Patients treated by surgeons who were previously reported by coworkers for bad behavior are more likely to experience complications after surgery, according to a study published Wednesday in JAMA Surgery.

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A pervasive stereotype: The rude-but-brilliant surgeon

"The stereotype of the abrasive, technically gifted … surgeon is ubiquitous among members of the public" and among clinicians themselves, according to the authors of an article published in AMA Journal of Ethics last year.

The stereotype might imply that abrasive surgeons actually produce better results than their kinder, more empathetic peers. So to put that notion to the test, a group of researchers set out to see whether rude surgeons truly perform better.

The reality: Ill-behaved surgeons produce worse results

For the study, researchers analyzed data on the behavior of 202 surgeons and on surgical and medical complications within 30 days of operation for 13,653 patients from two academic medical centers. 

The researchers searched post-operation reports to determine whether the surgeons' coworkers had reported them for any unprofessional behavior, including unsafe care, a lack of respectful communication, lack of integrity, and failure to complete professional tasks.

The researchers found that, contrary to what stereotype might imply, surgeons who had more reports for bad behavior tended to produce worse patient outcomes.

Specifically, compared with patients of surgeons who had no professional behavior complaints in the last 36 months, patients of those who did were 12% to 14% more likely to experience a complication within 30 days of surgery, such as pneumonia, stroke, infection, and kidney failure.

The risk increased for surgeons who had received multiple professional behavior complaints. Patients treated by surgeons with one to three reports of unprofessional behavior were at an 18% increased risk of complication, while those treated by surgeons with four or more reports were at almost 32% higher risk than surgeons with no reports in the last three years.

What should hospitals do about rude surgeons?

"These findings suggest that organizations interested in ensuring optimal patient outcomes should focus on addressing surgeons whose behavior toward other medical professionals may increase patients' risk for adverse outcomes," the authors said in the report.

The findings show that there is "truly a safety benefit to professional behavior," according to Jonah Stulberg, a general surgeon at Northwestern Memorial Hospital who was not involved in the study. He explained that, for example, "nurses may be more likely to speak up about breaks in sterile technique if the physician is more receptive to them speaking up." By contrast, if the surgeon is "yelling all the time," nurses may be less likely to say something.

According to William Cooper, director of the Vanderbilt Center for Patient and Professional Advocacy at Vanderbilt University Medical Center, the study results, when translated nationally, imply that surgeons with bad reviews could lead to negatively health consequences for about 500,000 patients across the country.

According to Fierce Healthcare, 70 to 80% of surgeons have never received a complaint about their behavior. On the other hand, Cooper noted, "a very small proportion account for a disproportionate share of adverse outcomes."

According to Cooper, previous research shows that feedback on their behavior can help surgeons improve their outcomes. "[W]hat we found is very effective is just sharing data with them—non-judgmental, comparative data," Cooper said. "We found … they will improve just by getting feedback on their performance relative to their peers."

As for the abrasive-but-brilliant surgeon stereotype, Cooper said it's time to put it to rest. "[W]e should have a zero-tolerance approach to unprofessional behavior in the workplace," he said (Finnegan, FierceHealthcare, 6/20; Neilson, "Shots," NPR, 6/19).