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Background: Hazardous attitudes can adversely impact decision-making leading to negative outcomes. The FAA believes that this concept is so important that they have taught it to all student pilots in the USA for more than 25 years. These hazardous attitudes are Macho, Impulsive, Worry, Resignation, Self-confidence and Antiauthority. As surgeons, it is important to understand to what extent we harbor these attitudes and recognize the impact that these attitudes have on our outcomes.
Methods: Validated aviation psychology tools which are used to measure these attitudes in pilots were converted for use with surgeons. Attending orthopaedic surgeons completed the Modified Surgeon Hazardous Attitude Scale as well as a series of additional instruments. Readmission and reoperation data was collected from 2009 & 2010.
Results: Thirty-seven surgeons completed the protocol. Thirty-one percent of surgeons harbored at least one abnormally high hazardous attitude. There were no significant differences in the amount of hazardous attitudes harbored by each subspecialty. Macho attitude (r = 0.436, p = 0.014) and choice of subspecialty (r = 0.354, p = 0.05) moderately correlated with the total number of readmissions and reoperations. In a regression model, Macho alone accounted for 19% of the variance in total number of readmission and reoperations.
Conclusions: High levels of hazardous attitudes are not consistent with the routine delivery of safe surgical care in a modern teamwork setting accounting for roughly 1 out of every 5 readmissions and reoperations. Over 1/3 of our population harbored at least one hazardous attitude.