Obnoxious doctors hurt patients

HouseGregoryHouse-276x300Doctors, nurses, and hospitals should stop ignoring colleagues who act like jerks because obnoxious physicians—think of  Dr. Gregory House, the TV internist—may hurt patients, especially in surgery.

Researchers, who published a study in the JAMA Surgery, looked at two years of quality care data from seven medical centers, involving 800 surgeons and 32,000 adult patients. They also had information on physicians with “unsolicited patient observations,” meaning complaints from those undergoing care and their friends and families.

Stat, the online health information site, summarizes what the researchers found:

Complications were most common in patients whose surgeons had received lots of earlier complaints about their behavior. … Post-surgery problems were 14 percent more common in patients whose surgeons had at least 14 complaints in the last two years, compared with patients whose doctors received few or no complaints.

How were some doctors so rude as to prompt complaints? The researchers cited these examples:

  • “I asked Dr. Y how long he thought the operation would take. He said, ‘Look, your wife will die without this procedure. If you want to ask questions instead of allowing me to do my job, I can just go home and not do it.’”
  • “Dr. X rushed us through the appointment so quickly; she didn’t even explain why she was recommending this procedure over other treatment approaches.”
  • “I witnessed a tense exchange between Dr. Z and a nurse. It was difficult to watch someone try to humiliate another person like that. I was embarrassed and it made me feel vulnerable.”

Obnoxious docs may harm patients’ care because they distract or demoralize colleagues whose contributions may be crucial to avoiding preventable error or to ensuring procedures’ success, the researchers say. Some MDs also may lash out at others because they feel inadequate due to their own poor training or lesser abilities, qualities that may preclude top colleagues from working with them.

Although opponents counter-factually contend that all physicians live with a rising fear of lawsuits over their practices, the researchers note that only a slice of doctors end up in court, all too often repeatedly. Their rudeness may be one reason why, they say.

I have certainly see in my practice the harms that bad or negligent medical care can cause. Although so-called “reformers” want to limit patients’ rights to file what they term “frivolous” lawsuits after they suffer harm from medical services, I know that patients pursue this difficult course both to ensure they get the considerable financial support they will need and to seek justice.

Research, as well as common sense, suggests that doctors, who are human and make mistakes, serve themselves and their patients well with humility and apologies when they err. Surgeons long have suffered under or upheld a stereotype that, among medical specialists, they are the MDs who are most arrogant, swaggering, and omnipotent. It takes skill and a kind of courage to undertake some of the life-and-death procedures they handle. But the medical establishment, starting with medical schools, should take a long hard look at what practitioners they’re training up and what kind of culture of care they will spread and grow.

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