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Unprofessional Surgeons have more Surgical Complications

Posted Monday, July 22, 2019 by Carl-Erich Kruse

A surgeon is more than just a steady hand. An article published recently in The Journal of the American Medical Association (“JAMA”) Surgery finds a correlation between surgeons’ (un)professional behavior and surgical complications. The authors set out to investigate whether patients of surgeons with a higher rate of coworker reports about unprofessional behavior experienced a higher rate of complications than surgeons with no such reports. They concluded that indeed there was a significant correlation.

The authors reviewed 13,653 surgeries performed on adults by 202 surgeons at two “geographically diverse academic medical centers” from 2012 through 2016. They reviewed the professional background for the 202 surgeons for coworker complaints of unprofessional conduct in the thirty-six months preceding the offending operation. The authors found that the complication rate was 14.3% higher for surgeons with one to three reports of unprofessional conduct and 11.9% higher for surgeons with more than four reports than for those with zero reports.

If we extrapolate those outcomes to all surgeries performed nationwide, the difference is hundreds of thousands of complications each year. What does the study mean, though, for improving those outcomes? The article does not address causation. However, hospitals should, in theory, already have systems in place to address personnel issues. And many of the reported behaviors have corollaries with hostile work environments. The authors did not distinguish the character of unprofessional conduct; the general term was meant to encompass things such as reports of yelling at co-workers, throwing of instruments, or violating hospital policies. For a patient’s surgery, each of these “work environments” is reduced to that patient’s individual experience. After all, a successful surgery requires good communication, respect, and situational awareness. Not clearly explained or addressed in the article is that perhaps these hostile environments interfere with the smooth process of a successful surgery, by putting up barriers in communication or situational awareness, or even simply distracting the staff in the room. This area may be fodder for further research.

From a patient’s perspective, there is frustratingly little we can do to research our surgeon’s background. Washington law, for example, protects as privileged all hospital records in a doctor’s file related to quality improvement. This likely includes individual reports by hospital staff of unprofessional incidents. Where we have a choice, as patients we are therefore tasked with using our gut instinct. For hospitals, however, correlating unprofessional incidents with bad patient outcomes should spur greater urgency for intervention.

Read the original report here.

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