Surgeons With Conduct Reports From Peers Put Patients at Risk

Marcia Frellick

June 19, 2019

Patients whose surgeons had received a relatively high number of coworker reports concerning their lack of professionalism were at significantly increased risk for surgical and medical complications, new research indicates.

William O. Cooper, MD, MPH, of the Center for Patient and Professional Advocacy at Vanderbilt University in Nashville, Tennessee, and colleagues assessed postoperative outcomes for patients who had been treated by surgeons for whom a high number of reports of lack of professionalism had been made by coworkers. The investigators compared those outcomes with the outcomes of patients whose surgeons had received fewer or no reports of lack of professionalism.

The researchers assessed data from coworkers' reports of unprofessional behavior for 202 surgeons from two large, geographically diverse academic centers, as well as data on surgical and medical complications for 13,653 patients within the month after an operation.

The study was published online today in JAMA Surgery.

Among all patients in the cohort (average age, 57 years), 11.6% experienced a complication; 825 complications were surgical (6.0%), and 1070 were medical (7.8%).

The risk for postoperative complications went up significantly and consistently with the number of reports by peers in the 3 years before the patients' operations.

"The adjusted complication rate was 14.3% higher for patients whose surgeons had 1 to 3 reports and 11.9% higher for patients whose surgeons had 4 or more reports compared with patients whose surgeons had no coworker reports (p = .05)," the authors write.

Table. Percentage of Complications by Number of Coworker Reports

Type of Complication Zero Reports At Least Four Reports P Value
Any complication 10.7 14.1 < .001
Any medical complication 7.1 9.4 < .001
Any surgical complication 5.8 7.6 < .01
Number of reports in the past 36 months.

Four Categories for Behaviors

Data on unprofessional behavior by surgeons and complications came from the American College of Surgeons' National Surgical Quality Improvement Program.

Patients were comparable with respect to sex, age, race/ethnicity, and functional status.

Researchers considered four categories for unprofessional behavior: "concerns about poor or unsafe care (eg, 'Dr ___ wiped the lens of the bronchoscopy scope on the bedsheets and then used the scope on the patient.'), clear and respectful communication (eg, 'Dr ___ demanded, "Who's the moron who has the patient in room 16?" '), integrity (eg, 'Dr ___ instructed me to create false patients so it would look like the schedule was full.'), and responsibility (eg, 'Dr ___ refused to enter the electronic order after I described the verbal orders policy.')."

A limitations of the study is that reporting of observed behaviors may be subjective and coworkers may have different standards for bad behavior.

The authors conclude, "[O]rganizations interested in ensuring optimal patient outcomes should focus on addressing surgeons whose behavior toward other medical professionals may increase their patients' risk for adverse outcomes."

Future work should test whether interventions with surgeons reverse the trend and improve patient outcomes, they say.

In an accompanying commentary, Leonid V. Emerel, MD, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Presbyterian Hospital, Pennsylvania, and colleagues write that the study is the first to demonstrate a link between unprofessional surgeon behavior reported by coworkers and clinical outcomes.

They add that just as the #MeToo movement has vowed no tolerance regarding harassment in work arenas, including healthcare, there should be "zero tolerance" for unprofessional behaviors in the surgery environment.

However, they caution that, aside from dangerous and egregious behavior, there should be a presumption of innocence while matters are investigated. Otherwise, vigilance could have unintended consequences.

The authors and editorialists have disclosed no relevant financial relationships.

JAMA Surg. Published online June 18, 2019. Abstract, Commentary

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