Home E-Weekly May 9, 2017

The Dangers of Disruptive Docs

Published: May 8, 2017

IMPAIRED High-risk surgeons can create situations that could compromise patient care and, in turn, lead to malpractice suits.

Beware the rude, brash, hot-tempered surgeon. His boorish behavior represents a profound threat to staff and patients alike, says Gerald B. Hickson, MD, senior vice president for quality, safety and risk prevention at Vanderbilt University Medical Center in Nashville, Tenn.

Nurses who fear getting snapped at may be less willing to ask for help or in "a constant state of distraction," as Dr. Hickson describes it, focused less on patient care and more on avoiding getting "chewed out." This kind of unhealthy environment can become a breeding ground for surgical site infections and other situations that could compromise patient care and give life to malpractice suits.

Dr. Hickson would know. He's the lead author of a JAMA Surgery study that shows a correlation between negative patient observations and post-operative complications. Among the more than 32,100 patients studied, Dr. Hickson and his fellow researchers noted an almost 14% variance in the complication rate between those who were treated by the most respectful surgeons and those who were treated by the least respectful ones.

"Roll that out on a national basis and that's 300,000 to 400,000 avoidable adverse outcomes," he says.

The estimated price tag of these avoidable outcomes: $3.5 billion in annual costs to the U.S. healthcare system, according to Dr. Hickson — and that's not even touching the cost of having to defend any malpractice claims that could follow.

In other words, correcting such behavior should be given high priority. The intervention process doesn't have to be complex, says Dr. Hickson, but "there has to be a will to set it up and apply it to everyone, regardless of status." He suggests encouraging offenders to self-regulate and then, if that fails, taking a more direct and instructive approach to rehabilitation.

"Eighty percent of [surgeons] will respond to you making them aware of their behavior," he says. "But you've got to ask yourself: What are we equipped or prepared to do for this individual to help them change [his] behavior? If they can't change, you might have to tell them that continuing to practice medicine is not in their — or in society's — best interest."

Bill Donahue

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