Is There a Surgeons’ Effect on Patients’ Physical Health, Beyond the Intervention, That Requires Further Investigation? A Systematic Review

Abstract

Objective To find and review published papers researching surgeons’ effects on patients’ physical health. Clinical outcomes of surgery patients with similar prognoses cannot be fully explained by surgeon skill or experience. Just as there are “hospital” and “psychotherapist” effects, there may be “surgeons” effects that persist after controlling for known variables like patient health and operation riskiness. Methods Cohort studies and randomized controlled trials (RCTs) of any surgical intervention, which, after multivariate adjustment, either showed proportion of variance in patients’ physical health outcomes due to surgeons (random effects) or graded surgeons from best to worst (fixed effects). Studies with <15 surgeons or only ascribing surgeons’ effects to known variables excluded. Medline, PubMed, Embase, and PsycINFO were used for search until June 2020. Manual search for papers referring/referred by resulting studies. Risk of bias assessed by Cochrane risk-of-bias tool and Newcastle–Ottawa Scale. Results Included studies: 52 cohort studies and three RCTs of 52,436+ surgeons covering 102 outcomes (33 unique). Studies either graded surgeons from best to worst or calculated the intra-class correlation coefficient (ICC), the percentage of patients’ variation due to surgeons, in diverse ways. Sixteen studies showed exceptionally good and/or bad performers with confidence intervals wholly above or below the average performance. ICCs ranged from 0 to 47%, median 4.0%. There are no well-established reporting standards; highly heterogeneous reporting, therefore no meta-analysis. Discussion Interpretation: There is a surgeons' effect on patients’ physical health for many types of surgeries and outcomes, ranging from small to substantial. Surgeons with exceptional patient outcomes appear regularly even after accounting for all known confounding variables. Many existing cohort studies and RCTs could be reanalyzed for surgeons’ effects especially after methodological reporting guidelines are published. Conclusion In terms of patient outcomes, it can matter which surgeon is chosen. Surgeons with exceptional patient outcomes are worth studying further.

Qualitative Study of Medical Doctors on Their Experiences and Opinions of the Characteristics of Exceptionally Good Doctors

“…Previous research has shown that there are psychotherapists who have exceptionally good patients' mental health outcomes 46 and surgeons who have exceptionally good patients' physical health outcomes, 33 but none of the studies that https://doi.org/10.2147/AMEP.S370980…”

“…The authors of this study have previously systematically reviewed studies reporting doctors' effects on patients' physical health outcomes beyond those explained by known factors such as doctor experience. 33,47,48 Results showed there are doctors that have exceptional patient outcomes that are not explained by known factors, suggesting exceptional doctors exist. The aim of the present study is to qualitatively study the opinions of medical doctors on their experiences of exceptional doctors and what made these doctors exceptionally good.…”

The Doctors’ Effect on Patients’ Physical Health Outcomes Beyond the Intervention: A Methodological Review

“… 33 The search strategy, data collection, and extraction are explained in detail in a previous report of a systematic review of the surgeons’ effect on patients’ physical health outcomes. 32 …”

Is There a Doctors’ Effect on Patients’ Physical Health, Beyond the Intervention and All Known Factors? A Systematic Review

“…Surgeons were excluded from this review as they were reviewed in a separate paper. 8 No restrictions were placed on publication date or language.…”

“…It is well-known that psychotherapists can have a significant effect on their patients’ mental health, an effect that equals the strength of pharmaceutical interventions and is mentioned in training manuals. 7 It is also known that surgeons, after accounting for all known information, 8 do have a widely varying effect on patients’ physical health. Therefore, it would be useful to know whether this applies to other medical doctors, as a fundamental question in medical research is what effect the medical practitioner has on patients’ physical health.…”