Patient reliability and surgical decision-making biases amongst hand surgeons.

The perception of patient reliability may create surgical decision-making biases amongst hand surgeons. In this study, anonymous surveys were distributed to hand surgeons to understand how patient 'reliability' is defined and how it alters treatment decisions. Participants rated the importance of patient factors in assessing reliability, then completed fictional clinical vignettes detailing histories of patients undergoing elective surgery. Suspected substance usage and history of mental illness were rated as important factors in determining reliability, while gender and race were rated as not important. Physicians were significantly less likely to recommend surgery and exhibited less confidence in their recommendations when presented with a patient with a history of mental illness (p < 0.001) or suspected substance usage (p = 0.003). These findings suggest that while race and gender may not explicitly impact surgical decision-making, biases related to mental illness and substance use do affect treatment decisions and confidence levels. Recognizing these biases is critical for ensuring equitable care, and future efforts should explore strategies to mitigate their impact on surgical recommendations. Level of evidence: IV.