Thursday, August 8, 2013

Doctors Badmouthing Doctors

Excerpted from “Doctors Badmouthing Other Doctors,” The New York Times. July 11, 2013 -- A physician friend recently disclosed that she was named in a malpractice lawsuit. Her revelation was rattling not only because there were no discernible errors in the care she provided, but also because another doctor had provoked the patient to hire a lawyer. “I’m shocked that nothing was done sooner,” the other doctor had said when the patient went for a second opinion. “You could have died.”
Surely, the doctor who had trashed his colleague was out of line. Throughout training and regularly at work, we are reminded of the importance of professionalism and respect. Shifting blame demoralizes other clinicians, undermines patient trust and compromises patient outcomes.

But it didn’t take long for me to recall instances when friends and I had been equally critical about other doctors’ work. Are we all capable of talking like that in front of patients? The answer, according to a recent study in The Journal of General Internal Medicine, is an unqualified and disturbing, “Yes.” “Doctors will throw each other under the bus,” said Susan H. McDaniel, lead author of the study and a professor of psychiatry and family medicine at the University of Rochester Medical Center. “I don’t think they even realize the extent to which they do that or how it can affect patients.”

“There is probably something reassuring in saying, ‘Boy, your doctor didn’t do a good job and now I’m going to take care of you,’” Dr. McDaniel noted. “But those kinds of comments are bad for the patient.” To help remedy this problem, Dr. McDaniel began a physician coaching program at the University of Rochester Medical Center a year and a half ago. “There’s a lot of attention focused on the patient experience, but I think we need to work on improving the clinician experience as well,” Dr. McDaniel said.


Dr. J. Scott RiesCMDA Vice President and National Director of Campus & Community Ministries J. Scott Ries, MD -- “When I first read the title of this article, my initial reaction was, ‘I don’t do that.’ Then the rubber met the road. Just last week, a 7-year-old girl accompanied by her grandmother came to my clinic with the same abdominal pain that had been plaguing her for four days. Initially evaluated by her grandmother’s family physician, she had been diagnosed with a urinary tract infection and treated with antibiotics. Three days later, when the pain had not improved, she returned to that doctor. A repeat urinalysis was normal and they were sent home with instructions on how to treat constipation. “Later that day, they came to me. I had the advantage of both urinalysis results (neither remarkable) as I evaluated the healthy appearing child in front of me. But something didn’t seem quite right. A couple hours later, I whisked her off to meet the surgeon at the OR to intervene for her ruptured appendix. But before they left the clinic, the question came: ‘Should the other doctor have diagnosed this on Monday?’ Two things hit at me at once, freezing any potential response. The first was the reaction, ‘I’m just glad you brought her to me. She could have died.’ The second was the article adducing that very phrase.

“How should we respond when we encounter and disagree with the work of a colleague? Try answering these three questions before responding:

  1. Will my response benefit my patient?
  2. Will my response attempt to inflate trust in me, by diminishing that in another?
  3. Am I representing well with my words the Physician I desire to emulate?

“If we are honest, our pejorative off-the-cuff responses are often (if not subconsciously) geared at building our own ego. Confident in our abilities, we want to make sure our patient shares our confidence in our prowess. But is this how the Great Physician treated His colleagues? Is this the grace with which the Great Physician has treated me? Ephesians 4:29 offers the answer that we need at this precise moment, ‘Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up according to their needs, that it may benefit those who listen’ (NIV 2011).”

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