The brilliance tradeoff.

A few weeks back I spent five days in hospital. This is the longest hospital stay I’ve ever had and – as with many hospital stays – it was quite unexpected.

I’d been cleaning up part of our garden and a spider had apparently bitten me on the leg. At the time I didn’t feel or see any spider, but five days later what started as a small itchy pimple-like sore had started to grow into a scary-looking ulcer.

One doctor gave me some oral antibiotics which had no effect, and another doctor suggested I go to the emergency department to get it examined. He said they’d probably just cut it open and drain it, and it would probably only take an hour or two.

However, once the ED doctors had made their examinations, they instead concluded that I needed five days of serious antibiotics through a drip, three times per day, as well as some skin surgery to make sure the infection was eradicated. It turns out that the wound had become infected and “necrosis” was involved. Sounds bad, right? Without significant treatment, it would certainly have worsened.

Surgical intervention.

I hadn’t really been told much about any surgery – only that it was a possibility. And then one day in hospital, I’d been informed that I’d been put on a surgical list for the next day.

I’m someone who enjoys having some sort of say in what’s going on with my body, and the fact that nobody had really told me what the surgical procedure was all about was quite grating. I asked the nurses to try to contact the surgeon, as they had no real knowledge of what was planned either.

Later in the day, they told me that the surgeon would drop in to speak to me in the morning of the planned surgery to explain what was needed.

I am somewhat skeptical of the opinions of surgeons, ever since one told me that I must have knee surgery if I’m ever to play sport again. It turns out that this wasn’t true. I never had knee surgery, and I still play sport twice per week (when I haven’t been bitten by a spider).

As a result, I am aware that surgeons – like everyone else – are fallible and have limitations. As with any profession, there are those that are very driven, and while I don’t believe that they are intentionally going out to cause harm, they may not think twice when it comes to suggesting surgery even if it might not be the only available option.

That being said, I wasn’t aiming to decline the surgery. I simply wanted to know exactly what the procedure was, what it aimed to achieve, and how invasive it might be. That’s not too much to ask when someone is about to slice into you, is it?

Strengths and weaknesses.

The surgeon arrived early in the morning and greeted me, full of energy and with good humour. They enlightened me on the particulars of the procedure, and the reasons for it. It seemed clear to me that the surgery was a necessary precaution, to ensure the infection was completely removed and that it wouldn’t return.

And quick as a flash, the surgeon was gone again. No doubt off to see the many other patients that required their services. They were very friendly and we got along well, but something in the surgeon’s demeanour told me they thought they were doing me a favour by coming to speak to me before the surgery.

The surgery was a success – my leg has not been eaten away and the wound is healing well. So this is not a story about failed or unnecessary surgery. Instead it’s a story about strengths, weaknesses and expectations.

Because what I noticed in the hospital that day is not unusual in other settings. What interested me most were the dynamics surrounding the surgery. The ward doctor and infectious diseases specialist involved with my treatment, along with several nurses, had no idea what the plan was with regard to the surgery in the lead up to the event. They didn’t seem to know exactly what the surgeon would do, or how invasive the procedure might be. They didn’t even know if it was going to happen or not – only that it was a potential option.

The nursing staff were very helpful. They tried to contact the surgeon to work out what the plan was, but were unable to reach them. Early on in my stay, nobody could tell me whether I would actually need surgery or not, or whether the procedure could be done with local or general anaesthetic.

As such, the nurses spent time throughout the day looking at the surgical lists to see whether my name was on them. That was their way of monitoring, so they could tell me what the plan was. You don’t have to be a clinical professional to know that this is not an efficient use of time. It would have been much more efficient if somebody had simply informed them of the proposed plan, so they could pass it on to me.

All this is to say – my surgeon had a particular style. A style that caused confusion for the people around them. Other doctors, specialists and nurses were all trying to work out the plan, so they could tell me what it was. My surgeon was technically brilliant, supremely qualified, and sits on several different surgical boards. But I would judge that my surgeon perhaps wasn’t the best communicator in some situations.

The only communication that was clear was from their team who wanted me to sign the consent for the surgery and pay an up-front cost… before I even knew what the procedure was. And when I replied that I’d like to understand the procedure first before I pay or give consent, please, the surgeon suddenly appeared.

“They’re really great though”

This phenomenon doesn’t just happen in the medical field. Far from it. I’d say most organisations in every industry in the world have people like this running around.

That’s not to say they don’t add value. They obviously do, because they’re highly skilled, qualified and competent. But it’s the rest of the package that can cause disruption and stress for the people around them.

Several times during my hospital stay, when nurses or other doctors were speaking about the surgeon, I noticed that they felt compelled to add a suffix to their sentences:

“… they’re a really excellent surgeon though”.

As in “we’re just trying to contact them, we haven’t been told what is happening… but they’re really great”.

You might have noticed this in your workplace as well.

It’s about the person who is the technical expert on a particular process, system, or piece of legislation, but has a prickly personality and is difficult to deal with. It’s the person who gets more clients and makes more sales than everyone else… but is rude to the colleagues and administrative teams that support them. Or maybe it’s the person with the brilliant mind and a chaotic way of working that leaves a mess behind them.

And we tend to tolerate it. We tolerate it because the potential issues that the brilliance creates seem relatively minor when compared to the benefits. After all, wouldn’t I rather suffer some poor communication than die from a rapidly-worsening spider bite wound?

Am I being ungrateful?

Perhaps it’s simply too much to expect that someone should be a technically brilliant, competent and qualified person and be good at everything else, too.

The tradeoff.

We accept this type of situation because we understand – consciously or otherwise – that it’s all about making a tradeoff.

Sometimes we accept such a tradeoff because a person’s technical expertise is in limited supply. Or because they hold a high level of authority. At other times we accept the tradeoff because of the potential risk or upside they bring from maintaining strong relationships with others.

I think the underlying theme has a scent of powerlessness. If we feel that we are not in a position to push back or critique dysfunctional behaviours, then we’ll let them slide. If we know that the angst-inducing person is a critical and unique part of delivering our service, we’ll look the other way when we notice problematic behaviour.

But we’ll still feel the tension. It’s that tension where we know something isn’t quite the way we’d like it to be. The tension which encourages us to say “but they’re really actually great at what they do” as a justification for why we let brilliant people get away with not-so-brilliant behaviour.

So what happens if we don’t fall under the “brilliant” category? If we aren’t as qualified or intelligent as those we are dealing with? Are we condemned to suffer at the hands of those brilliant minds who can do as they please?

I think it’s important to remain conscious and aware of the tradeoffs we are making in these situations. We don’t necessarily need to agree with or be content with them, but it’s worth knowing that they exist.

Because when we know the tradeoff is there, we can make a decision as to whether we are willing to let it remain. And if we aren’t willing, we may consider our options to reduce the tension.

And for those brilliant souls that provide so much value – along with a certain degree of angst – it’s worth wondering what the whole package might look like if the angst wasn’t a part of it.

It may be too much to expect a brilliant person to be brilliant at everything, for we are all born with strengths and weaknesses. But improvement is something we can all strive for, and not just to strengthen the things that we are already so very good at.

Or should we just accept that brilliant people get a free pass?