Should More Surgeons Say They're Sorry?

National guidelines suggest surgeons should fully disclose medical errors to patients and their family members, but a new report in JAMA Surgery says many physicians fail to fully discuss the details of surgical mishaps or apologize for their mistakes.

The study's authors surveyed 62 surgeons working in 12 specialties at 3 Veterans Affairs medical centers about recent adverse events they experienced. According to the results, only 55% of the respondents say they discuss whether the adverse events were preventable or apologize to patients, and only one-third claim to have discussed how the same mistake could be avoided in the future.

Surgeons who were less likely to have open dialogues with patients about medical errors and preventative strategies were more likely to be negatively impacted by the experience, suggesting full disclosure of an error is an important step in a surgeon's ability to mentally move past the mistake. The study's findings show surgeons have difficulty discussing error prevention strategies or worry that doing so suggests blame for mistakes, according to the researchers.

"It's important to know that not all surgeons are disclosing error information, even though patients have indicated they would prefer to know," says A. Rani Elwy, PhD, the study's lead author and an associate professor of health law, policy and management at the Boston University School of Public Health. "Recognizing the association between disclosure and surgeons' well-being is also important. It suggests that open disclosure policies have many benefits, for surgeons as well as patients."

The authors say efforts may be needed to improve the training surgeons receive in discussing difficult issues with patients, including how medical errors could have been prevented, in order to promote transparent care and a healthier surgeon workforce.

Daniel Cook

How Text Messages Help Prevent SSIs

Could automated text and voicemail messages reduce surgical site infections in orthopedic patients? A new study suggests it's possible.

Researchers at the Washington University School of Medicine in St. Louis, Mo., recently found that orthopedic patients responded positively to pre- and post-op care reminders sent through an automated electronic messaging system, suggesting that the messages could potentially help improve patient compliance with SSI prevention practices.

In the study, researchers tested the use of healthcare startup Epharmix's EpxDecolonization and EpxWound, 2 automated electronic text and voice messaging systems, on 430 patients undergoing orthopedic surgery at the Washington University Barnes-Jewish Hospital. EpxDecolonization messages reminded patients pre-operatively to follow decolonization protocol, while EpxWound helped patients recognize and report the signs of surgical site infections postoperatively. The researchers found that 96% of patients responded to the decolonization messages while 90% responded to the wound care follow-up messages.

The study also discovered that most patients believed the systems significantly improved communication with their surgeon, and most rated their overall care as excellent. The researchers note that since the study showed patients responded well to these automated systems, they plan to next test whether the messaging systems have any effect on SSI rates.

"We want to make some slight modifications and assess the systems with operations that have higher rates of SSI and see if we can have an impact on lowering the incidence of that complication," says lead author and second year MD-PhD student Christopher Chermside-Scabbo.

Kendal Gapinski

Exercise is as Effective as Surgery for Meniscal Tears

Supervised exercise therapy may be just as effective as arthroscopic surgery for middle-aged patients with meniscal tears, a new study suggests.

A team of researchers in Europe found that among 140 patients (mean age 49.5 years) with degenerative medial meniscal tears, there was no clinically relevant difference after 2 years between those who'd had 12 weeks of supervised exercise therapy and those who'd had surgery. The only significant difference: After 3 months, the exercise group had greater improvements in thigh strength.

The results, say the researchers, should encourage clinicians and middle-aged patients who don't have osteoarthritis to consider supervised exercise therapy as a treatment option.

Jim Burger

InstaPoll: Can Your Patients Pre-Register Online?

Are your patients able to pre-register and fill out their medical histories online, in advance of their procedures? Tell us in this week's InstaPoll.

About three-fourths (73%) of last week's 210 poll respondents handle surgeon credentialing themselves. The results:

Do you outsource credentialing?

  • Yes, we outsource to a credentials verification organization. 27%
  • No, we handle credentialing in-house. 73%

Dan O'Connor

News & Notes

  • Minimally invasive surgery accreditation available Physicians and facilities who focus on low-impact, high-outcome procedures can now distinguish themselves through the Surgical Review Corporation's minimally invasive surgery accreditation programs. The "Center of Excellence in Minimally Invasive Surgery" designation is granted to a hospital or surgery center along with at least one co-applicant surgeon, while the "Surgeon of Excellence in Minimally Invasive Surgery" is geared toward individual surgeons, perhaps those who practice at multiple facilities.
  • What a crew can do for safety Completion of crew resource management — the checklist-, communication- and conflict management-focused team training program that seeks to avert human error in high-risk environments — significantly improves healthcare employees' views of their facilities' safety cultures, according to Ohio State University researchers in the American Journal of Medical Quality.
  • Who's at risk of reinjuring ACL? Women under age 25 whose grafts are smaller than 8 mm are most likely to reinjure their reconstructed ACLs within 2 years of surgery, according to a study presented at the American Orthopaedic Society of Sports Medicine's annual meeting earlier this month. While further research is needed to determine the reasons for this tendency (the study's authors speculated it was due to estrogen levels, anatomical differences and decreased knee strength), physicians may want to consider using larger grafts and emphasizing post-op rehabilitation.