Dr. Barkus Yellby…the doctor who yells.

I’ve never been the doctor who yells.  However, if you work in medicine, you’ve met him or her.  I’ll call this physician ‘Dr. Barkus Yellby.’  (For the younglings, this is homage to famed television doctor Marcus Welby:   https://www.imdb.com/title/tt0063927/.)

Not every physician who yells is Dr. Yellby.  Sometimes, and I’ve seen it, a physician yells out of passion, out of urgency.  ‘We need blood right now!’  I get that.  The same doctor is usually nice after the fog of battle blows away.  But that’s not the Dr. Yellby I have come to know.

The Dr. Yellby is angry.  A lot.  In the old days (and not so old days), he threw instruments in the OR when they weren’t what he wanted.  Or if the charts and labs weren’t ready for rounds, he slammed things on the desk and berated wide-eyed nurses who were holding back sobs.

As an emergency physician, I’ve talked to him any number of times on the phone.  ‘Did you even examine the patient?’  ‘Why are you calling me?’  ‘How is this my problem?’  I was reminded of Dr. Yellby a few months ago when I called a surgeon for an incarcerated umbilical hernia.  Silly me, I’ve been trained over the past few years to ‘finish the workup’ and ‘order the CT,’ so a CT I ordered.  ‘I chose…poorly.’

‘How long has she been there?  Did you even examine her?  Now I have to come back in and we’ve had a delay!’  On and on the berating went.  Heck, I didn’t think surgeons did anything without a CT scan these days.  Lesson learned.

I’ve been insulted, cursed and treated like a perpetual intern, all because I either angered the on-call ‘real doctors’ or because I dared to run my all too Appalachian mouth.  Dr. Barkus Yellby, having fussed at me, was deeply offended that I told him ‘I don’t need your crap.’  Shocked, he was, and threatened to report me to the medical board.  We long since made up.  But I smile looking back.

Some time ago I saw a young man who had a nasty open knee injury while skiing out of state. Rather than have surgery as recommended when he was evaluated near the ski area, he came home and went to the local ER.  He was concerned about costs and insurance.

I called Dr. Yellby.  (Remember, there are more than one…)  ‘So he refused care.’  ‘Well, not really,’ says I.  ‘He was worried about the money.’

‘So he refused care.  I get it.  I’ll see him in the office tomorrow.’  He was unhappy.

Today a physician, angry at his patient, told me ‘that’s the last time I’ll ever see him.   He’s yours now.’  I didn’t do anything to earn him, but that was that.  The patient’s family rolled their eyes in humor.  ‘Oh, he’s like that.  He’ll see him again.’  Dr. Yellby had clearly yelled at this family before.  Maybe they were in the habit of yelling back.

I sometimes wish I could be Dr. Yellby.  I’m more sarcastic, I guess.  Maybe passive aggressive.  Now and then it would seem cathartic to have the confidence, the bravado to simply ‘cry havoc and unleash the dogs of…’ well, not war, but at least medicine.  But as much as I wanted to, I never felt the yelling was beneficial.  Besides which, it has to be unhealthy for the ‘yeller.’  In my experience it only unnerves the team, who need the team-leader, ie me, to be calm in stressful situations.  Calm even in anger.

In the end, I’ve come to realize that Dr.Yellby yells most often because he (or she) is just, plain unhappy. It’s a way to rage against the universe, against trouble, against personal frustration and demons.  Maybe it’s a way for a tough, stoic physician to direct all of that inner turmoil to the nearest receptive target.  Dr. Yellby can be a sad figure, screaming in anger to cover up sorrow and loss, regret or substance abuse.

Then again, for a few, it’s bullying and nothing more.  And that’s the saddest of all.

Poor Dr.  Yellby.  Don’t fear her.

Pity her.  And say a prayer that she, or he, finds some peace.