Reports of surgeons' unprofessional behavior from co-workers linked to patient complications

There’s the old stereotype about surgeons being abrasive, arrogant and difficult to work with.

But a new study has found a link between surgeons whose co-workers have reported unprofessional behavior and a higher risk of postoperative complications for their patients.

Turns out unprofessional behavior by surgeons doesn’t just make life difficult for their co-workers, it’s bad for patients, according to the study published in JAMA Surgery.

Researchers looked at reports of unprofessional behavior by co-workers for 202 surgeons from two academic medical centers that participated in the National Surgical Quality Improvement Program. They also examined surgical and medical complications within 30 days of operation for 13,653 patients. Reported unprofessional behavior included concerns about poor or unsafe care, clear and respectful communication, a lack of integrity and failure to follow through on professional responsibilities.

RELATED: Disruptive docs make more mistakes in the operating room

Among the patients, 1,583 (11.6%) experienced a complication. The study found patients whose surgeons had more reports by co-workers of bad behavior were more likely to experience a complication than patients whose surgeons had no co-worker reports.

And the more reports, the more complications. Patients whose surgeon had one to three reports were at 18% higher estimated risk of complication and those who surgeons had four or more reports were at an almost 32% higher risk than surgeons who had no reports of unprofessional behavior in the 36 months before their surgery.

In addition, the researchers found that women surgeons were less likely to generate co-worker concerns than men.

The researchers said surgeons who demonstrate unprofessional behaviors may help to undermine a culture of safety, threaten teamwork and increase the risk for medical errors and surgical complications. Those complications included surgical site infections, pneumonia, renal conditions, stroke, cardiovascular conditions, sepsis and urinary tract infections.

The research provides reasons why hospital leaders shouldn’t turn a blind eye to badly behaving surgeons and physicians.

When translated nationally across the U.S. where 7 million surgical procedures are performed each year, that could impact about 500,000 patients who experience complications, said the study’s lead author William Cooper, M.D., Cornelius Vanderbilt Professor of Pediatrics and director of the Vanderbilt Center for Patient and Professional Advocacy at Vanderbilt University Medical Center in Nashville, in an interview with FierceHealthcare.

It's an expensive problem, he said. The medical literature estimates it costs hospitals $13,000 in direct costs per patient complication. That translates to an estimated cost from these surgical complications to be as much as $7 billion annually for the healthcare industry.

“These findings suggest that organizations interested in ensuring optimal patient outcomes should focus on addressing surgeons whose behavior toward other medical professionals may increase patients’ risk for adverse outcomes,” the study authors said.

For instance, the study authors write about a nurse who reports she asked for a time out during surgery because of a safety concern and was told by the surgeon, ‘Look, we’re all on the same page here. Let’s get going without all this time out nonsense.’ In another case, a physician from another service says he was yelled at for five minutes by a surgeon for not providing him with the necessary information after he started a patient on medication to raise blood pressure, which might make the doctor hesitant to speak up in future cases when a patient’s condition deteriorates.

“Hospitals that want to ensure optimal patient outcomes should really focus on the small number of surgeons whose behavior towards other team members may increase hospital patients risk for complications,” said Cooper.

Overall, 70% to 80% of surgeons never have a complaint about their behavior. So, what can be done to change the behavior of the small number of disruptive doctors?

“For the small number who are outliers, what we found is very effective is just sharing data with them—nonjudgmental, comparative data,” Cooper said. “We found 75% to 85% of the time, they will improve just by getting feedback on their performance relative to their peers.”

Surgeons, in fact, often are among some of the easiest colleagues to work with because they are eager to improve their performance and often experienced in reviewing data about their performance, he said.

Vanderbilt has a program where doctors are trained to share data with peers in a nonjudgmental, one-on-one meeting to encourage improvement when there are a high number of co-worker concerns, he said.

And it’s not just complaints from co-workers that hospitals should review. Earlier research found that physicians who receive complaints about behavior from patients and their families also had more complications.

In an accompanying commentary, three doctors said it’s time for changes in the surgical community and said promoting professionalism should be seen as #MeToo 2.0

One of the authors, Danny Chu, M.D., of the division of cardiac surgery at the University of Pittsburgh School of Medicine, recalled when he was a medical student, a prominent attending surgeon struck his fingers with a surgical instrument because he wasn’t holding the refractor correctly. The same surgeon threw instruments across the operating room when he was handed the wrong instrument.

“Those behaviors were tolerated decades ago, and all incidents were kept behind closed doors,” wrote Chu, Leonid V. Emerel, M.D., and Tara Kent, M.D. While the recent #MeToo movement has shed light on harassment in fields, such as the entertainment industry and the media, a hostile workplace is still not uncommon in academic surgical environments, they said.

The new study is the first to show an association between unprofessional surgeon behavior and clinical outcomes. “As surgeons, we should have a zero-tolerance approach to unprofessional behavior in the workplace,” they wrote.