Practical institutional politics for doctors.

Stewart Stonewall, MD, a star surgeon, stormed into the OR dressing room, threw his surgical cap and mask in the general direction of the trash container, and sputtered, “Dammit! I told them I’d need a resident to help with that case, but no! Dominie said they all had more important things to do. She’s sure Miss High-and-Mighty since they made her residency director. I’m going to go tell Masters a thing or two right now.” Still wearing his scrubs, he headed straight for the office of the hospital’s CEO. “Hi, sweetie,” he said to the CEO’s receptionist, “I need to talk to Freddy boy, if he’s not too busy counting profits to listen to one of the guys who’s keeping this place afloat.” “Mr. Masters is in a meeting,” she replied coolly, “but I’ll tell him you’re here.” She picked up the telephone and announced the surgeon’s presence. The CEO was doing paperwork that could have waited, but he chose not to see Dr. Stonewall. For years, he had kept his composure in the face of the surgeon’s repeated undiplomatic reminders of how important a busy operating suite was to the hospital’s bottom line. Now, with surgeons in oversupply and the surgical facility downsized, he no longer felt obliged to be deferential; there being no bond of mutual respect between them, he saw no reason to listen to Dr. Stonewall at all.