How does an internationally trained anesthesia residents and consultant adapt to USA system for better safety and efficiency?
Medicine & Team Dynamics: Why "hate" bonds fast and "love" sustains care
In medicine, the question isn't abstract-it plays out every day in ICUs, ORs, and emergency departments.
1. The shared enemy effect (fast, functional unity)
In healthcare, the "enemy" is rarely a person-it's death, disease, time, or chaos.
Examples:
- A crashing patient in the OR
- Massive hemorrhage
- Septic shock at 3 a.m.
- A difficult airway
In these moments:
- Hierarchies flatten
- Communication becomes crisp
- Personal conflicts disappear
Everyone is united by a negative goal: prevent something bad from happening.
🔑 This is why crisis teams often perform exceptionally well despite poor interpersonal relationships.
But: Once the crisis passes, that unity evaporates.
2. Why crisis-based bonding burns teams out
Teams held together primarily by stress or shared adversity develop:
- Emotional exhaustion
- Cynicism ("us vs administration," "us vs patients," "us vs other specialties")
- Moral injury
In medicine, this often shows up as:
- Specialty tribalism
- OR culture toxicity
- ICU nurse–physician friction
The enemy shifts-from disease to each other.
3. Love-based cohesion in medicine (slow, powerful, protective)
"Love" in medicine doesn't mean sentimentality. It means:
- Mutual respect
- Psychological safety
- Shared purpose beyond survival
- Trust that persists when no one is dying
Research on high-performing medical teams shows:
- Teams with psychological safety make more errors-but have better outcomes, because errors are surfaced early.
- Compassionate leadership reduces burnout and improves patient safety.
Examples:
- An anesthesiologist who thanks the circulating nurse after the case
- A senior resident who covers a junior without shaming
- An attending who says, "That was on me."
These acts don't help in a code blue-but they determine whether the team functions tomorrow.
4. The paradox of medicine
Crisis Culture
Hate/fear-based unity excels Love-based unity endures
Fast coordination Long-term resilience
Short-lived Protective against burnout High performance under pressure High performance over time
Medicine needs both-but is often trained only in the first.
5. Why anesthesiology is a perfect lens
Anesthesia teams are:
- Temporarily assembled
- High-risk
- Dependent on trust without long history
You often work with:
- Surgeons you don't love
- Nurses you've never met
- Patients you just met
So anesthesiology thrives on:
- Professional respect over personal affection
- Micro-acts of kindness
- Clear leadership without ego
That's love in a professional form.
6. A practical takeaway
If you want a team to:
- Save a life today → give them a shared enemy
- Still care about each other next year → give them dignity, voice, and meaning
Or more bluntly:
Fear makes a team effective. Care makes it human.
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JASKARAN SINGH
clinical instructor
UW Medicine/Harborview Medical Center
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