Why do surgeons receive more complaints than their physician peers?

Abstract

Background: Compared with other doctors, surgeons are at an increased risk of medicolegal events, including patient complaints and negligence claims. This retrospective study aimed to describe the frequency and nature of complaints involving surgeons compared with physicians. Methods: We assembled a national data set of complaints about surgeons and physicians lodged with medical regulators in Australia from 2011 to 2016. We classified the complaints into 19 issues across four domains: treatment and procedures, other performance, professional conduct and health. We assessed differences in complaint risk using incidence rate ratios (IRRs). Finally, we used a multivariate model to identify predictors of complaints among surgeons. Results: The rate of complaints was 2.3 times higher for surgeons than physicians (112 compared with 48 complaints per 1000 practice years, P < 0.001). Two-fifths (41%) of the higher rate of complaints among surgeons was attributable to issues other than treatments and procedures, including fees (IRR = 2.68), substance use (IRR = 2.10), communication (IRR = 1.98) and interpersonal behaviour (IRR = 1.92). Male surgeons were at a higher risk of complaints, as were specialists in orthopaedics, plastic surgery and neurosurgery. Discussion: Surgeons are more than twice as likely to attract complaints as their physician peers. This elevated risk arises partly from involvement in surgical procedures and treatments, but also reflects wider concerns about interpersonal skills, professional ethics and substance use. Improved understanding of these patterns may assist efforts to reduce harm and support safe practise.

Characteristics of Lawyers Who Are Subject to Complaints and Misconduct Findings

“…We found that lawyers in the older age groups were at increased risk of complaints, including complaints with misconduct outcomes. This finding is broadly consistent with previous research in both the legal and medical professions (Unwin et al ; Spittal et al ; Hatamyar & Simmons ; Tibble et al ). There are several plausible explanations for the seemingly counterintuitive finding that more experienced lawyers are at higher risk of complaint and misconduct findings.…”

“…This is relevant as lawyers who work part‐time are likely to have fewer client encounters, which may partly explain their lower rate of complaints. Studies of doctors suggest that adjusting for hours worked reduces, but does not eliminate, the higher complaint rate among male practitioners (Unwin et al ; Tibble et al ).…”

“…More recent research has homed in on track records, and demonstrated that complaints and claims are highly maldistributed, clustering among a relatively small group of doctors (Tibble et al ; Studdert et al ; Spittal et al ; Bismark et al 2013; Jena et al ; Rolph et al ). For example, in a national sample of nearly 19,000 complaints about doctors lodged with Australian health complaints entities over an 11‐year period, 3 percent of the medical workforce accounted for 49 percent of all complaints (Bismark et al ).…”

Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights

“…However, even for small healthcare settings, it is critical that reliable coding outputs are produced locally and shared externally to enable national monitoring of complaints. Quantitative data outputs should however not be used independently to measure or benchmark between-setting care performance as the risk of receiving complaints is not evenly distributed across clinicians, specialties, procedural risks and patient characteristics 52 75 83–92…”

Being a better surgeon: a multi‐competency challenge

“…The ANZ Journal of Surgery has, for a number of years, promoted the non‐technical competencies in addition to the many publications that relate to technical expertise and surgical outcomes . Professionalism, clinical decision‐making, communication and leadership have at least received some attention, but nonetheless, submissions on these topics to the journal have been few and limited.…”