Arrogant surgeons who bully patients and staff should attend “ego classes” or be banned from the operating table. The Daily Mail reports that this is according to a group of leading Scottish doctors who maintained that if surgeons could not be educated to improve behaviour, they should be “removed from the clinical frontline”. The letter to the BMJ was sent in response to a paper that appeared in the journal about the harmful effects of egos in the operating theatre.
Simon Paterson-Brown, former chairman of the patient safety board at the Royal College of Surgeons of Edinburgh (RCSE), and colleagues said that the personality and “poor behaviour” of some surgeons was affecting patient survival rates. The report says Paterson-Brown is among several influential medics who believe surgeons should attend courses to hone non-technical skills, such as decision-making, communication, leadership and ‘situation awareness’.
Paterson-Brown said his research in this area revealed that surgeons who attracted higher numbers of complaints from patients and staff tended to have more complications on the operating table. He said: “There are surgeons who have poor leadership skills and who bully and harass other staff. It happens in Scotland, as it does in every other country. But we are addressing it in Scotland by providing courses to help teach surgeons how to behave better because we know that it improves mortality rates. Surely now is the time to address these issues once and for all?”
The report says he added that the most arrogant surgeons were unlikely to attend anti-ego classes, meaning National Health Service (NHS) bosses should intervene.
Paterson-Brown, an Edinburgh-based surgeon, has called for the classes along with George Youngson, emeritus professor of paediatric surgery at Aberdeen University, Forth Valley-based surgeon Craig McIlhenny, director of the faculty of surgical trainers at the RCSE, and Rhona Flin, emeritus professor of psychology at Aberdeen University.
In their letter, the doctors state: “The effects of surgical egos and poor behaviour on teamwork, clinical performance, and patient outcomes have been recognised for some time but are often poorly understood and very poorly managed.
“While action must be taken to educate and, if possible, rescue the “poor” performers, sometimes they actually may need to be removed from the clinical frontline; often a difficult and painful process for all concerned.”
The report says other signatories of the letter included Nikki Maran, a consultant anaesthetist at Edinburgh Royal Infirmary, and Steve Yule, an associate professor at Harvard University.
Examples of ego-driven behaviour were cited in a paper published by the journal in November. The report says they included transplant surgeon Simon Bramhall, who was convicted of assault last January for branding his initials on patients’ livers during operations at Queen Elizabeth Hospital – Birmingham. A judge described his actions as “conduct born of professional arrogance of such magnitude that it strayed into criminal behaviour”.
The report says in 2013, Sam Eljamel, the former head of neurosurgery at NHS Tayside, was suspended after an investigation by the Royal College of Surgeons claimed he often “rushed” through surgery and had “bullied” colleagues. In one case he removed a patient’s tear gland instead of a brain tumour.
Last May Scottish surgeon Ian Paterson was jailed for 15 years for carrying out unnecessary breast operations on ten patients. The report says his trial at Nottingham Crown Court heard harrowing evidence from the nine women and one man who were treated in the private sector between 1997 and 2011 at Little Aston and Parkway hospitals in the West Midlands.
A study of personality traits among UK healthcare professionals in 2015 found surgeons had significantly higher levels of narcissism, the report says. Other research has found greater numbers of disruptive behaviours and patient complaints among surgeons than non-surgeons, which could be the result of more arrogant attitudes.
Healthy self-confidence has an important role in surgery, but we must take care that it doesn’t develop into disruptive ego, say Christopher G Myers and colleagues in the BMJ analysis.
They write: “Recent years have seen a palpable change in the surgical community, with major efforts made to shift towards a more positive, humanistic surgical culture. This reflects a broad recognition that ego driven behaviours and disruptive attitudes pose a risk to surgical culture and to patients. The objective and subjective evidence that has prompted these efforts, however, has not been thoroughly explored and understood by the surgical community.
“Periodically, drastic examples of ego driven behaviour generate increased scrutiny and discussion, but these are often fleeting and do not fuel substantive changes. In December 2017, for example, transplant surgeon Simon Bramhall was convicted of assault in the United Kingdom for cauterising his initials on patients’ livers during operations. Unnecessary cauterisation of any kind may be considered a reckless behaviour, but the choice to cauterise his initials highlights an element of ego in his behaviour. The judge in his case described the action as ‘conduct born of professional arrogance of such magnitude that it strayed into criminal behaviour.’
“Fortunately, such cases of extreme arrogance are rare among surgeons. But milder forms of ego driven behaviour are still observed in modern surgery….”