or no one else will listen to you.
What Does “Disruptive” Really Mean?
In surgical circles, “disruptive behaviour” is sometimes dismissed as a catch-all phrase for surgeons with strong personalities. But the distinction is vital.
Disruptive behaviour is not about holding high standards or demanding precision. It is about conduct that interferes with the ability of others to perform their roles effectively. It includes:
- Verbal abuse or intimidation
- Demeaning or sarcastic remarks
- Throwing or slamming instruments
- Refusal to communicate or cooperate with team members
- Undermining colleagues in front of patients or staff
There are also subtler forms: refusing to return calls, dismissing input from other specialties, or belittling juniors under the guise of “tough love.” The unifying thread is the effect—it disrupts team dynamics and patient care.
Why Spine Surgery Breeds Pressure
Every specialty has its share of difficult personalities, but spine surgery occupies a unique crucible. The reasons are not hard to see.
The operations are long, physically taxing, and mentally draining. The margin for error is razor-thin; a misplaced screw or an unrecognized bleed can spell catastrophe. Surgeons shoulder enormous responsibility, often in environments where litigation looms large.
Add to this the culture of surgical training, which historically celebrated authoritarian mentors and stoic endurance.
Many spine surgeons came of age in theatres where shouting was normalized, and humiliation was a rite of passage. While younger generations are less tolerant of such practices, the echoes of that culture persist.
And then there is the nature of spine itself: complex, high-stakes, and laden with grey zones. Surgeons in this field often wrestle with uncertainty, with no single “right” way to tackle a deformity, tumor, or failed back. That uncertainty can feed insecurity, and insecurity, under pressure, can turn into aggression.
The Ripple Effects on Patients and Teams
The immediate victims of disruptive behaviour are the colleagues on the receiving end. But the deeper casualty is patient safety.
Research across surgical fields is clear:
When team members feel intimidated, they stop speaking up. The nurse who notices a skipped step in the safety checklist stays quiet. The registrar who spots a subtle neuromonitoring change hesitates. Silence, born of fear, can be deadly.
Case in point: a spine unit in the United States documented a rise in wrong-level surgery incidents. When investigated, it wasn’t a lack of skill or technology at fault. Rather, nurses and junior doctors admitted they didn’t feel comfortable questioning senior surgeons who had reputations for reacting harshly. A preventable error became an inevitable outcome of a silenced culture.
The consequences extend beyond safety. Staff morale erodes. Nursing and anaesthesia teams quietly request not to be assigned to certain surgeons. Talented trainees avoid rotations in toxic environments, depriving themselves of valuable experience. Over time, departments fracture, reputations tarnish, and careers stagnate.
When Assertiveness Turns Grey
It’s important to acknowledge the nuance. Surgery is not a gentle pursuit. Emergencies arise. Moments in the OR demand sharp, urgent commands. A raised voice in the face of catastrophic bleeding is not disruptive—it’s leadership under pressure.
The grey zone lies in intent and aftermath. Did the surgeon debrief afterward, thanking the team for responding swiftly? Or did they leave behind a trail of humiliation and fear? Assertiveness motivates; disruption silences.
A colleague once shared a story of his mentor, renowned for calm authority. In the midst of a sudden vascular injury, his instructions were crisp and commanding. The team responded like clockwork, the crisis was averted. Later, he gathered the staff, acknowledged their composure, and expressed gratitude. The difference was not volume, but respect.
The Roots of the Problem
Why do otherwise competent, even brilliant, surgeons fall into disruptive patterns?
Part of the answer lies in personality. Spine surgeons are often perfectionists, driven, sometimes bordering on obsessive. These traits fuel surgical excellence but can sour into impatience and intolerance.
Burnout is another culprit. Long hours, administrative burdens, and the emotional weight of complications sap resilience. Sleep deprivation dulls empathy. Stress narrows tolerance.
And then there is the legacy of surgical culture. Many senior surgeons trained under mentors who modeled disruptive behaviour as “toughness.” The lesson absorbed: this is how leaders assert authority. Without intentional unlearning, the cycle repeats.
Breaking the Cycle
Hospitals are increasingly unwilling to excuse disruptive behaviour. Not only because of its human cost, but also its legal one. Patient safety bodies now mandate reporting, and accreditation boards link professional conduct to licensing.
Yet punitive approaches alone rarely change entrenched behaviour. A more effective path combines accountability with support. Coaching, communication training, and peer mentorship have shown promise. Surgeons, like athletes, can learn emotional regulation and leadership skills.
One anonymized case illustrates this well. Dr. M, a spine surgeon known for fiery outbursts, was referred to a physician well-being program after repeated complaints. Initial resistance gave way to self-reflection when he realized staff actively avoided his cases. With coaching, he learned to reframe frustration, use structured communication, and solicit feedback. Two years later, he not only improved relationships but became a mentor for younger surgeons struggling with similar issues.
The lesson: disruptive behaviour is not destiny. It can be unlearned, if we’re willing.
A New Model of Surgical Leadership
Spine surgery is evolving rapidly. Endoscopic spine surgeries,Navigation, robotics, multidisciplinary spine boards—these advances reinforce that surgery today is not a solo act.For example, having another surgeon to help you for high stakes surgery or an experienced junior to assist you can dial down the tension in the OR.
The “hero surgeon” archetype is giving way to team-based models of care.
In this new landscape, the surgeon’s role is not only to wield the scalpel, but to orchestrate collaboration. The best outcomes will belong to those who can lead with both technical mastery and emotional intelligence.
Patients, too, are more discerning. They read reviews, speak to nurses, and sense the culture of a practice. A reputation for disruptive behaviour doesn’t stay confined to the OR—it follows into clinics, referrals, and career opportunities.
The Legacy We Leave Behind
Perhaps the most sobering reflection is this: surgical careers are not defined solely by the number of operations performed or innovations pioneered. They are also defined by the teams we build, the trainees we shape, and the colleagues who choose to stand beside us.
Years from now, few will recall the exact technical steps of a pedicle subtraction osteotomy performed in 2025. But they will remember whether the surgeon created an environment of fear or of respect.
One of my own mentors used to say,
“Skill gets you through the first decade. Character carries you through the rest.”
In the end, disruptive behaviour is not just a workplace issue. It is a legacy issue.
Toolkit: Handling Disruptive Behaviour in the OT
1. Immediate Actions (During the Case)
Stay focused on the patient – Patient safety is always the priority.
De-escalate calmly – Use neutral language:
- “Let’s focus on the patient right now.”
- “We’ll discuss this after the case.”
Avoid confrontation in the heat of the moment – Match urgency, not anger.
Redirect attention – Bring the team back to the task at hand.
2. After the Case (Debrief)
Hold a brief team debrief (5 minutes max).
Use the Stop–Start–Continue framework:
- Stop – behaviours that disrupted the team.
- Start – strategies that can improve communication.
- Continue – positive teamwork elements.
3. Feedback (Private, Respectful, Direct)
Apply the SBI Model (Situation–Behaviour–Impact):
- “During closing (situation), when you shouted at the scrub nurse (behaviour), she froze and we were delayed (impact).”
Focus on behaviour, not personality.
Always link back to patient safety.
4. Reporting & Accountability
Use institutional reporting channels (anonymous if necessary).
Ensure zero tolerance for repeated disruptive behaviour.
Leaders should follow up with documented conversations.
5. Support & Improvement
Offer coaching, stress management, or mentoring.
Encourage closed-loop communication (“I need X / I confirm X”).
Promote psychological safety – everyone has the right to speak up.
Acknowledge improvement publicly.
Closing Remarks
Disruptive behaviour among spine surgeons is not an abstract HR problem. It is a lived reality that undermines safety, fractures teams, and corrodes careers. It flourishes when excused, and diminishes when confronted with honesty, humility, and support.
The challenge for our generation of spine surgeons is not merely to master robotics, endoscopy, or new implants. It is to master ourselves.
In the operating theatre, skill saves lives—but behaviour shapes outcomes. Every word, every action, sets the tone for teamwork, safety, and patient trust. Disruptive behaviour may last a moment, but its impact lingers long after the incision is closed. The choice is ours: to be remembered as skilled surgeons, or as leaders who heal not just with our hands, but also with our conduct.
