People who are operated on by surgeons who frequently display rude and abrasive behavior toward patients and others are at increased risk of surgical and medical complications, according to a study published Wednesday in the journal JAMA Surgery.
The authors of the study suggest that those acts of disrespect by the surgeon raise the risk of poor patient outcomes because they can affect the entire medical team’s performance in the operating room and immediately afterward.
“Team members who experience disrespect may be less likely to speak up, ask for help, or see changes in patients’ conditions,” explained Dr. William Cooper, the study’s lead author and director of Vanderbilt University’s Center for Patient and Professional Advocacy, in a released statement. “For example, if a surgeon speaks disrespectfully to an anesthesiologist during a procedure, the anesthesiologist may become reluctant to speak up the next time the surgeon and the anesthesiologist work together. Similarly, if a nurse’s reminder to perform a safety procedure such as a surgical time-out is repeatedly ignored, the nurse may be less likely to continue to share his or her concerns with the surgeon.”
For the study, Cooper and his colleagues analyzed data from the National Surgical Quality Improvement Program (NSQIP) for 32,125 patients who underwent surgery at one of seven large academic medical centers across the country in the years 2011-2013. (The data contained no names to protect the identity of the patients.)
That data was then compared with patient and family complaints of surgeon behavior for the two years before each patient underwent an operation. (Again, patient confidentiality was protected.) Such data has been gathered by hospitals since 2000 to help identify and intervene with doctors who might be at high risk for medical malpractice claims. Other research has shown that doctors with high numbers of patient complaints about disrespectful behavior are an increased risk of being sued for malpractice.
The authors of the current study offer a few examples of the complaints they found in the database:
“I asked Dr. Y how long he though the operation would take. He said, ‘Look, your wife will die without this procedure. If you want to ask questions instead of allowing me to do my job, I can just go home and not do it.”
“Dr. X rushed us through the appointment so quickly, she didn’t even explain why she was recommending this procedure over the other treatment approaches.”
“I witnessed a tense exchange between Dr. Z and a nurse. It was difficult to watch someone try to humiliate another person like that. I was embarrassed and it made me feel vulnerable.”
After the data was collected, the researchers divided the surgeons into four groups based on the number of patient complaints they had received. An analysis revealed that patients whose surgeons were in the group with the highest number of complaints experienced 13.9 percent more surgical and medical complications in the 30 days following their surgeries than patients whose surgeons were in the group with the lowest number of complaints. Those complications included surgical-site infections, pneumonia, kidney complications, heart complications, stroke, sepsis and urinary tract infections.
The findings held even after the researchers adjusted them for several factors related to an increased risk of adverse surgical outcomes.
A broad impact
The study has several limitations. For example, there may have been some hidden bias in how the complaints were collected, and therefore the reports may not accurately reflect each individual surgeon’s overall experiences with patients. It’s also possible that some patients were not followed properly for a full 30 days after the surgery — an oversight that might have skewed the study’s results regarding surgical complications.
Still, the study’s strengths — particularly that it included data from seven different medical centers — are impressive. Its findings, therefore, are troubling.
“Even though there was only a 14 percent difference in adverse outcomes between patients cared for by the most respectful and least respectful surgeons, if you take those numbers and distribute them across the United States where 27 million surgical procedures are performed each year, that could represent more than 350,000 surgical site infections, urinary tract infections, sepsis — all kinds of things that we know can be avoided when surgical teams work well together,” said study co-author Dr. Gerald Hickson in the released statement.
“We need to reflect on the impact patients and families experience from these avoidable outcomes,” he added. “From conservative economic estimates, the cost of addressing the excess surgical complications could amount to more than $3 billion annually.”
What does this study mean for patients contemplating surgery? Well, patients have no easy way of finding out if other patients have observed disrespectful behavior from their surgeon, but they should certainly pay attention — and report it to the hospital — if they witness it themselves.
Patients may also want to reconsider using a surgeon whose behavior is questionable.
But hospitals need to get involved as well. They need to be more aggressive about intervening when surgeons — or any doctors — display rude, hostile behavior to patients, families, nurses and others.
As the authors of this study conclude: “Efforts to promote patient safety and address risk of malpractice claims should continue to focus on surgeons’ ability to communicate respectfully and effectively with patients and other medical professionals.”
FMI: The study can be read in full on the JAMA Surgery website.