Friday, June 17, 2016

How frequently do surgeons and anesthesiologists lie to each other?

More often than you might think.

Results of a survey published in the journal Patient Safety in Surgery found that 27% of anesthesiologists and 7% of surgeons admitted that they “misreported” information to each other at least once a month in the perioperative setting.

Surveys were mailed to 2260 anesthesiologists and surgeons. The response rate was only 11%, which the authors ascribed to the sensitive nature of the questions asked.

The demographics of the respondents in each group were similar regarding age, sex, years of practice, hospital type, and self-described involvement with religion.

The most commonly misreported events by anesthesiologists were actions that affected vital signs, and the misrepresentation of vital signs and amounts of fluid administered. Surgeons most commonly admitted to incorrectly estimating the expected length of a case and misstating the nature of intraoperative adverse events, degree of surgical risk, and how urgent a case was.

Excuses that the information was not clinically relevant or that they were already taking care of the situation was used significantly more often by anesthesiologists.

Justifications that their counterpart would not understand, would demand an unreasonable treatment, or that it was not a good time to discuss the problem did not differ significantly between the two disciplines.

The impact of misreporting on patient safety was illustrated “by the fact that 7 % of responding anesthesiologists and 2 % of surgeons said that a patient had been harmed by their misrepresentation of the truth to a colleague, [and] 1 % of anesthesiologists and 4 % of surgeons reported suffering adverse consequences themselves due to an episode of misrepresentation.”

The authors expressed concern that “dishonest communication between colleagues in the perioperative setting may … damage teamwork among professionals engaged in high-stakes activities.”

They noted that 36% of anesthesiologists said they had seen their teachers misrepresent information during their training compared to only 8% of surgeons.

This paper had to have been written by surgeons, right? Not so. The authors were three anesthesiologists, two biostatisticians, and an ethicist—all from respected institutions.

Discuss.

Source: Nurok et al. “Are surgeons and anesthesiologists lying to each other or gaming the system? A national random sample survey about 'truth-telling practices' in the perioperative setting in the United States.” A full text copy of the paper is available here.

18 comments:

Old Fool said...

The most bloodcurdling anesthesia vs. surgeon disputes I have been involved with were questions related to the need for transfusions. As a scrub nurse, I always sided with the surgeon who was captain of the ship. A typical exchange went like this; Anesthetist- " I think it's time to call the blood bank for a couple of units, look at all that blood in the suction bottle." Surgeon - "That's balderdash .. that's all irrigant in the bottle just ask Nurse Fool." My standard reply was always the same, "Oh yes, a couple of liters of irrigant." That reply always reminded me of the police officer asking a driver about his alcohol consumption. The standard answer was always "A couple of beers." The driver and the scrub nurse probably had equal credibility in their fluid volume estimates.

Here is another classic; Surgeon - "What the heck did you do to his BP?, he is barely bleeding." Anesthesia - Oh it's just your superior operative technique, his vitals are good."

Anonymous said...

That's scary. Seriously, you guys can't level with each other?

That's taking the blood brain barrier a bit too far, don't you think?

Blacksails said...

Apart from lying about the urgency of a case, I cant say ive ever seen this happen.

Ive seen people lie about the urgency of a case because otherwise the case will not go. Friday 4 PM is prime time for cancellations of nonurgent cases, so of course the appy im going to bring up next is "pretty sick, and cant really wait."

Anonymous said...

An interesting end around used to be the use of nurse anesthetists. Surgeons used to love them because they never said no to a doctor.

Skeptical Scalpel said...

Old Fool, it's always irrigation. I think I've said this before regarding estimated blood loss. Take what the anesthesiologist says and divide it by 2. Take what the surgeon says and double it.

I agree with you that surgeons exaggerate the degree of urgency of some cases. But I disagree that it's the only issue. I think the paper grossly underestimates the magnitude of the problem. "Misreporting" is much more common than the survey indicates.

Good point about nurse anesthetists.

Anonymous said...

Surgeons prefer working with nurse anesthetists because they are more likely to oblige requests? As an anesthesia resident, that is a little disheartening...

qtipp said...

I was in the OR once when 2 attendings (surg/anes) joked about the NBL: negotiated blood loss.

I would love to know what proportion of respondents felt they were lied to by their colleagues.

Skeptical Scalpel said...

Anon, I must admit the comments about nurse anesthetists are anecdotal. I don't know of any published evidence that this is true.

qtipp, that's a good question. The answer can be found in the full text version of the paper in Table 6 on page 4. The link is in the last paragraph starting with "Source..."

dennoh said...

God have mercy. The way we trust them with all our hearts!!OMG.

artiger said...

I never understood the adversarial attitude toward Anesthesia that many of my surgical colleagues had. Yes, there are some of them that will go to great lengths to delay/cancel a case, but many on our side think the only urgent cases are their own. My relationships with Anesthesia in the past were way beyond collegial...they were downright fun most of the time. Maybe I'm lucky.

Speaking of humor, does anyone know what OAFAT stands for?

Skeptical Scalpel said...

I've heard the term before. I will give my readers a shot at getting the answer.

Old Fool said...

OAFAT is an oncology term. It stands for Obstructed Airway From A Tumor. Someone better fetch the trach tray! (-:

Skeptical Scalpel said...

Close but not the answer we are looking for.

Skeptical Scalpel said...

Close but not the answer we are looking for.

artiger said...

Here's a hint...One of the A's stands for Anesthesia.

Anonymous said...

Obligatory anesthesia f******* around time.

artiger said...

Finally, a winner

Skeptical Scalpel said...

Congrats to Anonymous.

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