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

View More View Less
  • 1 Department of Neurological Surgery,
  • | 2 Vanderbilt University School of Medicine,
  • | 3 Department of Biostatistics,
  • | 4 Center for Patient and Professional Advocacy, and
  • | 5 Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The 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.

METHODS

Patient 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.

RESULTS

Among 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).

CONCLUSIONS

Neurosurgeons 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.

ABBREVIATIONS

CORS = Co-worker Observation Reporting System; CPPA = Vanderbilt Center for Patient and Professional Advocacy; PARS = Patient Advocacy Reporting System; UPC = unsolicited patient complaint.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Scott L. Zuckerman: Vanderbilt University Medical Center, Nashville, TN. zuckerman.scott@gmail.com.

INCLUDE WHEN CITING Published online July 31, 2020; DOI: 10.3171/2020.4.JNS20870.

R.J.D. and S.L.Z. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Studdert DM , Mello MM , Sage WM , et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment . JAMA . 2005 ;293 (21 ):2609 2617 .

    • Search Google Scholar
    • Export Citation
  • 2

    Thomas R , Gupta R , Griessenauer CJ , et al. Medical malpractice in neurosurgery: a comprehensive analysis . World Neurosurg . 2018 ;110 :e552 e559 .

    • Search Google Scholar
    • Export Citation
  • 3

    Jena AB , Seabury S , Lakdawalla D , Chandra A . Malpractice risk according to physician specialty . N Engl J Med . 2011 ;365 (7 ):629 636 .

    • Search Google Scholar
    • Export Citation
  • 4

    Nahed BV , Babu MA , Smith TR , Heary RF . Malpractice liability and defensive medicine: a national survey of neurosurgeons . PLoS One . 2012 ;7 (6 ):e39237 .

    • Search Google Scholar
    • Export Citation
  • 5

    Balch CM , Oreskovich MR , Dyrbye LN , et al. Personal consequences of malpractice lawsuits on American surgeons . J Am Coll Surg . 2011 ;213 (5 ):657 667 .

    • Search Google Scholar
    • Export Citation
  • 6

    Cooper WO , Guillamondegui O , Hines OJ , et al. Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications . JAMA Surg . 2017 ;152 (6 ):522 529 .

    • Search Google Scholar
    • Export Citation
  • 7

    Hickson GB , Federspiel CF , Blackford J , et al. Patient complaints and malpractice risk in a regional healthcare center . South Med J . 2007 ;100 (8 ):791 796 .

    • Search Google Scholar
    • Export Citation
  • 8

    Stelfox HT , Gandhi TK , Orav EJ , Gustafson ML . The relation of patient satisfaction with complaints against physicians and malpractice lawsuits . Am J Med . 2005 ;118 (10 ):1126 1133 .

    • Search Google Scholar
    • Export Citation
  • 9

    Hickson GB , Federspiel CF , Pichert JW , et al. Patient complaints and malpractice risk . JAMA . 2002 ;287 (22 ):2951 2957 .

  • 10

    Pichert JW , Moore IN , Karrass J , et al. An intervention model that promotes accountability: peer messengers and patient/family complaints . Jt Comm J Qual Patient Saf . 2013 ;39 (10 ):435 446 .

    • Search Google Scholar
    • Export Citation
  • 11

    Fathy CA , Pichert JW , Domenico H , et al. Association between ophthalmologist age and unsolicited patient complaints . JAMA Ophthalmol . 2018 ;136 (1 ):61 67 .

    • Search Google Scholar
    • Export Citation
  • 12

    Kohanim S , Sternberg P Jr , Karrass J , et al. Unsolicited patient complaints in ophthalmology: an empirical analysis from a large national database . Ophthalmology . 2016 ;123 (2 ):234 241 .

    • Search Google Scholar
    • Export Citation
  • 13

    Hultman CS , Gwyther R , Saou MA , et al. Stuck in a moment: an ex ante analysis of patient complaints in plastic surgery, used to predict malpractice risk profiles, from a large cohort of physicians in the Patient Advocacy Reporting System . Ann Plast Surg . 2015 ;74 (suppl 4 ):S241 S246 .

    • Search Google Scholar
    • Export Citation
  • 14

    Mukherjee K , Pichert JW , Cornett MB , et al. All trauma surgeons are not created equal: asymmetric distribution of malpractice claims risk . J Trauma . 2010 ;69 (3 ):549 556 .

    • Search Google Scholar
    • Export Citation
  • 15

    Nassiri AM , Pichert JW , Domenico HJ , et al. Unsolicited patient complaints among otolaryngologists . Otolaryngol Head Neck Surg . 2019 ;160 (5 ):810 817 .

    • Search Google Scholar
    • Export Citation
  • 16

    Stimson CJ , Pichert JW , Moore IN , et al. Medical malpractice claims risk in urology: an empirical analysis of patient complaint data . J Urol . 2010 ;183 (5 ):1971 1976 .

    • Search Google Scholar
    • Export Citation
  • 17

    Rolston JD , Han SJ , Lau CY , et al. Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011 . J Neurosurg . 2014 ;120 (3 ):736 745 .

    • Search Google Scholar
    • Export Citation
  • 18

    Daniels AH , Ruttiman R , Eltorai AEM , et al. Malpractice litigation following spine surgery . J Neurosurg Spine . 2017 ;27 (4 ):470 475 .

    • Search Google Scholar
    • Export Citation
  • 19

    Taylor CL . Neurosurgical practice liability: relative risk by procedure type . Neurosurgery . 2014 ;75 (6 ):609 613 .

  • 20

    Kessler RA , Benzil DL , Loewenstern J , et al. Malpractice litigation in brain tumor surgery: a 31-year analysis of causative factors in the United States from the Westlaw database . World Neurosurg . 2019 ;122 :e1570 e1577 .

    • Search Google Scholar
    • Export Citation
  • 21

    Webb LE , Dmochowski RR , Moore IN , et al. Using coworker observations to promote accountability for disrespectful and unsafe behaviors by physicians and advanced practice professionals . Jt Comm J Qual Patient Saf . 2016 ;42 (4 ):149 164 .

    • Search Google Scholar
    • Export Citation
  • 22

    Boissy A , Windover AK , Bokar D , et al. Communication skills training for physicians improves patient satisfaction . J Gen Intern Med . 2016 ;31 (7 ):755 761 .

    • Search Google Scholar
    • Export Citation
  • 23

    Statement of the American Association of Neurological Surgeons, American Board of Neurological Surgery, Congress of Neurological Surgeons, and the Society of Neurological Surgeons before the Institute of Medicine. Ensuring an Adequate Neurosurgical Workforce for the 21st Century . 2012 . Accessed May 21, 2020. https://www.cns.org/sites/default/files/legislative/NeurosurgeryIOMGMEPaper121912.pdf

    • Search Google Scholar
    • Export Citation
  • 24

    Rosman J , Slane S , Dery B , et al. Is there a shortage of neurosurgeons in the United States? Neurosurgery . 2013 ;73 (2 ):354 355 , 365–366 .

    • Search Google Scholar
    • Export Citation
  • 25

    Diao K , Sun Y , Yoo SK , et al. Safety-net versus private hospital setting for brain metastasis patients treated with radiosurgery alone: disparities in follow-up care and outcomes . Cancer . 2018 ;124 (1 ):167 175 .

    • Search Google Scholar
    • Export Citation
  • 26

    Donoho DA , Patel A , Buchanan IA , et al. Treatment at safety-net hospitals is associated with delays in coil embolization in patients with subarachnoid hemorrhage . World Neurosurg . 2018 ;120 :e434 e439 .

    • Search Google Scholar
    • Export Citation
  • 27

    Cyprich J , Pangal DJ , Rutkowski M , et al. Comparative preoperative characteristics and postoperative outcomes at a private versus a safety-net hospital following endoscopic endonasal transsphenoidal resection of pituitary adenomas . J Neurosurg . Published online February 28, 2020. doi:10.3171/2019.12.JNS192506

    • Search Google Scholar
    • Export Citation
  • 28

    Seicean A , Alan N , Seicean S , et al. Surgeon specialty and outcomes after elective spine surgery . Spine (Phila Pa 1976) . 2014 ;39 (19 ):1605 1613 .

    • Search Google Scholar
    • Export Citation
  • 29

    Mabud T , Norden J , Veeravagu A , et al. Complications, readmissions, and revisions for spine procedures performed by orthopedic surgeons versus neurosurgeons: a retrospective, longitudinal study . Clin Spine Surg . 2017 ;30 (10 ):E1376 E1381 .

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 74 74 74
Full Text Views 59 59 59
PDF Downloads 76 76 76
EPUB Downloads 0 0 0