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Stanford University School of Medicine

Patients of high-complaint surgeons more likely to experience complications

doctor-650534_1920Patients treated by surgeons who are brusque, dismissive or disrespectful to patients and other caregivers are more likely to suffer complications, a new study shows.

The research, which appears today in JAMA Surgery, linked complaints — which often took the form of comments submitted to a hospital in response to a survey — to complications ranging from infections to blood clots. Among a group of more than 32,000 patients from seven academic medical systems, those treated by surgeons receiving the most complaints were 14 percent more likely to suffer complications post-surgery than patients whose surgeons had the least complaints. The researchers tapped two national data sets for the information.

The complaints ranged from surgeons rushing through appointments and being rude to nurses to rudeness toward patients and families themselves. "I asked Dr. Y how long he thought the operation would take," one complaint read. "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.'" 

Researchers from Vanderbilt University Medical Center led the multi-institutional team, which included Stanford surgeon David Spain, MD.

In an email, Spain said the outcome made sense, but that no one had demonstrated it before. He emphasized that the study design did not include complaints made because a patient experienced a complication.

The researchers further explain in the paper:

Patients and families are uniquely positioned to observe physicians' behavior and performance. Although anesthetized patients cannot observe what happens in the operating arena or outside their hospital room, analysis of their collective stories offers insight into how physicians may also interact with other medical professionals. Disrespect and rudeness toward other professionals affect willingness to share information and seek help and, in turn, may affect both procedural and diagnostic performance.

Concerns about a surgeon who previously lashed out at an anesthesiologist during an intraoperative emergency may distract the anesthesiologist from recognizing a change in the patient's status or inhibit him or her from speaking up...

If a nurse notes a break in the sterile field or violation of safety protocols... the nurse may be less likely to share his or her concerns with the team if he or she has been ignored or disrespected by the surgeon...

The authors also noted that their study "provides additional insight into why a small subset of surgeons attracts a disproportionate share of malpractice claims." Spain said the work isn't likely to lead to immediate reform, but it might provide support to ensure "disruptive physicians" receive guidance.

Previously: Small number of physicians account for many malpractice claims and Stanford Medicine magazine opens up the world of surgery
Photo by marionbrun

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