Monday, February 27, 2017

Rude, Disrespectful Surgeons May Also Be More Error-Prone

Researchers compared surgical outcomes with patient reports of unprofessional behavior by their doctors at several health systems in the United States.

The investigators found that people treated by surgeons who had the most complaints had nearly 14% more complications in the month after surgery than patients treated by surgeons viewed as more respectful.

Complications included surgical-site infections, pneumonia, kidney conditions, stroke, heart problems, blood clots, sepsis and urinary tract infections, according to the study lead by Vanderbilt University Medical Center (VUMC) researchers.

Lead author Dr. William Cooper said surgeons who are rude and disrespectful to patients might also treat other medical professionals poorly, which could affect the quality of care. Cooper is a professor of pediatrics and director of the Vanderbilt Center for Patient and professional Advocacy.

“For example, 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,” Cooper noted.

Study co-author Dr. Gerald Hickson is senior vice president for quality, safety and risk prevention at VUMC. He said that “we need to reflect on the impact patients and families experience from there avoidable outcomes. From conservative economic estimates, the cost of addressing the excess surgical complications could amount to more than $3 billion annually.”

The findings also suggest that analyzing patient and family reports about unprofessional behavior could help spot surgeons with higher complication rates.

Hospitals could then take steps to improve the doctors’ behavior and, possibly, also patient care, the researchers said.

“Even though there was only a 14% 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,” Hickson said in the news release.

The study was published online Feb. 15 in the journal JAMA Surgery.

My Take:
I see this issue commonly in orthopedic surgery. It’s the doctor with the larger-than-life ego. I watched a video of one of my patients having shoulder surgery where the surgeon claimed he was fixing one of God’s mistakes by removing a “vestigial ligament” to make more room. “After all, we don’t walk on all four limbs anymore, you don’t need this ligament.” Six months later, the patient injured his shoulder while pushing a boat off a sand bar. Without that ligament, he could not use the shoulder to push, do a push-up, or walk on all fours.

The Bottom Line:
If you must have surgery, you want a doctor that is confident in their skills. However, avoid the surgeon with the real attitude, that dismisses your concerns and input. If you cannot develop a partnership with a physician, they should not be your physician.

Source: February 15, 2017 National Institutes of Health

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