Do neurosurgeons receive more patient complaints than other physicians? Describing who is most at risk and how we can improve

Abstract

OBJECTIVEThe number of unsolicited patient complaints (UPCs) about surgeons correlates with surgical complications and malpractice claims. Using a large, national patient complaint database, the authors sought to do the following: 1) compare the rates of UPCs for neurosurgeons to those for other physicians, 2) analyze the risk of UPCs with individual neurosurgeon characteristics, and 3) describe the types of UPCs made about neurosurgeons.METHODSPatient and family complaint reports among 36,265 physicians, including 423 neurosurgeons, 8292 other surgeons, and 27,550 nonsurgeons who practiced at 33 medical centers (22 academic and 11 regional) from January 1, 2014, to December 31, 2017, were coded with a previously validated Patient Advocacy Reporting System (PARS) algorithm.RESULTSAmong 423 neurosurgeons, 93% were male, and most (71%) practiced in academic medical centers. Neurosurgical subspecialties included general practice (25%), spine (25%), tumor (16%), vascular (13%), functional (10%), and pediatrics (10%). Neurosurgeons had more average total UPCs per physician (8.68; 95% CI 7.68–9.67) than nonsurgeons (3.40; 95% CI 3.33–3.47) and other surgeons (5.01; 95% CI 4.85–5.17; p < 0.001). In addition, a significantly higher percentage of neurosurgeons received at least one UPC (71.6%; 95% CI 67.3%–75.9%) than did nonsurgeons (50.2%; 95% CI 49.6%–50.8%) and other surgeons (58.2%; 95% CI 57.1%–59.3%; p < 0.001). Factors most associated with increased average UPCs were younger age, measured as median medical school graduation year (1990.5 in the 0-UPC group vs 1993 in the 14+-UPC group, p = 0.009) and spine subspecialty (13.4 mean UPCs in spine vs 7.9 mean UPCs in other specialties, 95% CI 2.3–8.5, p < 0.001). No difference in complaints was seen in those who graduated from non-US versus US medical schools (p = 0.605). The most common complaint types were related to issues surrounding care and treatment, communication, and accessibility, each of which was significantly more common for neurosurgeons than other surgical specialties (p < 0.001).CONCLUSIONSNeurosurgeons were more likely to generate UPCs than other surgical specialties, and almost 3 out of 4 neurosurgeons (71.6%) had at least one UPC during the study period. Prior studies have shown that feedback to physicians about behavior can result in fewer UPCs. These results suggest that neurosurgeons have opportunities to reduce complaints and potentially improve the overall quality of care delivered.

Unsolicited patient complaints among radiation, medical, and surgical oncologists

“…This is consistent with the finding that malpractice claim rates are highest for physicians in their first decade of practice and peak around the age of 40 years 28‐30 . This trend has also been observed in studies of US ophthalmologists and neurosurgeons, which showed that increasing physician age was associated with a decreased risk of patient complaints 25,26 . Younger physicians face a number of challenges, such as mastering new clinical systems, providing attending‐level care largely on their own, working with less experienced staff and nurses, encountering more complicated patients referred to them by older physicians, and lacking sufficient experience in having emotionally difficult conversations 26,31 .…”

“…Prior studies showed that 37% of ophthalmologists, 65% of otolaryngologists, 51% of plastic surgeons, and 53% of urologists had at least 1 UPC over a 3‐ to 4‐year period 20‐23 . The proportion of SOs with at least 1 complaint was similar to the proportions for neurosurgeons and trauma surgeons, 72% and 82% of whom had at least 1 UPC over this time period, respectively 24,25 . The reasons underlying the increased number of UPCs among SOs versus many other surgical subspecialties is unclear but may reflect inadequate communication of surgical expectations with patients and differences in the risks of procedures.…”

“…First, we did not have access to patient volume data for individual oncologists; therefore, the analysis did not adjust for clinical volume. However, previous studies controlling for patient volume have shown that the number of UPCs is an independent risk factor for malpractice claims and surgical complications 4,5,8,25 . Individual physicians' experiences with malpractice claims and data for SOs' postprocedural complications were not available for evaluation.…”

Automatic Meningioma Segmentation and Grading Prediction: A Hybrid Deep-Learning Method

“…Ineffective communication can lead to patients failing to truly understand their condition, followed by arguments, followed by complaints. Previous research reported that neurosurgeons were much more likely to generate unsolicited patient complaints than other surgical specialties, and 71.6% of neurosurgeons had at least one complaint during their study [ 18 ]. Rendering structures could provide better, clearer demonstrations for patients by providing basic information about the tumor, including size, location, shape, and grading prediction.…”

Professionalism of Admitting and Consulting Services and Trauma Patient Outcomes

“…High risk was defined by specialty because PARS scores, malpractice claims, and surgical complications are specialty-specific. 23,25,[27][28][29] Internal validation measures of the service professionalism measures ranged from 83.3% to 100.0% (Supplemental Digital Content A, http://links. lww.com/SLA/D682).…”