As Dr. Gregory House in the TV drama "House," actor Hugh Laurie crafted a compelling portrait of a rude, arrogant and self-destructive physician who upset his superiors, peers and patients in every episode only to redeem himself in the show's final moments with his brilliant solutions to his patients' illnesses.
But while a Dr. Jerk may make for fascinating television, it doesn't make for good patient care, and can be a magnet for medical malpractice lawsuits, according to a new study from Vanderbilt University Medical Center.
Vanderbilt researchers looked at complaints against surgeons from 32,000 patients who had operations at seven academic medical centers over the past two years, including Vanderbilt, Emory, the University of North Carolina, Wake Forest, Penn, UCLA and Stanford. They identified the surgeons with the most complaints, and then looked at whether their patients had suffered complications within 30 days after their operations.
They discovered that patients of the surgeons who had the most complaints were 14 percent more likely to have a problem post-surgery.
Dr. William Cooper, the study's lead author, said he believes the reason for the discrepancy is that surgeons who are rude or disrespectful to patients treat their operating room team members in the same manner, resulting in poor treatment for the patient.
"You think about a nurse in the operating room who says, 'It's time for the time-out procedures. Let's make sure we have the right patient, and are operating at the right site.' This is a standard safety procedure," Cooper said. "But if the surgeon says, 'This is a waste of time, let's keep moving,' over and over again, the nurse may stop bringing it up, and we know those are important. If in another setting a surgeon speaks disrespectfully of someone, they may be distracted and worrying about what the surgeon will do next and pay less attention to the task at hand."
While a 14 percent difference in complications from surgery may not seem significant, Cooper said on a national basis that would add up to $3 billion in extra costs to patients, hospitals and insurers.
Surgeons who get a lot of patient complaints also draw the majority of medical malpractice lawsuits, Cooper said.
"We know that 3 percent of physicians nationally account for 50 percent of patient complaints," he said, "and those same physicians account for 50 to 60 percent of the malpractice risk. So what that means is that patients are picking up something in their interaction with their doctor that did not sit right with them."
Cooper's work is not just academic. Vanderbilt has been working with 140 hospitals across the U.S., focusing on those who have a high number of patient complaints and medical malpractice cases.
"We have peer interventions with them and they drop their number of medical malpractice complaints," he said. "We have worked with 27,000 physicians and done 1,600 interventions, and 80 percent of those doctors have responded."
While this latest study focused on surgeons, Cooper said its conclusions apply to other health professionals as well.
"We do this work with advanced practice nurses and find very similar patterns," he said.
The Vanderbilt study is not news to local hospital executives.
"Medicine is a team sport nowadays," said Dr. Helen Kuroki, chief medical officer at CHI Memorial. "As physicians, we rely on nurses and other colleagues to watch our patients closely and advise us of any change in status. That requires a comfortable conversation in which nurses have to feel they can bring things to our attention that later don't turn out to be serious without any fear of reprimand."
"If a nurse feels that she has been treated dismissively or disrespectfully," Kuroki said, "she is not only less likely to report a problem, she is also less likely to share it with colleagues."
Both Cooper and Kuroki emphasized that getting feedback from patients is critical.
"We do surveys of many of our patients," Kuroki said. "We are looking for their input, their perception of the quality of their care while they are hospitalized. With physician behavior issues, we look for complaints from patients, plus behavioral changes from the physicians."
"This highlights the importance of the patient's voice," Cooper said. "If they have a health care expert who doesn't meet their expectations they should speak up and let the doctor and hospital know."