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Patient reliability and surgical decision-making biases amongst hand surgeons
Madeline C Rocks1, Riana Brown2, Karen J Noh3
1George Washington School of Medicine and Health Sciences, USA.
The Journal of Hand Surgery, European Volume
|May 29, 2025
Summary
Hand surgeons show bias in surgical recommendations based on patient history of mental illness or substance use. These perceptions of patient reliability significantly impact treatment decisions and surgeon confidence, affecting equitable care.
Area of Science:
- Orthopedics
- Hand Surgery
- Medical Ethics
Background:
- Patient reliability perceptions can influence clinical decision-making among hand surgeons.
- Biases in surgical recommendations may stem from how surgeons assess patient reliability.
Purpose of the Study:
- To investigate how hand surgeons define patient reliability.
- To determine if patient reliability perceptions alter surgical treatment decisions.
Main Methods:
- Anonymous surveys distributed to hand surgeons.
- Surgeons rated the importance of patient factors in assessing reliability.
- Fictional clinical vignettes were used to assess treatment recommendations for hypothetical patients.
Main Results:
- Suspected substance usage and history of mental illness were deemed important for reliability.
- Physicians were less likely to recommend surgery for patients with a history of mental illness (p < 0.001) or suspected substance usage (p = 0.003).
- Surgeons exhibited less confidence in recommendations for these patient groups.
Conclusions:
- Biases related to mental illness and substance use significantly affect surgical decision-making and confidence.
- Race and gender did not explicitly impact surgical recommendations in this study.
- Recognizing and mitigating these biases is crucial for ensuring equitable patient care in hand surgery.
