WEDNESDAY, July 20 (HealthDay News) -- The behavior of surgeons in the operating room affects more than their patients' health, new research indicates.

It also plays a part in determining health-care costs, the number of medical errors and patient satisfaction, according to a commentary in the July issue of The Archives of Surgery. Surgeons who are civil, the report claimed, can more effectively help their patients and reduce costs.

"Often, surgeons get hired on the basis of their knowledge, training and technical accomplishments," lead author Dr. Andrew S. Klein, director of the Cedars-Sinai Comprehensive Transplant Center and the Esther and Mark Schulman Chair in Surgery and Transplantation Medicine, said in a news release from Cedars Sinai. "But operating rooms are social environments where everyone must work together for the patient's benefit. When a surgeon, who is in the position of power, is rude and belittles the rest of the staff, it affects everything."

In writing the report, Klein and his co-author Pier M. Forni, cited numerous studies demonstrating the link between rudeness and adverse effects on patient care. For instance, a study of 300 operations in which surgeons had their behavior ranked showed a connection between civility during surgery and fewer postoperative deaths and complications.

One reason for the more favorable outcomes, the commentary pointed out, may be that 75 percent of hospital pharmacists and nurses say they try to avoid rude or difficult physicians even if they have questions about a patient's medication, according to recent research.

Nurses also play a vital role in how well a surgical patient does in the hospital, the article asserted. As a result, hospitals with high nursing turnover typically have more medical errors and more negative outcomes. The commentary noted however, that high turnover among nurses should be expected when a separate survey revealed more than two-thirds of nurses say physicians verbally abuse them at least once every three months.

The article's authors concluded that during surgery, surgeons must treat their staff in a civil manner. Outside the operating room, they added, surgeons must enable others to lead. Doing so, they said, will allow surgeons to gain respect and create a culture of loyalty.

Stress and anonymity however, are often working against such cultures of loyalty, the researchers noted. For example, if surgeons knew their co-workers better it would help establish a positive culture that would result in improved care, surgical outcomes and job satisfaction.

To address the problem, polite or civil behavior must be nurtured during surgeons' training along with other essential qualities, such as ego strength, confidence, focus, work ethic and dedication.

Hospitals often hire surgeons based solely on surgical volume or grant funding, rather than other key qualities such as interpersonal skills, the article authors added.

"We should place increased emphasis on nontechnical skills such as leadership, communication and situational awareness and teamwork," said Klein. "The temptation to ignore warning signs that a surgeon will not play well in the sandbox with peers and co-workers is seductive when large clinical practices and NIH funding are at stake."

More information

The U.S. Bureau of Labor Statistics provides more information on the work environment of surgeons.