COMMENTARY

Doctors Badmouthing Other Doctors Incites Patients to Sue; More

Wayne J. Guglielmo, MA

Disclosures

August 20, 2013

In This Article

When Doctors Criticize Other Doctors

For years, patients and their advocates have claimed that there is a medical equivalent of policing's thin blue line -- the notion that doctors don't talk about, much less criticize, other doctors to patients. But a study published recently in the Journal of General Internal Medicine raises questions about that assumption.[1]

Researchers wanted to know how doctors talked about other doctors to a group of seriously ill patients. To investigate this, they enlisted people to portray patients with advanced cancer and then covertly recorded their conversations with 20 community-based oncologists and 19 family physicians. The actors carried records of their previous treatment, which reflected universally accepted standards of care, but none was encouraged to solicit opinions about the nature or appropriateness of this treatment. In total, they made nearly 3 dozen visits to the various participating doctors.

Reviewing transcripts of the encounters, researchers first identified exchanges in which doctors volunteered comments about a patient's previous doctor. These exchanges were then categorized as neutral, supportive, or critical.

Of the 34 doctor-patient encounters, 14 (41%) included comments about a patient's previous care. The number of such comments totaled 42, of which 12 were deemed supportive, 28 critical, and 2 neutral. One form of critical comment was a doctor in one specialty criticizing a doctor in another.

The study authors concluded, "This behavior may affect patient satisfaction and patient care. Healthcare system policies and training should discourage this behavior."

In her comment in the New York Times on the study -- "Doctors Badmouthing Other Doctors" -- surgeon and columnist Pauline W. Chen quoted the lead author of the study, Susan H. McDaniel, a family psychologist on the faculty of the University of Rochester School of Medicine and Dentistry.[2] "Doctors will throw each other under the bus," McDaniel told Chen. "I don't even think they realize the extent to which they do that or how it can affect patients."

Or, for that matter, the doctor being criticized. When a physician friend of hers revealed that a year ago she had been named in a malpractice suit, Chen says she was rattled on 2 accounts. First, the care her friend had provided revealed evidence of "no discernible errors." And second, the person who had prompted her friend's patient to hire a lawyer was...another doctor.

In Medscape's 2013 Malpractice Report, physicians -- particularly hospital physicians gratuitously denigrating the care of doctors in ambulatory practices before patients and their families -- were cited as a prime reason for malpractice lawsuits by many respondents, who included nearly 3500 physicians across 25 specialty areas.

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