Teamwork in all facets of life requires collaborative and collegial relationships
among the team members. A team is defined as several persons associated together in
work or activity. The original concept is the middle age English word teme—a group of draft animals.[1] A group of animals used to pull the cart is called a team. The actual focus of the
task is the cart which needs to go from point A to point B. This cart contains all
the valuables. The same holds for the team taking care of neurological impair patients.
Arrogance has been described as an obstacle to the performance of members of the team.[2] This can include an element of condescension due to differences in experience, knowledge,
exposure, and relationship with the task at hand. Arrogance is present among physicians
and this impacts the practice of medicine. Physicians are an instrument for healing
and comfort for the sick among humans.[3]
In neurosurgery and neurocritical care, teamwork and arrogance inside the teamwork
is an unexplored topic. Just like any other teamwork, the element of arrogance is
present in this team. Going on with the business and accepting this factor in this
teamwork neurological practice might not be the correct approach. Recognization of
presence is the first step toward a list of steps to overcome and make this teamwork
to take the patient from an extremely unstable stage to discharging home.
Once it is accepted that arrogance can be present, the next step is humility among
the team members, the key players are neurosurgeons and neurointensivist. Humility
includes selecting the treatment, daily conduct, listening to clinical information,
manner of intervention, and professional length of work.[4] A neurointensivist plays the role of a hinged door between surgical intervention
with anesthesia component and postoperative care to dealing with complications and
devices. Humility for the neurosurgeons in the team is to accept this hinged door
concept, while neurointensivist humility is to accept the surgical expertise of the
neurosurgeon.
Roberto C. Heros proposed six[5] competencies for young neurosurgery trainees which were intellectual honesty, scholarship,
practicing in a hyperlegalistic society, time and cost-efficient practices, dignity
for the patients, and pride in being a neurosurgeon, which carries a sense of elitism without arrogance. There is a need for a similar overarching statement for neurointensivists who are
part of this teamwork and can feel elite due to their unique training and fall victim
to arrogance.
In conclusion, education and recognition of arrogance in an elite group of physicians
is part of this process. Neurological impaired patients are unique and require teamwork
for the best outcome. Further research will open up this aspect of medicine and the
human relationship.
