​Patients treated by surgeons who generate a large number of unsolicited patient observations are 14% more likely to experience postoperative complications than those treated by surgeons with fewer complaints against them, according to a February 15, 2017, original investigation published in JAMA Surgery. Unsolicited patient observations might describe, for example, the doctor interacting rudely or disrespectfully with the healthcare team or communicating in a way that intimidates patients. The authors analyzed data on 32,125 patients who were treated at one of seven academic medical centers between January 1, 2011, and December 31, 2013. Even after they accounted for patient, surgeon, and operative factors, the authors found that complications were more likely in patients who had been treated by a surgeon viewed by the most patients as disrespectful when compared with surgeons viewed as the most respectful. These results, the authors said, if extrapolated across the United States, could contribute to more than 350,000 additional complications and $3 billion in additional costs per year. "Disrespect and rudeness toward other professionals affect willingness to share information and seek help and, in turn, may affect both procedural and diagnostic performance," the authors added. Patients and families are in a unique position to observe physician behaviors, the authors noted, and the study provides further insight into why a small subset of surgeons currently accounts for the majority of malpractice claims. "Efforts to promote patient safety and address risk of malpractice claims should continue to focus on surgeons' ability to communicate respectfully and effectively with patients and other medical professionals," the authors concluded.

HRC Recommends: Disruptive practitioner behavior can compromise safe patient care. Healthcare facilities must define disruptive behavior in policies and bylaws and implement a code of professional conduct, a confidential reporting mechanism, and a process for investigating, confronting, and disciplining disruptive practitioners. Staff should be educated regarding behavioral standards and how to recognize and report disruptive behavior. Hospital and medical staff leadership should ensure that well-planned interventions, which might also include identification of behavioral health problems, are available for physicians identified as demonstrating behavior that undermines patient safety.