The Federal Aviation Administration and the Canadian Air Transport Administration have defined "hazardous attitudes" (macho, impulsive, antiauthority, resignation, invulnerable, and confident). These attitudes have been associated with road traffic incidents among college-aged drivers and aviation accidents. These authors surveyed a cohort of orthopaedic surgeons to determine the following: (1) What is the prevalence of these attitudes in a cohort of surgeons? (2) Do practice setting and/or demographics influence these attitudes in this cohort of surgeons? (3) Do surgeons feel they work in a climate that promotes patient safety?
They asked 364 members of practicing orthopaedic and trauma surgeons from around the world to complete (1) a questionnaire validated in college-aged drivers measuring six attitudes associated with a greater likelihood of collision and used by pilots to assess and teach aviation safety and (2) a questionnaire assessing the absence of a safety climate that is based on the patient safety cultures in healthcare organizations instrument.
137 of the 364 surgeons had at least one score that would have been considered dangerously high in pilots, including 102 with dangerous levels of macho (28%) and 41 with dangerous levels of self-confidence (11%). The variables most closely associated with a macho attitude were supervision of surgical trainees in the operating room; location of practice in Canada, Europe, and the United States; and being an orthopaedic trauma surgeon (when compared with general orthopaedic surgeons). However these factors accounted for only 5% of the variance. On average, 19% of surgeon responses implied absence of a safety climate.
Comment: It is not known if these attitudes are associated with adverse surgical outcomes. Certainly, one of the attitudes, 'confidence' and 'supervision of surgical trainees in the operating room' must be common among the best and safest surgeons and may not by themselves lead to increased rates of adverse outcomes.
Comment: It is not known if these attitudes are associated with adverse surgical outcomes. Certainly, one of the attitudes, 'confidence' and 'supervision of surgical trainees in the operating room' must be common among the best and safest surgeons and may not by themselves lead to increased rates of adverse outcomes.
Because of the importance of patient safety and the multiple factors that contribute to it, we suggest that each organization needs to implement a system that seeks to identify the relationship of adverse outcomes to variations in surgeon attitude, experience and skill.
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