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