Hollywood loves the image of the powerful, gifted surgeon who barks orders at his or her assistants. The drama in the operating room is heightened, which is great for show or movie ratings, and the physician is usually excused for being a jerk because they ultimately wind up saving the day.
For the patients and coworkers of real surgeons, who are not actors, this troubling behavior can have a real negative impact. It appears that an increased number of mistakes happen in operating rooms if the surgeon is rude or disrespectful to their coworkers. The complications experienced by patients can be serious — and even deadly.
Published in JAMA Surgery, the study grouped surgeons based on how many reports of unprofessional behavior had been logged against them by coworkers after surgical operations. What they found was that the risk of a patient experiencing complications within 30 days of surgery was increased by as much as 14% if their surgeon had multiple such reports.
The study did not demonstrate causality but showed a strong link between these bad outcomes and a lack of respect and teamwork in the operating room. Documented complications included site infection, wound disruption and the development of pulmonary, renal and cardiovascular conditions.
How Did the Study Measure ‘Unprofessional Behavior’?
Researchers looked at 2 academic medical centers in different parts of the country, using data from the American College of Surgeons (ACS) National Surgical Quality Improvement Program. NSQIP, as the program is known, helps hospitals improve quality by tracking and analyzing surgical complications.
First, they collected coworker concerns about professionalism recorded after surgical operations in each hospital’s electronic safety-reporting system. Then, they analyzed the patient’s health record for 30 days after the surgery to check for surgical or medical complications. Were operating rooms with rude behavior more likely to have medical errors?
Given that coworkers differ about what counts as unprofessional behavior, the study included only surgeons with at least 36 months of NSQIP monitoring prior to the surgery date. Since the surgeons practiced at 1 of 2 medical centers, the researchers argued they “presumably had similar opportunities to have reports filed by the same coworkers.”
In the end, the study included 13,653 patients, operated on by 202 different surgeons.
Unprofessional behavior was coded into 4 domains:
- Concerns about poor or unsafe care: For example, “[The] Dr. wiped the lens of the bronchoscopy scope on the bedsheets and then used the scope on the patient.”
- Clear and disrespectful communication: For example, “Dr. X demanded, ‘Who’s the moron who has the patient in room 16?’”
- Integrity: For example, “Dr. X instructed me to create false patients so it would look like the schedule was full.”
- Responsibility: For example, “Dr. X refused to enter the electronic order after I described the verbal orders policy.”
Every hospital environment depends on teamwork — behaviors like those above cause obvious problems that could easily disrupt the complex sequence of care that surgery requires. When surgeons had multiple reports alleging these types of troublesome behaviors, the number of complications arose.
Medical Malpractice and Unprofessional Surgeons
In the early 2000s, one of the study’s authors, Dr. William O. Cooper, was trying to figure out why certain areas of specialization had higher rates of medical malpractice lawsuits than others. He began to take an interest in the things that families involved malpractice claims were reporting about rude surgeon behaviors.
Families of those injured in hospitals would say that the surgeon was not around when needed, not following hospital policies, mean to their staff, or cite other unprofessional behavior. Were these complaints about the surgeons true? And was it impacting the quality of care?
Although the study was relatively small in size, the results are a clear indicator that rude behavior is having a negative impact on a significant number of patients. Cooper and his team hope that the results will help hospitals recognize and respond to problems of respect in the workplace before more people get hurt.
“We think that teamwork is incredibly important to great care,” said Cooper. “That teamwork requires respect and a willingness of all team members to speak up at the right time.” How many times is a nurse going to speak up if they are constantly yelled at?
It is important to note that most surgeons don’t act unprofessionally. The overwhelming majority of surgeons had no reports of unprofessional behavior, and the authors remarked that prior research has shown that many surgeons who receive constructive feedback are able to make productive changes to their behavior.
Medical errors are now the third-leading cause of death in America. The link between postoperative complications and surgeon behavior provides a clear target for policymakers to address. The portrait of a difficult genius may work in well for a hospital drama on TV, but they have no place in the real-world operating room.
