title: Surgeon personality is associated with recommendation for operative treatment.
abstract: OBJECTIVE
  When surgeons disagree about the role of surgery, patient values and preferences should drive decision-making, but there is evidence that surgeon preferences have substantial influence. Surgeon preferences may relate to surgeon personality. Our primary null hypothesis is that specific personality characteristics (work styles) are not associated with the recommendation for operative treatment accounting for surgeon demographics.
  
  
  METHODS
  We invited members of the Science of Variation Group to assess images of 15 upper extremity injuries with debatable indications for surgery, recommended operative or non-operative treatment, and grade their confidence in this decision (n = 270); subsequently, participants completed the validated Octogram Work and Leadership Style Test (n = 223). We selected injuries that could be treated either operatively or non-operatively including fractures of the clavicle, scapula, humerus, and radius fractures, and proximal and distal bicep ruptures.
  
  
  RESULTS
  A higher proportion of recommendations for surgery was independently associated with a higher Octogram test pioneer score (β regression coefficient [β] 0.0054, partial R (2) 0.065, 95 % confidence interval [CI] 0.0027-0.0080, P < 0.001) and practice location outside North America and Europe (β 0.13, partial R (2) 0.079, 95% CI 0.073-0.020, P < 0.001) (adjusted R (2) 0.12, P < 0.001). No work styles were associated with more confidence in treatment.
  
  
  CONCLUSIONS
  A recommendation for discretionary surgery for musculoskeletal injury was related to surgeon personality. Surgeon self-awareness of how their work style can influence their recommendations might make them more receptive to techniques that ensure patient values have more influence than surgeon preferences on treatment decisions.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Teun
authors.initials: T
authors.lastname: Teunis
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Stein J
authors.initials: SJ
authors.lastname: Janssen
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Guitton
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Vranceanu
authors.affiliation: Online Talent Manager, Claudius Prinsenlaan 126, 4818 CP Breda, The Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: Goos
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: David
authors.initials: D
authors.lastname: Ring
keywords: Practice variation; Surgical decision-making; Work style