Becker's Clinical Quality & Infection Control

17 INFECTION CONTROL & PATIENT SAFETY Rude Surgeons May Also Be Most Hazardous: 5 Study Findings to Know By Molly Gamble P atients seeing surgeons who elicit the greatest number of pa- tient complaints are 14 percent more likely to experience com- plications within 30 days of a procedure than patients who see surgeons widely perceived as respectful, according to new research from Vanderbilt University Medical Center in Nashville, Tenn. Here are five things to know from the study, which is published in JAMA Surgery. 1. e study examined de-identified data from the National Surgical Quality Improvement Program for 32,125 patients treated at one of seven health systems. Eleven percent of patients experienced a com- plication, including surgical site infections, pneumonia, renal condi- tions, stroke, cardiovascular conditions, thromboembolic conditions, sepsis and urinary tract infections. 2. Researchers correlated that complication rate with patient and fam- ily reports of disrespectful and rude surgeon behavior. ese accounts were documented by the hospitals' patient relations offices for two years before the patient underwent a surgical procedure. 3. Some patient complaints described behaviors that could intimidate or deter patient-physician communication. Other complaints detailed observations of a physician's disrespectful or rude interaction with other healthcare team members that might distract focus. 4. "Even though there was only a 14 percent difference in adverse outcomes between patients cared for by the most respectful and least respectful surgeons, if you take those numbers and distribute them across the United States where 27 million surgical procedures are per- formed each year, that could represent more than 350,000 surgical site infections, urinary tract infections, sepsis — all kinds of things that we know can be avoided when surgical teams work well together," said Gerald Hickson, MD, senior vice president for quality, safety and risk prevention at VUMC. 5. is study builds on a body of research out of Vanderbilt examining the link between patient satisfaction and the likelihood of malpractice litigation. It also suggests physician incivility can impair the health- care team's response to patient complications. "Patients and their families are uniquely positioned to observe physician behavior and performance," said lead author William Cooper, MD, a pro- fessor of pediatrics at Vanderbilt University and director of the Vander- bilt Center for Patient and Professional Advocacy. "And analysis of their stories provides insight into how physicians who interact with patients with disrespect and rudeness might also interact with other medical pro- fessionals and how those interactions could impact patient care. Team members who experience disrespect may be less likely to speak up, ask for help or see changes in patients' conditions." n Study: Medicare Patients Treated by Foreign-Educated Physicians Are More Likely to Survive By Kelly Gooch M edicare patients admitted to U.S. hospitals had lower mortality when cared for by foreign-educated physicians than by graduates of U.S. medical schools, according to a study published in the journal BMJ. For the study, Harvard University re- searchers examined data for Medicare fee-for-service beneficiaries admitted to a hospital with a medical condition between 2011 and 2014 and treated by international or U.S. medical grad- uates who were general internists. They looked at more than 1.2 million hospital admissions treated by 44,227 general internists. After adjusting for patient and physi- cian characteristics and hospital fixed effects, they found patients treated by foreign-educated physicians had low- er mortality (11.2 percent) compared to patients treated by U.S. medical school graduates (11.6 percent). "We found no evidence that patient outcomes for graduates who had trained outside of the U.S. were worse than for graduates from a U.S. medical school. If any, patients treated by the in- ternational graduates had lower 30-day mortality than those treated by the U.S. graduates. These differences persisted across a broad range of clinical con- ditions, and even among hospitalists, where patient selection might be less of a concern," the study's authors wrote. Researchers said patients treated by foreign-educated physicians also had slightly higher costs of care per ad- mission ($1,145) compared to patients treated by U.S. medical school gradu- ates ($1,098). According to the study, readmission rates remained similar between foreign-educated physicians and U.S. medical school graduates. Researchers noted several explanations for why foreign-educated physicians might have better patient outcomes than U.S. medical school graduates, including the fact that the approach for allowing foreign-educated physicians to practice in the U.S. may select for, on average, better physicians. "Indeed, the match rate for U.S. resi- dency programs is substantially lower for international medical graduates (49.4 percent) than for U.S. medical graduates (94 percent for graduates of U.S. allopathic medical schools), and therefore, it is possible that internation- al graduates who are successful in the U.S. matching process might represent some of the best physicians in their country of origin," they wrote. n

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