Sunday, February 26, 2017

Patients can sense the quality of their surgeons

Use of Unsolicited Patient Observations to Identify Surgeons With Increased Risk for Postoperative Complications

These authors point out that unsolicited patient negative observations regarding the surgeon are associated with an increased risk of medical malpractice claims. Because lawsuits may be triggered by an unexpected adverse outcome superimposed on a strained patient-physician relationship, they sought to determine whether behaviors that generate patient dissatisfaction might also contribute to the cause of adverse outcomes. In other words, are patients of surgeons with a history of higher numbers of unsolicited patient observations at greater risk for postoperative complications than patients whose surgeons generate fewer such unsolicited patient observations?

They conducted a retrospective cohort study of data from 7 academic medical centers participating in the National Surgical Quality Improvement Program and the Vanderbilt Patient Advocacy Reporting System from January 1, 2011, to December 31, 2013. Patients were included if the attending surgeon had at least two years of data in the Vanderbilt Patient Advocacy Reporting System preceding the date of the operation. Postoperative surgical or medical complications within 30 days of the operation were identified as defined by the National Surgical Quality Improvement Program.

Among the 32,125 patients in the cohort (13,230 men, 18,895 women; mean age, 55.8) 3501 (10.9%) experienced a complication, including 1,754 (5.5%) surgical and 2,422 (7.5%) medical complications. 

Prior unsolicited patient observations for a surgeon were significantly associated with the risk of a patient having any complication (odds ratio, 1.0063; 95%CI, 1.0004-1.0123; P = .03), any surgical complication (odds ratio, 1.0104; 95%CI, 1.0022-1.0186; P = .01), any medical complication (odds ratio, 1.0079; 95%CI, 1.0009-1.0148; P = .03), and being readmitted (odds ratio, 1.0088, 95%CI, 1.0024-1.0151; P = .007). 

The adjusted rate of complications was 13.9% higher for patients whose surgeon was in the highest quartile of unsolicited patient observations compared with patients whose surgeon was in the lowest quartile.

They concluded that patients whose surgeons have large numbers of unsolicited patient observations in the 2 years prior to the patient’s operation are at increased risk of surgical and medical complications. 

Comment: As the authors point out, patients and their families have many opportunities to observe a surgeon's behavior. These observations may reveal patterns of disrespect or rudeness that could compromise the safe conduct of surgical and postoperative care. 

Surgeons who generated more unsolicited patient observations had higher rates of complications. 

Patients whose surgeon fails to communicate clearly and respectfully are more likely to file a malpractice claim in the face of any adverse outcome. 

That same surgeon's behavior may contribute to the unexpected adverse outcomes that lead to claims. As an example, a rude or disparaging surgeon might be less likely to receive early alerts of a possible patient problem (fever, unexpected pain, drop in blood pressure) than that surgeon's more congenial partner.