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Effects of Disruptive Surgeons- ASE 2014

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DEPARTMENT OF SURGERY
Effects of disruptive surgeon
behavior in the operating room
William B. Elder, MS
Amalia Cochran, MD, FACS, FCCM
Association for Surgical Education
2014 Annual Meeting
@AmaliaCochranMD
DEPARTMENT OF SURGERY
Objective(s)
• To define the negative consequences of
disruptive behavior using the perspective
of those most impacted by it
• To identify coping strategies employed in
response to episodes of disruptive
surgeon behavior
@AmaliaCochranMD
DEPARTMENT OF SURGERY
Study design
• Confidential semi-structured interviews
were conducted with 19 OR staff of varied
professions, genders, racial backgrounds,
and ages
– Purposive sampling
• Verbatim transcripts of interviews were
analyzed using grounded theory methods
@AmaliaCochranMD
DEPARTMENT OF SURGERY
Shift of attention
• Identified by 12 interviewees
– All residents, 3 of 4 anesthesiologists
• “It‟s a distraction from the patient. When
I‟m…talking to the surgeon [and worrying]
I‟m going to get in trouble…I wasn‟t
paying attention to that critically ill patient.
And in fact, I did miss a critical value lab
on her.”
@AmaliaCochranMD
DEPARTMENT OF SURGERY
Increased medical errors
• Identified by 10 interviewees
– 3 residents, 3 anesthesiologists
• “Things become even less efficient
because now you‟ve instilled fear…You
become acutely aware that you‟re making
errors and you start making more
errors…and people start scrambling…it
builds on itself.”
@AmaliaCochranMD
DEPARTMENT OF SURGERY
Deterred from work in surgery
• Identified by 9 interviewees
– All 4 Medical students!
• “Both of us dropped our applications to
surgery after working with him. Neither one
of us was willing to go into a field where you
would have to work with someone like that,
or if there is a possibility of that field turning
you into that person.”
@AmaliaCochranMD

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Effects of Disruptive Surgeons- ASE 2014

  • 1. DEPARTMENT OF SURGERY Effects of disruptive surgeon behavior in the operating room William B. Elder, MS Amalia Cochran, MD, FACS, FCCM Association for Surgical Education 2014 Annual Meeting @AmaliaCochranMD
  • 2. DEPARTMENT OF SURGERY Objective(s) • To define the negative consequences of disruptive behavior using the perspective of those most impacted by it • To identify coping strategies employed in response to episodes of disruptive surgeon behavior @AmaliaCochranMD
  • 3. DEPARTMENT OF SURGERY Study design • Confidential semi-structured interviews were conducted with 19 OR staff of varied professions, genders, racial backgrounds, and ages – Purposive sampling • Verbatim transcripts of interviews were analyzed using grounded theory methods @AmaliaCochranMD
  • 4. DEPARTMENT OF SURGERY Shift of attention • Identified by 12 interviewees – All residents, 3 of 4 anesthesiologists • “It‟s a distraction from the patient. When I‟m…talking to the surgeon [and worrying] I‟m going to get in trouble…I wasn‟t paying attention to that critically ill patient. And in fact, I did miss a critical value lab on her.” @AmaliaCochranMD
  • 5. DEPARTMENT OF SURGERY Increased medical errors • Identified by 10 interviewees – 3 residents, 3 anesthesiologists • “Things become even less efficient because now you‟ve instilled fear…You become acutely aware that you‟re making errors and you start making more errors…and people start scrambling…it builds on itself.” @AmaliaCochranMD
  • 6. DEPARTMENT OF SURGERY Deterred from work in surgery • Identified by 9 interviewees – All 4 Medical students! • “Both of us dropped our applications to surgery after working with him. Neither one of us was willing to go into a field where you would have to work with someone like that, or if there is a possibility of that field turning you into that person.” @AmaliaCochranMD
  • 7. DEPARTMENT OF SURGERY Loss of respect for surgeons • Identified by 8 interviewees – At least one in each category – Individual level and professional level • “I used to idolize surgeons…because they‟ve had so much education, they‟re saving lives. But not as much anymore…I feel like they‟ve done it because they like the money and the status and the power.” @AmaliaCochranMD
  • 8. DEPARTMENT OF SURGERY STRATEGIES FOR COPING WITH DISRUPTIVE BEHAVIOR @AmaliaCochranMD
  • 9. DEPARTMENT OF SURGERY Talk to colleagues • Described by 14 participants – All residents and students, 3 of 4 nurses • “Afterwards, if they‟ve been berated or yelled at, or had something thrown at them, we can talk…Even though I can‟t control what happens in there, I can…empathize…so they‟re not internalizing that, „I‟m a terrible person.‟” @AmaliaCochranMD
  • 10. DEPARTMENT OF SURGERY Externalization of behavior • Discussed by 13 participants – All residents, 3 of 4 students • “Once I realized that they were angry at themselves most of the time and not angry at anyone else in the room, it became much, much easier to just ignore it and just talk to them in a normal way.” @AmaliaCochranMD
  • 11. DEPARTMENT OF SURGERY Avoidance • Eight participants – All nurse participants, no residents • “I‟ll ignore him completely because I know he‟s just going to yell…Either I just won‟t say anything or I won‟t talk to him, I‟ll talk to somebody else…just making myself invisible.” @AmaliaCochranMD
  • 12. DEPARTMENT OF SURGERY Warning others • Described by 7 interviewees – All groups except students • “I prepare them by telling them, „This person has issues with such and such. Just keep quiet, follow my lead, don‟t draw attention to yourself.‟” @AmaliaCochranMD
  • 13. DEPARTMENT OF SURGERY Conclusions • Disruptive surgeon behavior has negative consequences for patient care and negative implications for the future of surgery. • Coping mechanisms for those exposed to disruptive behaviors include both functional and dysfunctional responses. @AmaliaCochranMD

Editor's Notes

  1. Three types of cognitions- recognition of behaviorbeing the surgeon’s issue, reminder of own supportive role, and/ or reinforcing thoughts of self-worth.