Patients Fare Better With Well-Mannered Surgeons

A recent commentary claims that medical literature is starting to accept that surgical outcomes are better when the surgical team is acquainted with each other and works together well.

Researchers at the Cedars-Sinai Medical Center (CSMC; Los Angeles, CA, USA) and Johns Hopkins University (Baltimore, MD, USA) found that studies show that a lack of a supportive work environment is linked to several poor health outcomes, such as obesity and increased sick time off. At least one study, according to the researchers, shows that severe and persistent incivility may be tied to heart disease and depression. Health outcomes in the operating room (OR), are also associated with workplace culture and respect; one study of 300 surgeries concluded that "high-risk" uncivil behavior by the surgical team increased the risk of postoperative death and complications.

The problem extends outside of the OR as well; a 2002 study of nurses in US Veterans Affairs' hospitals found that 96% reported witnessing disruptive physician behavior. Another survey conducted by the Institute for Safe Medication Practices (ISMP; Horsham, PA, USA) showed that 75% of nurses had asked a coworker to help them interpret a confusing order to validate its safety, in order to avoid interacting with intimidating physicians. Seven percent of the nurses said they believed that during the past year they were involved in a medication error in which intimidation had played a role.

According to the researchers, a key to happier ORs may be a reworking of criteria for hiring new surgical employees. Currently, successful applicants are usually selected based on accomplishments, knowledge, training, and productivity, even though those attributes provide no insight into how the applicant functions in a social environment. Hospitals should also develop a code of conduct for surgeons, nurses, staff, administration, and patients, and the surgeon's leadership skills should be a model for the entire team. The commentary was published in the July 2011 issue of Archives of Surgery.

“Operating rooms are social environments where everyone must work together for the patient's benefit. When a surgeon, who is in the position of power, is rude and belittles the rest of the staff, it affects everything,” said study coauthors Andrew Klein, MD, director of the Cedars-Sinai transplant center, and Pier Forni, PhD, founder of the Johns Hopkins Civility Project.

Related Links:
Cedars-Sinai Medical Center
Johns Hopkins University
Institute for Safe Medication Practices