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How can surgeons avoid 350,000 surgical complications and save $3 billion? Respect patients

3/13/2017

The Daily Rise: A regular digest of the stories and news that affect patients.

Study: Patient complaints can identify worst-performing surgeons

Patients have long known that rude and disrespectful providers are bad for our health. There's new evidence to back us up.

According to a new study published in the February edition of JAMA Surgery, "rude and disrespectful behavior can identify surgeons with higher rates of surgical site infections and other avoidable adverse outcomes." After reviewing data for 800 surgeons and 32,125 patients, researchers from Vanderbilt University Medical Center found that surgeons with more complaints for unprofessional or disrespectful behavior had a 14 percent higher rate of surgical and medical complications.

"Patients and their families are uniquely positioned to observe physician behavior and performance," lead author Dr. William Cooper of Vanderbilt University’s Center for Patient and Professional Advocacy, told Science Daily. "And analysis of their stories provides insight into how physicians who interact with patients with disrespect and rudeness might also interact with other medical professionals and how those interactions could impact patient care." 

CBS News highlighted two examples of misbehaving surgeons from the study:

  • "Look, your wife will die without this procedure," a surgeon told a man, according to one complaint. "If you want to ask questions instead of allowing me to do my job, I can just go home and not do it."
  • "It was difficult to watch someone try to humiliate another person like that," one patient complained, after witnessing a doctor berate a nurse. "I was embarrassed and it made me feel vulnerable."

Consequences: 350,000 Surgical Site Infections, $3 Billion Per Year

Patients may be reluctant to file a complaint about an irritable or unfriendly doctor. Maybe he or she was just having a bad day?

Study co-author Dr. Gerald Hickson, senior vice president for Quality, Safety and Risk Prevention at VUMC, explains the broader implications from that 14 percent higher rate of surgical complications.  

"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," he tells Science Daily. "All kinds of things that we know can be avoided when surgical teams work well together." 

Among those surgical complications: surgical site infections, pneumonia, renal conditions, stroke, cardiovascular conditions, thromboembolic conditions, sepsis and urinary tract infections. Based on his conservative estimates, the cost is more than $3 billion per year.

"We need to reflect on the impact patients and families experience from these avoidable outcomes," he cautions.

Disrespect silences the patient's voice

Why would boorish behavior or a bad bedside manner lead to a higher rate of surgical complications? 

Researchers don't have a definitive conclusion but point to a number of possible reasons. For starters, disrespect silences the patient and discourages a patient from speaking up.

Consequently, a patient might not share important symptoms or ask relevant questions before or after a medical procedure. That silence is also likely to extend to a surgeon's co-workers, who might be in a position to prevent a critical error. 

"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," said Dr. Cooper, the study's lead author and Vanderbilt Professor of Pediatrics. "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."

He adds, "Team members who experience disrespect may be less likely to speak up, ask for help, or see changes in patients' conditions."