Surgeon “Unprofessional Behaviors” Linked Increased Risk of Medical Errors, Surgical Complications: Study

The findings of a new study suggest that surgeons who have more complaints involving “unprofessional behavior” brought by co-workers are more likely to have patients who experience surgical complications and medical errors.

The risk of postoperative problems increases if a surgeon has one or more reports made by coworkers involving behaviors that may undermine the culture of safety in the operating room, threaten teamwork or otherwise engage in conduct deemed unprofessional. That risk can increase up to 14% depending on how many reports the surgeon has, when compared to surgeons who do not have similar reports.

The findings were published this week in the medical journal JAMA Surgery, evaluating data from two geographically diverse academic medical centers that participated in the National Surgical Quality Improvement Program. The program recorded and acted on reports of safety events from coworkers.

Reports described unprofessional behaviors by surgeons, and included behavior that ranged from reports of yelling at coworkers, disregarding hospital policies, and throwing instruments, to reports of sexual harassment and verbal harassment.

More than 13,600 patients underwent surgery performed by 202 surgeons from 2012 to 2016. In all, 1,500 patients experienced complications after surgery, or roughly 11%. Of those, 825 were surgical complications and 1,100 were medical complications.

The data indicated patients with surgeons who had more reports of misconduct faced a 14% higher risk of experiencing a complication after surgery compared to patients with surgeons with no reports.

The risk of surgical complications increased from 6% to 8% if a surgeon had more than four reports. Similarly, the risk of medical complications increased from 7% to 9% if the surgeon had more than four reports as well.

Overall, the adjusted complication rate was 12% higher for surgeons that had 1 to 3 reports of misconduct. The risk was 14% higher for patients with surgeons that had 4 or more reports compared to patients with surgeons who had no reports.

This may be because a bad behaving surgeon can contribute to an environment where coworkers are afraid to speak out about mistakes or ask for help. Similarly, it reduces effective communication.

Timely and accurate communication, mutual respect, and an open environment regarding mistakes is key to make decisions during a critical situation like surgery. Without those conditions a negative work environment can occur and lead to disregard for processes, rules, and other policies that are key to the safety and success of surgery.

In a commentary published with the study, a cardiac surgeon recalled when another surgeon struck him on the fingers with a surgical instrument for not holding the retractor correctly. Many surgeons have said it is common for other surgeons to throw tools after being handed an incorrect tool.

Researchers warn that the increased risk of complications could result in more than half a million more surgical complications and medical errors each year. These problems may include infections, lung and kidney problems.

“Surgeons who model unprofessional behaviors may help to undermine a culture of safety, threaten teamwork, and thereby increase risk for medical errors and surgical complications,” wrote study authors.

Bad behavior must be addressed in the healthcare systems and policies must be put into place to account for situations such as these to help protect the safety of patients.